dexmethylphenidate-hcl

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Nov 27, 2023

Warnings

Dexmethylphenidate Risks, Warnings, and Complications

Dexmethylphenidate can cause or worsen health problems in some people. Talk to your doctor or pharmacist about other drugs for attention deficit hyperactivity disorder if you are at an increased risk of adverse reactions from this drug.

ABUSE, MISUSE, AND ADDICTION: Dexmethylphenidate carries a risk of abuse, misuse, and dependence. It is a Schedule II controlled substance and can be habit-forming. Suddenly stopping this medicine after taking it for a long time can lead to withdrawal symptoms. Misusing dexmethylphenidate is associated with an increased risk of serious side effects, including fast heart rate, high blood pressure, aggression, anxiety, and suicidal thinking and behavior.
The risk of abuse and addiction is higher in people with a history of substance use disorder (use of street drugs) or alcohol abuse and in those who take higher doses than prescribed.
Take dexmethylphenidate exactly as prescribed. Don't change the dose or dosing frequency without talking to your healthcare professional. Keep your medication in a safe place, preferably locked. Do not give or sell your stimulant medicine to anyone else or obtain the medicine from other people.
SERIOUS CARDIAC PROBLEMS: CNS stimulants like dexmethylphenidate can lead to increased blood pressure and heart rate. There are also reports of heart attack, stroke, and sudden death in people who took stimulants in the face of underlying heart problems such as coronary artery disease, cardiac arrhythmias, structural heart defects, and cardiomyopathy.
Tell your doctor if you have a history of heart problems before starting dexmethylphenidate. Call your doctor without delay if you develop chest pain with exercise, a fast or irregular heartbeat, or faint while on dexmethylphenidate.
ADVERSE PSYCHIATRIC REACTIONS: Taking stimulants like dexmethylphenidate can cause mental health symptoms such as paranoia, delusions, and hallucinations. This can happen even in people with no prior history of mental illness. CNS stimulants can also trigger manic symptoms or mixed episodes in people who are at risk of developing mania, such as those with a personal or family history of bipolar disorder, depression, or suicidal thinking. Tell your doctor right away if you develop any changes in mood or behavior while you're taking dexmethylphenidate.
PRIAPISM (PAINFUL OR PROLONGED ERECTION): Rarely adult and pediatric male patients taking methylphenidate (a medication similar to dexmethylphenidate) have developed a painful or prolonged penis erection. This is a serious condition that may require surgical treatment. The painful or prolonged erection typically occurs after a person has been on the medicine for a while, after the dose is increased, or during withdrawal from the drug. Stop taking dexmethylphenidate and seek immediate medical attention if you develop a painful or prolonged erection that lasts more than 4 hours.
BLOOD FLOW PROBLEMS: There are reports of peripheral vasculopathy (blood vessel disease) and Raynaud’s phenomenon (blood flow problems in the fingers or toes) in people taking dexmethylphenidate. Tell your doctor right away if you notice changes in skin color in your fingers or toes (red, blue, or pale fingers or toes), pain, a cold feeling, or numbness in your fingers or toes. These symptoms are usually mild and occasional. However, they can cause tissue damage. Your provider may adjust the dose of dexmethylphenidate or stop the medicine.
SUPPRESSION OF GROWTH IN CHILDREN: Studies have shown that children taking CNS stimulants like dexmethylphenidate can experience weight loss and temporary slowing of growth. Your child's doctor will monitor their growth closely (height and weight) during dexmethylphenidate therapy and may stop treatment if there is evidence of slowed growth.
GLAUCOMA: There are reports of increased intraocular pressure (increased pressure in the eye) and acute angle closure glaucoma in people taking methylphenidate, a stimulant drug that is similar to dexmethylphenidate. Your provider will discuss the benefits versus risks of taking this medicine if you have a history of eye problems. Tell your doctor immediately if you develop changes in vision while on this medicine.
TICS: CNS stimulants have been linked to new or worsening motor and verbal tics and worsening Tourette’s syndrome. Before starting dexmethylphenidate treatment, tell your doctor if you have a personal or family history of tics or Tourette’s syndrome. Call your doctor if you develop new or worsening tics while on this drug.
SEROTONIN SYNDROME: Stimulant medications can lead to a serious and possibly fatal complication called serotonin syndrome, which occurs because of too much serotonin in the body. Signs and symptoms may include muscle twitching, rigidity, loss of coordination, confusion, agitation, and fast heartbeat. Seek immediate medical care if you develop these symptoms.

