Methylphenidate (Ritalin) Interactions

Ritalin is a common CNS stimulant for ADHD and narcolepsy. However, when misused, it can increase the risk of unwanted dependence and substance use disorder (SUD). In more severe cases, side effects can lead to undesirable outcomes, such as death.
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What is Methylphenidate (Ritalin) Used For?

Methylphenidate is the chemical compound name for Ritalin and other brand name drugs, such as Concerta®, Quillivant®, Quillichew ER®, and Daytrana® (transdermal patch). This prescription drug is a central nervous system (CNS) stimulant. 

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This means that when an individual takes this medication, certain chemical levels will increase in the brain and raise alertness, focus, energy, and physical activity. The drug’s effect on the body is similar to amphetamines. 

Ritalin is available in different forms: immediate-release tablets, chewable tablets, solution, and extended-release tablets (Ritalin-SR), extended-release capsules(Ritalin-LA), and more. Healthcare professionals may prescribe the medication for individuals with attention deficit hyperactivity disorders (ADHD) in children under 6 years of age and adults. 

Individuals who live with narcolepsy may also take Ritalin under a doctor’s supervision. 

Individuals who have motor tics, Tourette’s syndrome, or a family history of the illness may not receive the drug. Other criteria that may not make an individual suitable for Ritalin are hyperthyroidism (overactive thyroid) and seizure disorder.

However, like any other CNS stimulant, Ritalin has a high potential for misuse and dependence. This risk can be higher for individuals who live with a substance use disorder, such as alcohol use disorder (AUD). 

In severe cases, Ritalin misuse, especially when mixed with other substances, could result in overdose or death. 

Side Effects of Ritalin

Ritalin has a series of common side effects, including:

  • Increase in blood pressure (hypertension) and heart rate (tachycardia)
  • Nervousness 
  • Insomnia 
  • Agitation
  • Dizziness
  • Nausea or vomiting
  • Decrease in appetite
  • Weight loss
  • Diarrhea
  • Stomach Pain
  • Restlessness
  • Heavy sweating
  • Decreased libido 
  • Dry Mouth
  • Abnormal liver function, such as severe hepatic injury 

It is important to note that ADHD medications like Ritalin may worsen symptoms of preexisting mental disorders. For example, Ritalin may trigger manic episodes in individuals living with bipolar disorder. 

New psychotic or manic symptoms may arise in individuals who do not have a prior history of psychotic disorders and are taking Ritalin. These symptoms include:

  • Hallucinations 
  • Delusional thinking 
  • Mania

Additional medical problems that have occurred in individuals taking Ritalin are:

  • Prolonged and painful erections (priapism)
  • Allergic reaction (hives or swelling of the eyes, face, lips, mouth, tongue, or throat)
  • Peripheral vasculopathy (gradual circulation problems like Raynaud’s phenomenon) Stroke
  • Chest pain
  • Heart problems (heart failure and heart attacks)
  • Sudden death 

Women who are breastfeeding should consult their healthcare provider before taking Ritalin. This drug can pass through breast milk.

What Drugs Interact With Ritalin?

Like any other prescription medication, Ritalin may interact with other drugs and intensify unwanted side effects. 

Individuals should consult their medical specialist before taking these drugs with Ritalin:

  • Monoamine oxidase inhibitor (MAOI) — this is a type of antidepressant prescribed for individuals living with depression. Examples include linezolid, methylene blue, phenelzine, tranylcypromine, and selegiline. Ritalin can interact with this drug, even if drug discontinuation has occurred within the past two weeks. When combined, these drugs may cause aortic dissection, eclampsia (the onset of seizures during pregnancy), pulmonary edema (fluid build-up in the lungs), renal failure, heart attack, and death. 
  • Antihypertensive drugs — individuals who take Ritalin or Ritalin-SR may see a decrease in antihypertensive drug efficacy. 
  • Halogenated anesthetics  — individuals may experience a sudden increase in blood pressure and heart rate during surgery when halogenated anesthetics and Ritalin or Ritalin-SR are used simultaneously. 
  • Antacids or acid blockers  — drugs of this kind may make it more difficult for individuals to absorb long-acting stimulants. Drug absorption depends on the amount of acid in the stomach. 

Can You Take Antihistamines With Ritalin?

If individuals take antihistamines with Ritalin, no severe side effects should arise. Antihistamines like diphenhydramine (brand name is Benadryl®) do not pose a risk of problematic drug interactions. 

In one study exploring antihistamines (cetirizine) and Ritalin, investigators found that positive results in allergic rhinitis and ADHD symptom relief. This means that using both drugs was more effective in treating these conditions than when taken alone. 

However, each individual has specific health needs. Because of that, it is always recommended to consult a healthcare provider before taking other drugs with Ritalin. A doctor will be able to prescribe the most suitable drug combination treatment. 

Dangers of Mixing Ritalin With Other Substances

Because Ritalin is a prescription stimulant that impacts the central nervous system, mixing the drug with other substances can negatively affect health. 

For example, drinking alcohol and taking Ritalin can put a lot of pressure on the liver. The hepatic organ is responsible for metabolizing both substances in the body. If an individual participates in heavy drinking or binge drinking while taking Ritalin, medical conditions such as liver damage could occur.  

Symptoms of Ritalin abuse (misuse) may include:

  • Increased heart and respiratory rate
  • High blood pressure
  • Dilated pupils
  • Loss of coordination 
  • Loss of appetite
  • Aggression

In the most severe cases, individuals who combine Ritalin with other substances may overdose or even result in death. 

According to the National Institute on Drug Abuse, the number of Americans to misuse prescription stimulants in 2017 was more than one million.

If you are misusing Ritalin either alone or with other substances, medical advice is available. Individuals thinking about stopping the medication should consult a doctor about developing a treatment plan and monitoring withdrawal symptoms. Although there are no FDA-approved medications for addictions to stimulant medications, doctors can speak to you about other options like behavioral therapies and drug tapering.

The journey to recovery may be difficult, but it is not impossible. 

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Resources

Melamed, Isaac, and Melinda Heffron. “Attention Deficit Disorder and Allergic Rhinitis: Are They Related?.” Journal of immunology research vol. 2016 (2016): 1596828. doi:10.1155/2016/1596828

“Methylphenidate.” Medications, University of Minnesota Student Mental Health, www.mentalhealth.umn.edu/medication/pdf/methylphenidate.pdf

National Institute on Drug Abuse. “How Can Prescription Drug Addiction Be Treated?” National Institute on Drug Abuse, 3 June 2020, www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/how-can-prescription-drug-addiction-be-treated.

National Institute on Drug Abuse. “What Is the Scope of Prescription Drug Misuse?” National Institute on Drug Abuse, 13 Apr. 2020, www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/what-scope-prescription-drug-misuse.

Novartis Pharmaceuticals A-Z. Novartis US, www.novartis.us/product-list/products?title=ritalin.

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Updated on: October 22, 2020
Author
Anthony Armenta
About
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Medically Reviewed
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Annamarie Coy,
BA, CADACII/ICADC, ICPR, MATS
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