Concerta Side Effects
Concerta (methylphenidate extended-release) commonly causes decreased appetite, insomnia, headache, and abdominal pain in children, while adults most frequently experience decreased appetite, headache, dry mouth, nausea, and insomnia. 1
Common Side Effects
In Children
- Upper abdominal pain (most common) 1
- Decreased appetite and weight loss 2, 1
- Insomnia/delayed sleep onset 2, 1
- Headache 2, 1
- Stomachache 2
- Jitteriness 2
In Adults
- Decreased appetite 1
- Headache 1
- Dry mouth 1
- Nausea 1
- Trouble sleeping 1
- Anxiety 1
- Dizziness 1
- Weight loss 1
- Irritability 1
- Increased sweating 1
Serious Side Effects (Rare)
Cardiovascular
- Sudden death in patients with serious heart disease or heart defects 1
- Increased blood pressure and heart rate (requires regular monitoring) 1
- Myocardial infarction and arrhythmias 3
Psychiatric
- New or worsening psychotic symptoms (hearing voices, hallucinations, believing things that are not real) 1
- New or worsening manic symptoms 1
- New or worsening behavioral problems 1
- Anxiety, agitation, and exacerbation of preexisting mood disorders 3
Neurological
- Seizures (treatment should be stopped if seizures occur) 1
- New or worsening tics or Tourette's syndrome 2, 1
Vascular
- Peripheral vasculopathy including Raynaud's phenomenon (fingers/toes may feel numb, cool, painful; may change color from pale to blue to red) 1
- Unexplained wounds on fingers or toes 1
Urological
- Priapism (painful and prolonged erections that may require surgery) 1
Growth-Related
- Slowing of growth (height and weight) in children (requires regular monitoring; treatment may need to be stopped if growth is inadequate) 2, 1
- Higher BMI and shorter height at adulthood in patients treated with methylphenidate during prepubertal years 4
Ophthalmologic
Gastrointestinal
- Possible intestinal blockage (Concerta should not be used in patients with severe gastrointestinal narrowing) 1
Management of Common Side Effects
For Appetite Loss
- Give stimulants with meals 2
- Provide high-calorie drink or snack late in the evening when stimulant effects have worn off 2
For Insomnia
- Lower the last stimulant dose of the day or move it earlier 2
- Distinguish whether delay is due to medication side effect or oppositional behavior/separation anxiety 2
- Implement bedtime ritual (e.g., reading) to address oppositional behavior 2
For Sadness
- Reevaluate the diagnosis 2
- Reduce the dose 2
- Switch to sustained-release products (peak of immediate-release may cause more depressive effects) 2
For Irritability
- Evaluate timing (if just after medication given, may be peak effect; if late afternoon, may be rebound) 2
- Reduce the dose 2
Important Clinical Considerations
Almost all stimulant-related side effects are rare and short-lived and respond to dose or timing adjustments. 2 Mild side effects are common, while serious side effects are rare and short-lived if medication is reduced or discontinued. 2
Severe movement disorders, obsessive-compulsive ruminations, or psychotic symptoms are very rare and disappear when medication is stopped. 2
With an estimated 3 million children and adolescents taking stimulants daily in the United States, serious side effects occur at a rate of less than 1/10,000. 2
Abuse and Dependence Risk
Concerta has high potential for abuse, misuse, and addiction. 1 Misuse and abuse can lead to overdose and death, with risk increased at higher doses or when used in unapproved ways (snorting, injection). 1 Physical dependence can develop after prolonged use even when taken as directed. 1
Monitoring Requirements
- Regular blood pressure and heart rate checks 1
- Height and weight monitoring at each visit in children 2, 1
- Blood tests during treatment to check blood count 1
- Monthly follow-up appointments until symptoms are stabilized 2
- More frequent appointments if side effects occur, significant comorbid psychiatric disorders exist, or adherence problems arise 2