Methylphenidate, sold under the brand names Ritalin and Concerta, among others, is a central nervous system (CNS) stimulant used in the treatment of attention deficit hyperactivity disorder (ADHD) and narcolepsy. It may be taken by mouth or applied to the skin, and different formulations have varying durations of effect. For ADHD, the effectiveness of methylphenidate is comparable to atomoxetine but modestly lower than amphetamine. However, methylphenidate is preferred as a first-line treatment in children, while amphetamine is preferred in adults. Methylphenidate reduces core ADHD symptoms and may do so in part by enhancing executive functions, such as working memory, sustained attention, and inhibitory control. At therapeutic doses, methylphenidate increases alertness and concentration and reduces hyperactivity and impulsive behavior in people with ADHD. Common side effects include loss of appetite, weight loss, trouble sleeping, and small increases in heart rate and blood pressure. Long-term treatment in children has been associated with slightly slower growth. Methylphenidate can be misused; dependence and withdrawal are mainly reported with high-dose or non-medical use and are uncommon at therapeutic doses. Methylphenidate is believed to work by blocking the reuptake of dopamine and norepinephrine by neurons. It is a CNS stimulant of the phenethylamine and piperidine classes. It is available as a generic medication. In 2023, it was the 50th most commonly prescribed medication in the United States, with more than 13 million prescriptions.
Uses
Medical Methylphenidate is most commonly used to treat ADHD and narcolepsy.
Attention deficit hyperactivity disorder Methylphenidate is used for the treatment of attention deficit hyperactivity disorder (ADHD). The dosage may vary and is titrated to effect, with some guidelines recommending initial treatment with a low dose. Methylphenidate is available in both immediate-release and modified-release formulations. Methylphenidate is not approved for children under six years of age. The International Consensus Statement on ADHD shows that the results from systematic reviews, meta-analyses and large scale studies are clear: methylphenidate is safe and among the most efficacious drugs in all of medicine; treatment in the long-term substantially reduces accidental injuries, traumatic brain injury, substance abuse, cigarette smoking, educational underachievement, bone fractures, sexually transmitted infections, depression, suicide, criminal activity, teenage pregnancy, vehicle crashes, burn injuries and overall-cause mortality, and eliminates the increased risk for obesity. One committee from the World Health Organization (WHO) responsible for the World Health Organization Essential Medicines List rejected an application in 2019, and a second application endorsed by 51 professional medical groups in 2021, for methylphenidate's inclusion due to uncertainty about its efficacy and safety. However, in November 2023, the WHO Mental Health Gap Action Programme Guidelines for mental, neurological, and substance use disorders recommended that methylphenidate should be considered for children aged 6 years and older who have ADHD, noting specifically that, "methylphenidate treatment shows substantial effects on symptom reduction", in addition to other WHO publications. In 2024, the European Society for Child and Adolescent Psychiatry (ESCAP) and the American Academy of Paediatrics (AAP) endorsed the inclusion of methylphenidate in the WHO EML. A new application for methylphenidate's inclusion is currently pending review, having sparked debate in the comment process among researchers engaged in the evaluation of the evidence-base. Safety and efficacy data have been reviewed extensively by medical regulators (e.g., the US Food and Drug Administration and the European Medicines Agency), the developers of evidence-based national guidelines (e.g., the UK National Institute for Health and Care Excellence and the American Academy of Pediatrics), and government agencies who have endorsed these guidelines (e.g., the Australian National Health and Medical Research Council). These professional groups unanimously conclude, based on the scientific evidence, that methylphenidate is safe and effective and should be considered as a first-line treatment for ADHD. Since the diagnosis of ADHD has increased around the world, methylphenidate may be misused as a "study drug" by students, which may be harmful. This also applies to people who may be experiencing a different issue and are misdiagnosed with ADHD. People in this category are prone to experience the adverse effects of the drug, which can worsen their condition. Long-term meta-analyses and systematic reviews show that the medications used to treat ADHD are not associated with observed deficits in brain structure, but with improved brain development and functioning, most prominently in inferior frontal and striatal regions. The most comprehensive meta-analysis available (19 studies with over 3.9 million participants) found "no statistically significant association between ADHD medications [including methylphenidate] and the risk of cardiovascular event among children and adolescents, young and middle-aged adults, or older adults"; as do other systematic reviews and meta-analyses.
Narcolepsy Narcolepsy, a chronic sleep disorder characterized by overwhelming daytime drowsiness and uncontrollable sleep, is treated primarily with stimulants. Methylphenidate is considered effective in increasing wakefulness, vigilance, and performance. Methylphenidate improves measures of somnolence on standardized tests, such as the Multiple Sleep Latency Test (MSLT), but performance does not improve to levels comparable to healthy people.
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