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Doctors' Answers to "Frequently Asked Questions" - Ritalin

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 09/18/2000]
Question: My son, who is now 15, has been taking ritalin for the past 3 years. He is short for his age and seems to be slow in reaching puberty. Does ritalin stunt a child's growth? His school work has improved 100% since he started taking ritalin. He went from mostly D's to being an Honor Student -- all A's and B's -- but we are worried about his slow growth.

Answer: Not usually, discuss his growth curves with his pediatrician, he may just be a slow constitutional growth child.

[posted 06/2/2000]
Question: Is there a difference in Brend name Ritalin and the gineric?My son has tried all of the medications out there for ADD. He Nothing was working and a doctor told us to try Ritalin. We told him that our son had tried it. He said to try the Brand name Ritalin. (we had only tried the Gineric) It was a gret success. It was so different and worked so well. I thought that they were suposed to be the same. Could you tell me if this is true? I really saw the difference in our son. The gineric made him irritible all the time. Ritalin really helped my son. We only give him the medication during school. He is an A student now that we found this difference.

Answer: Some patients do have different response to the generic versus brand name. If you see a difference, then there is one.

[posted 04/15/2000]
Question: Is it safe to take Ritalin during pregnancy? Are there any known birth defects, from the use of this drug?

Answer: Ritalin has not been studied in pregnant women and the PDR states firmly that the drug should not be taken while pregnant.

[posted 04/5/2000]
Question: What family is ritalin in? I heard it may be in the speed and/or cocaine family. Is this true?

Answer: Yes, it is a Sympathomimetic which belongs to the class of drugs that amphetamine belongs to.

[posted 11/23/1999]
Question: I am a 20 yr. old male with a history of psychiatric diagnoses. I was recently put on Ritalin for amotivation and apathy. I found that if alcohol was consumed within a few hours after the Ritalin, I would be thrown into serious depression or agitation that would last an hour or so. I know it was the Ritalin, as I was using higher doese than prescribed at the time. What could cause this problem, and are there any long-term neurophysiological problems to be concerned about?

Answer: The problem is combining a depressant with a stimulant-not a good idea. Even less of a good idea not to let your doctor know what medications you are taking. There would not usually be long term problems.

[posted 11/16/1999]
Question: i have been haveing problems studying fo many years now. it wasn't until recently that i had to sit down for long periods of time to
study. it seems that i can't concentrate for moe than five minites. i have the same problem in classes too. my mind is always wondering and it is effecting my preformance.
also it seems that i can't really sleep at night. more than five hours and i am wired all day. it is becomeing a problem. what do you think i should do. is it too late for a cure, is ritalin the answer?

Answer: First, check your thyroids. If normal sounds like Attention Deficit Disorder(ADD) a trial of Ritalin would be appropriate. Formal testing can be performed to document it if necessary. This would usually qualify as a disability and allow some allowance in terms of jobs, scholships etc.

[posted 08/22/1999]
Question: My question concerns my son who was diagnosed as bi-polar about five years
ago. I do believe the diagnosis has shifted at times to schizoaffective, but
he is being treated with Li as are bi-polar patients.

For the first year following his third hospitalization five years ago,
he was wonderful. He enrolled in college, resumed his prior business activities, and
seem better than he had ever been. However, within a year, that changeed. He seems to exist
in a chronic state of lethargy and apathy. Although he continues to attend college and
is in his final year, he is simply not himself and his speech at times is slurred..he contributes
very little conversationally and just seems 'dreamy'. I wrote his psychiatrist at the mental health clinic
three times about my concern. Finally, last week, he admitted my son to the hospital where he remained five days.
He was just released today and seems much, much better. BUt I can't figure out why since they did
not change his medications (something I felt was contributing to his lack of motivation and lethargy. Instead,
the added Ritalin. My question is why, on top of Trazodone, Lithium, and Ativan would they add another drug. And why should this
make such a difference in only a few days. I'm afraid that he'll slip back into
his prior state if the apparent improvement was only a result of being in the hospital . (which, incidentally, he rather enjoys because
there is structed time and activiites.

Apparetly his LI levels were fine - which greatly surprised me since the mental health center only checks them once a year or so.
I suggested to his doc that a TSH test be done so I hope it was. My son didn't mention the results.

Any comments would be appreciated.

