What are the interactions between Ritalin (methylphenone) and anesthesia?

From the Guidelines

Patients taking Ritalin (methylphenidate) should continue their medication on the day of surgery unless specifically instructed otherwise by the anesthesia team. The provided evidence does not directly address the interactions between Ritalin and anesthesia 1. However, it is known that methylphenidate is a central nervous system stimulant that increases dopamine and norepinephrine levels, which could potentially interact with anesthetic medications. The main concerns include possible effects on heart rate, blood pressure, and the potential for arrhythmias during anesthesia.

Some key considerations for anesthesiologists include:

• Potential effects on heart rate and blood pressure
• Risk of arrhythmias during anesthesia
• Possible interactions with other medications, such as those that may prolong the QT interval or increase the risk of serotonin syndrome
• Need for adjusted anesthetic dosages or monitoring approaches

In general, most modern anesthetic techniques can safely accommodate patients on stimulant medications. For elective procedures, the anesthesia team might recommend stopping Ritalin 24-72 hours before surgery in some cases, particularly for patients with cardiovascular concerns 1. After surgery, patients can typically resume their normal Ritalin dosing schedule once they are taking oral medications again, but should follow their doctor's specific instructions for their situation. It is essential for patients to inform their anesthesiologist about their Ritalin use before surgery to ensure the best possible outcomes.

From the FDA Drug Label

Halogenated Anesthetics Clinical Impact: Concomitant use of halogenated anesthetics and methylphenidate hydrochloride oral solution may increase the risk of sudden blood pressure and heart rate increase during surgery Intervention: Avoid use of methylphenidate hydrochloride oral solution in patients being treated with anesthetics on the day of surgery.

The interaction between Ritalin (methylphenidate) and anesthesia is that concomitant use of halogenated anesthetics and methylphenidate may increase the risk of sudden blood pressure and heart rate increase during surgery. To avoid this risk, it is recommended to avoid use of methylphenidate on the day of surgery when halogenated anesthetics are being used 2.

From the Research

Interactions between Ritalin and Anesthesia

• The interaction between Ritalin (methylphenidate) and anesthesia has been studied in various contexts, with a focus on the safety of administering general anesthesia to patients taking this medication 3.
• One study found that general anesthesia with epidural anesthesia could be safely administered to patients taking a usual dose of methylphenidate, with stable conditions maintained during and after the operation 3.
• However, patients taking methylphenidate may require more anesthetics than usual on induction, highlighting the need for careful consideration of medication interactions in the perioperative period 3.

Medication Compliance and Anesthesia

• Patient medication compliance on the day of surgery is an important consideration, with studies showing that standardized and simplified medication instructions can improve compliance 4.
• Factors such as age, American Society of Anesthesiologists status, and recall of verbal and written instructions can influence patient medication compliance, emphasizing the need for tailored approaches to medication management 4.

Perioperative Medication Management

• The management of medications in the perioperative period is complex, with anesthetists needing to evaluate the effectiveness and compatibility of various medications with anesthesia 5.
• While some medications can be safely continued without incident, others may require discontinuation or temporary alteration of the dosing schedule to avoid problems in the perioperative period 5.
• The decision to continue or discontinue psychiatric medications, including those that may interact with anesthetics, should be made in consultation with the attending psychiatrist and surgeon 6.

Anxiolytic Premedication and Discharge

• Anxiolytic premedication has been shown to not delay discharge from hospital in adult day case surgical patients, although the variety of drugs and anaesthetic techniques used in studies limits the generalizability of findings 7.
• The use of clinical criteria and tests of psychomotor function to assess recovery from anesthesia can help inform decisions about medication management and discharge 7.