What are the health risks of Ritalin (methylphenidate)?

From the Guidelines

Ritalin (methylphenidate) poses significant health risks, including cardiovascular problems, psychiatric side effects, and potential for abuse and dependence, which must be carefully weighed against its benefits in treating ADHD, particularly in children and adolescents 1. The health risks associated with Ritalin are numerous and can be severe. Common side effects include decreased appetite, trouble sleeping, increased heart rate, increased blood pressure, headaches, stomach pain, and nervousness. More serious risks include cardiovascular problems such as heart attack or stroke, particularly in people with pre-existing heart conditions. Psychiatric side effects can occur, including new or worsening anxiety, aggression, hallucinations, or psychosis. Long-term use may potentially affect growth in children, requiring regular monitoring. Ritalin also has a high potential for abuse and dependence, as it's a controlled substance that stimulates the central nervous system similar to amphetamines. Some key considerations for prescribing Ritalin include:

• Severity of symptoms: Ritalin should only be considered for children with moderate-to-severe ADHD symptoms that have not responded to behavioral therapy 1.
• Age: Ritalin is not approved for use in children under 6 years old, and its use in preschool-aged children should be approached with caution and careful consideration 1.
• Comorbidities: Ritalin may not be suitable for children with certain comorbidities, such as severe anxiety, glaucoma, tics or Tourette's syndrome, or heart problems 1.
• Monitoring: Regular monitoring by a healthcare provider is essential while taking Ritalin to check blood pressure, heart rate, and mental health status 1. It's essential to carefully evaluate the potential benefits and risks of Ritalin and to consider alternative treatment options, such as behavioral therapy or other medications, before initiating treatment. Additionally, medication adherence should be regularly assessed, and potential issues in adherence openly discussed to ensure the safe and effective use of Ritalin 1.

From the FDA Drug Label

Methylphenidate Hydrochloride Oral Solution may cause serious side effects, including: Abuse, misuse, and addiction Methylphenidate Hydrochloride Oral Solution has a high chance for abuse and misuse and may lead to substance use problems, including addiction. Misuse and abuse of Methylphenidate Hydrochloride Oral Solution, other methylphenidate containing medicines, and amphetamine containing medicines, can lead to overdose and death The risk of overdose and death is increased with higher doses of Methylphenidate Hydrochloride Oral Solution or when it is used in ways that are not approved, such as snorting or injection Risks for people with serious heart disease. Sudden death has happened in people who have heart defects or other serious heart disease Increased blood pressure and heart rate Mental (psychiatric) problems, including: new or worse behavior and thought problems new or worse bipolar illness new psychotic symptoms (such as hearing voices, or seeing or believing things that are not real) or new manic symptoms

The health risks of Ritalin (methylphenidate) include:

• Abuse, misuse, and addiction: Methylphenidate has a high potential for abuse and misuse, which can lead to substance use disorders, including addiction 2.
• Cardiovascular problems: Risks for people with serious heart disease, including sudden death, increased blood pressure, and heart rate 2.
• Mental health problems: New or worse behavior and thought problems, new or worse bipolar illness, and new psychotic symptoms or new manic symptoms 2.
• Overdose and death: Misuse and abuse of methylphenidate can lead to overdose and death, especially with higher doses or unapproved methods of administration 2.
• Physical dependence: Methylphenidate may produce physical dependence, and withdrawal signs and symptoms may occur after abrupt discontinuation or dose reduction 2.

From the Research

Health Risks of Ritalin

• Ritalin, also known as methylphenidate, is a commonly prescribed medication for attention-deficit hyperactivity disorder (ADHD) 3.
• The use of Ritalin has been associated with several health risks, including:
  • Increased heart rate and blood pressure [(3,4,5)]
  • Cardiovascular effects, such as increased risk of sudden death or ventricular arrhythmia [(3,6,7)]
  • Potential increases in the corrected QT interval (QTc), although the evidence is limited and inconclusive 3
• Studies have compared the cardiovascular safety of Ritalin with other ADHD medications, such as amphetamines and atomoxetine [(3,4,6)].
• The risk of cardiac events, including sudden death, has been found to be similar among users of Ritalin and amphetamines 6.
• However, one study found that initiation of Ritalin was associated with a 1.8-fold increase in risk of sudden death or ventricular arrhythmia, although the lack of a dose-response relationship suggests that this association may not be causal 7.
• The mechanisms underlying the cardiovascular effects of Ritalin are not fully understood, but may involve increases in dopamine in the brain and epinephrine in plasma 5.
• Overall, the evidence suggests that Ritalin can have significant health risks, particularly related to cardiovascular effects, and that patients should be closely monitored while taking this medication [(3,4,7)].