B.J. Perkins

Answer: Ritalin and similar drugs are often used to treat depression. Sometimes as a "kick start" the depression since most antidepressants take some time to start working and the Ritalin will work rapidly. Sometimes as a chronic treatment. Addicting but often works when nothing else will.

[posted 08/21/1999]
Question: My 9 yr old son has been treated for ADHD for a year now. Jon is very bright, testing as Gifted in some areas, which makes him challenging, rewarding and frustrating to work with. Due to his sleeplessness on Adderall, which otherwise has worked pretty well for him, our Dr. prescribed Klonopin . 5 mg and later Alprazolam .25 to help him sleep. Neither seemed to help at all. Jon is awake until 11, 12, 1 every nite, and mornings are horrible trying to get him up, fed and dressed for school by 7:15. He's not getting enough sleep. Even with medication, he has trouble following directions, staying on task - he can get lost crossing the kitchen! We are changing to Ritalin, hoping it will wear off and let him sleep. But I am concerned about it's side effects. Since last October he's only grown 1/2" (54 1/2" % 67lbs) and not gained much weight (if any). I am also concerned with how much the lack of medication in the evening, dealing with homework, Scouts, etcwithout meds, will add to the stress in our household- for both of us. I am a single working parent, probably ADD myself, and don't have alot of resources to lean on. I don't like giving him too much medication - for ADD or to sleep - but if he's awake, I am too - and I need my rest to work and deal with him. What is your opinion of Adderall Vs. Ritalin? Should he be on medication vacations in the summer to allow growth? (Prior to medication, he almost got thrown out of daycare for misbehavior - so I hesitate to not medicate - I have to work) Do you have any suggestions to help Jon sleep?

Answer: There is a lot of debate about this. My personal feeling is that some do better on one and some on the other. You'll need to try both to see. Growth seems not to be an issue as long as they get sufficient sleep(that is when growth hormone is secreted).

Ritalin [posted 1/12/99]
Question: I am trying to find the date when Ritalin was approved by the FDA and when it went on sale. Also, are there any countries that it is not sold in?

Answer: You'd need to check with the company, Novartis: 888-669-6682.

Ritalin and elevated liver enzymes [posted 1/8/99]
Question: I have been taking Ritalin (10 mg 2 or 3 times daily) for about 20 years for fatigue. I have been diagnosed with MS and this treatment has been associated with that disease. I currently show elevated liver enzymes and I wonder if long term usage of Ritalin could cause these symptoms?

Answer: Not usually, but it could occur. You really won't know without stopping the drug and watching.

Ritalin for Adults [posted 11/18/98]
Question: I need as much info re ritalin use for adults as I can get, can you refer me to any resources. my son has used high dosages of ritalin(80 to 160mg/daily) for five years and has become very very depressed. so much so that he was given ect which helped but he is still on ritalin for add. I have seen the development of depression during the last five years although he was always somewhat depressed before, now it has become severe. He has tried to stop taking the ritalin and has reacted with increased severe depression. Thank You

Answer: The ritalin is not the cause of the depression, he needs to see a psychiatrist who is adept at drug manipulation. Also, some neuropsychiatric testing to document his problem would be helpful.

Ritalin for Sleepiness ? [posted 10/29/98]
Question: I noted one FAQ dealt with 3 doses daily of Ritalin. I was prescribed for "sleepiness" and told to take 10 mg three times daily. I quickly cut that back to 10mg ONCE a day as I became "hyper" and oversensitized. It causes insomnia for me as well. Now, if I need a "boost", I take one tablet (10mg) and break it into fourths. One fourth = 3 hours of increased awareness; one half = 8 hours; etc. Any dosage causes some insomnia for at least one night. My regular maintenance medications are ADALAT, 60mg; LIPITOR, 20mg; 325gr Aspirin. I also take Vitamin E 400 units.

Answer: Why are you sleepy? Do you have a sleep disorder. If so, see a sleep lab or a sleep specialist, don't use these drugs for drowsiness unless there is no alternative. I assume you have cardiac or hypertension problems with your meds, this drug is used with great caution in either situation.

Ritalin [posted 8/14/98]
Question: Is ritalin from a cocaine derivative and does it cause liver damage?

Answer: It is not related to cocaine. Occasional patients have had elevated liver enzymes, but this is an uncommon problem with this drug.