Precautions Before Starting Dexmethylphenidate

Tell your doctor if you have ever had an allergic reaction to dexmethylphenidate, methylphenidate (Ritalin, Concerta, Methylin, Metadate), any of the active or inactive ingredients in dexmethylphenidate tablets or capsules, other ADHD medications, or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of your medications, including prescription medications, over-the-counter medicines, vitamins, nutritional supplements, and herbal supplements. This can help avoid possible drug interactions between dexmethylphenidate and your other medicines.

Dexmethylphenidate may not be right for people with certain medical conditions. Tell your doctor if you have tics, Tourette’s syndrome, glaucoma, an irregular heartbeat, increased blood pressure, heart disease, a family history of sudden cardiac death, circulation problems, thyroid disease, hepatic impairment (liver disease), renal impairment (kidney disease), abnormal EEG, anxiety, depression, agitation, bipolar illness, mania, or suicidal thinking or behavior.

Tell your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding.

Precautions During Use of Dexmethylphenidate

Keep all your medical and lab appointments while on dexmethylphenidate. Your doctor will adjust your dose based on your response to the medicine.

Dexmethylphenidate can cause dizziness, drowsiness, and blurred vision as side effects. Be cautious while driving or doing other hazardous activities until you know how the medicine affects you. Get up slowly from a sitting or lying position to prevent falls due to lightheadedness.

Tell your doctor if you become pregnant while on dexmethylphenidate. Your doctor will likely recommend that you register with the National Pregnancy Registry of ADHD medications.

Tell all your healthcare providers you are on dexmethylphenidate before any surgery, including dental procedures.

Dexmethylphenidate is used to treat ADHD as part of a comprehensive treatment plan that includes counseling, behavior therapy, training, and medications. Follow your doctor’s recommendations for treating ADHD with these various approaches to get the maximum improvement in your symptoms.

Dexmethylphenidate Drug Interactions

Concomitant use of certain medicines with dexmethylphenidate can affect how it works. Possible interactions with other medicines can cause severe side effects and health complications.

You should not take a monoamine oxidase inhibitor (MAO inhibitor), such as selegiline (Eldepryl, Emsam, Zelapar), phenelzine (Nardil), isocarboxazid (Marplan), methylene blue, linezolid (Zyvox), or tranylcypromine (Parnate) at the same time as dexmethylphenidate. If you are on an MAO inhibitor or have taken one within the last 14 days, your doctor will not start you on dexmethylphenidate until at least 14 days have passed since your last dose of an MAO inhibitor.

The following medications can also have drug interactions with dexmethylphenidate:

Anticoagulants or blood thinners such as warfarin (Coumadin, Jantoven)
Certain diuretics or water pills
Decongestants (cough and cold medications)
Tricyclic antidepressants such as amitriptyline (Elavil), clomipramine (Anafranil), doxepin (Silenor), desipramine (Norpramin), amoxapine, imipramine (Tofranil), protriptyline (Vivactil), nortriptyline (Aventyl, Pamelor), and trimipramine (Surmontil)
Selective serotonin reuptake inhibitors (SSRIs) antidepressants such as fluoxetine (Prozac, Sarafem), paroxetine (Paxil), citalopram (Celexa), fluvoxamine (Luvox), and sertraline (Zoloft)
Serotonin and norepinephrine reuptake inhibitors (SNRIs) antidepressants such as venlafaxine (Effexor)
Medications used to treat high blood pressure, such as guanabenz and guanfacine
Anti-seizure medications such as phenytoin (Dilantin), phenobarbital, and primidone (Mysoline)
Parkinson’s disease medications such as methyldopa
Antacids and other drugs used to treat heartburn or ulcers (these can interact with the extended-release capsules of dexmethylphenidate)

The above list may not include all the potential drug interactions of dexmethylphenidate. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, nonprescription drugs, nutritional supplements, and herbal supplements. Also, tell your healthcare professional if you smoke, drink alcohol, or use illegal drugs because some of these substances can cause serious health complications when used with prescription medications.

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