Ritalin And Long Term Effects [posted 8/11/98]
Question: I have a 20 year old son that took ritalin from age 5 until he was a junior in high school. Since he graduated from high school he has had several encounters with the law with regards to marijuana and alcohol. It recently was brought to my attention that there could be a connection as to when we took him off the ritalin and the problems he is currently facing. Is there any connection to ritalin and substance abuse? The individual that made this point also indicated that if my son was not put back on ritalin that things will become even worse, especially when he reaches the age of 30 Is there any truth to these statements?

Answer: I would try a repeat of the Ritalin. Since we are just seeing the first generation of children treated for ADD, we do not know whether these children need to be treated long term as adults. Like children, start the medication and observe his attention/behavior. That would be my approach. Whether it will have any affect on the drug behavior is unpredictable.

Ritalin [posted 8/7/98]
Question: My grandson was recently placed on Ritalin. What could the long term affects of this drug be? Around my wife and I he was perfectly calm could sit and read to us, do first grade math, color, etc., for hours and even play catch. Now he seems very tired most of the time. When his parents used to show up he would misbehave frequently, until my wife or I asked him to behave like a nice young man and he would.

Answer: The question is whether his concentration is better at school with the drug or not. I would ask him, he will know. The dosage may need to be adjusted depending on his performance on the drug.

Ritalin and Alcohol Interactions
Question: I have heard some people say it is OK to take ritalin and to have a drink or two. I have also heard some people state that it is not safe to mix these two. What is a safe time between the last ritalin dosage and having a drink? I did not know if 3 or 4 hours would do, or if it needed to be something more along the lines of 8 or 9 hours.

Answer: There shouldn't be a big deal for a drink or two. However, individuals vary. Start with only one drink several hours post dosage and see what your reactions are. I wouldn't go past two.

Question: Are there any studies about taking Ritilan while pregnant? I am a 34 year old and have been on Ritilan (20 mg sr) for three years.

Answer: There have been no studies in animals or humans concerning this drug. There are no anecdotal studies in the literature concerning case studies. Risks are unknown currently.

Question: I need information about adverse reactions with Ritalin.

Answer: Ritalin (methylphenidate hydrochloride) is a central nervous system stimulant whose mode of action is not completely clear. It may cause insomnia, nervousness, allergic reactions (rash, hives, fever, arthritis) nausea, irregular heart beats and types of psychotic thought processes. Several cases of Tourette's Syndrome have been reported as well, but is a rare problem.

Ritalin Dosage
Question: How much Ritalin is too much for a 65 pound, 7 year old female. The doctor has prescribed 10 mg upon awakening, 20 mg at 8:30 a.m., 20 mg at noon, 20 mg at 4:00 p.m., and 10 mg at 7:00 p.m.

Answer: Ritalin use in children is based on effectiveness. That is, using the minimal dose to decrease the hyperactivity. Very large doses are occasionally used, focusing on the effect. Once the child is normal the dosage is slowly decreased until the child becomes more active. The dose is usually titrated up and down based on the child’s response.

General Information
Question:What food, drinks, drugs, and activities should one be careful of or avoid when taking this drug. The patient is 35yrs old, male, and an active athelete.

Answer:Ritalin(methylphenidate hydrochloride) is a drug with several uses. The most common is in the treatment of hyperactive children. It is also used in attention deficit disorders and narcolepsy. It can have potential interactions with MAO inhibitors and may affect the metabolism of different drugs like coumadin, dilantin, phenobarbital and tricyclic antidepressants. There does not appear to be major problems with foods.

Question: My son Dylan has been put on ritalin. Our doctor and teacher agree that it should help him in school, his grades are good but he has to try real hard. He can not stay still or stay focused on what is goning on. After reading all the negative things about it. I still wonder if it was the right thing to do?

Answer: Ritalin is used in ADD ( attention deficit disorder) as well as treating the "hyperactive kid'. In the right population it can be very effective. Paradoxically, it tends to calm overactive children who have difficulty concentrating rather than the normal effect seen in adults of increasing agitation. There are many support groups concerning ritalin and I would discuss your concerns with other parents. Like many things they can give the best information. There are many people who think this is an overdiagnosed problem and that we are harming a generation of children. It clearly is extremely effective in properly selected children.

Course of Action
Question: If ritalin is a stimulant, why does it "calm" hyperactive children?

Answer: Excellent question-no one knows for sure. Clearly, it affects some inhibitor site as well as an activator site. Where and how is not known.

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