• If you are allergic to anything, including medicines, dyes, additives, or foods.

• If you have any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, gout, or infections. These conditions may require that your doctor watch you more closely during your treatment.

• If you have high blood pressure. This drug may raise blood pressure and also block the actions of blood pressure medicines. If you take this drug, your doctor will likely want to check your blood pressure often during treatment.

• If you have heart disease, heart rhythm problems, cardiomyopathy, abnormal heart structure, hardening of the arteries, or have recently had a heart attack. You may not be able to take this drug, since it may stress the heart and cause heart attacks or strokes.

• If you or a relative have movement tics (repeated muscle twitches that are hard to control), verbal tics (repeated sound or words that are hard to control), or Tourette's syndrome. You may not be able to take this drug, because it may worsen the problem.

• If you have glaucoma. You may not be able to take this drug, because it may worsen the problem.

• If you have any blockage or narrowing of the stomach or intestine.

• If you have had seizures. This drug may make you more likely to have them again.

• If you have taken any antidepressants of the MAO inhibitor type in the past 2 weeks (see drug interactions, below). This drug can cause a serious increase in body temperature and blood pressure.

• If you have anxiety, tension, or agitation. You may not be able to take this drug, since it can make these symptoms worse.

• If you have trouble with addiction, alcohol, or drug abuse now or have had one in the past. Methylphenidate can be habit forming, especially for those who have had problems before.

• If you have serious mental illness, especially psychosis, hallucinations (seeing or hearing things others cannot) or bipolar disorder (manic-depressive illness) or depression. This drug can worsen your symptoms. You should also tell the doctor if any family members have one or more of these illnesses.

• If you are breast-feeding. Small amounts of this drug pass into breast milk. Talk with your doctor about whether this drug might affect your baby.

• If you are breast-feeding. It is not known whether this drug passes into breast milk. If it does, it may affect the baby.

• About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

• tricyclic antidepressants such as amitriptylene, nortriptylene, desiprimine, and doxepin
• selective serotonin reuptake inhibitor antidepressants, such as fluoxetine, citalopram, fluvoxamine, paroxetine, sertraline, and others.
• anti-seizure medicines such as phenobarbital, primidone, or phenytoin, methylphenidate
• blood thinners such as warfarin (Coumadin)

Your doctor may lower your dose of these medicines to lower the risk of these problems.

If you have taken monoamine oxidase (MAO) inhibitors, such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl), and tranylcypromine (Parnate) within 2 weeks of taking methylphenidate, they can rarely cause a serious reaction with high blood pressure and life-threatening increases in body temperature. These drugs can also slow down the body's attempts to get rid of methylphenidate.

Clonidine may increase your risk of serious side effects from methylphenidate.

Methylphenidate may reduce the effectiveness of blood pressure medicines (anti-hypertensive drugs).

Any medicine that raises blood pressure can have a more pronounced effect if you are taking methylphenidate. Cold, sinus, or allergy medicines containing pseudoephedrine (decongestants) and pain medicines containing caffeine may cause even more of an increase in heart rate and blood pressure, as well as other stimulant effects.

Check with your doctor, nurse, or pharmacist about whether other medicines, vitamins, herbs, and supplements can cause problems with this medicine.

Short-acting methylphenidate tablets and capsules may be taken with or without food. The liquid (solution) form is taken before meals. The first dose of methylphenidate is usually taken in the morning, with a second dose 4 to 6 hours later. If a third dose is needed, it is usually taken later in the afternoon. Take the last dose of the day no later than 6 p.m. to reduce the chance of interfering with sleep.

Long-acting or time-released methylphenidate tablets or capsules should be given each day before breakfast. To avoid overdose, don't crush, chew, break, or dissolve time-released pills or capsules.

Ritalin LA is a special type of long-acting methylphenidate with capsules that contain coated beads. These capsules can be carefully opened and sprinkled on a spoonful of cold applesauce or pudding. The food must be swallowed right away, without chewing. Rinse your mouth with water afterward to wash down and swallow any remaining beads without chewing them. If the food mixture is not eaten right away, flush it down the toilet. Do not save it for later, because its moisture may dissolve the beads. These capsules can also be swallowed whole.

The methylphenidate transdermal patch is placed on the hip area below the waist to keep clothing from rubbing it. Choose clean dry skin without irritations, cuts, sores, or previous radiation treatment. Don't use oils, lotions, or powder on areas where the patch will be used. Use scissors to open the package just before you plan to use it. Carefully remove half of the protective liner, without touching the sticky part with your fingers. Use the covered half as a handle and press the sticky side of the patch firmly to the skin. Then pull off the other half of the liner, pressing your palm on the whole patch for at least 30 seconds. Make sure that all the edges stick to your skin. Wash your hands after applying the patch, and write the date and time on the administration record on the carton. The patch should be removed 9 hours after it is put on the skin. Try to put the patch on at about the same time of the day, about 2 to 3 hours before you want it to work. If needed, the patch may be removed before 9 hours has passed.

When removing the old patch, gently pull it off the skin and fold the sticky side in half back on itself. Flush it down the toilet to get rid of any drug left in it, or throw into a covered trash can. Wash your hands and record the time the patch was removed on the administration record. Do not throw it into a trash container where a child, pet, or another person might accidentally find or come in contact with it.

Select a different place for a new patch each morning and apply it as noted above. Never use more than one patch at a time unless your doctor tells you to. Do not apply heat (heating pad, electric blanket, etc.) to the patch because it will make the medicine absorb too quickly.

Take this drug exactly as directed by your doctor. If you do not understand the instructions, ask your doctor or nurse to explain them to you.

Keep the medicine in a tightly closed container away from heat and moisture and out of the reach of children, pets, and others. Do not allow anyone else to take your medicine. When no longer needed, this drug should be flushed down the toilet or discarded in a safe way so that pets, children, and others cannot get to it.

Methylphenidate speeds up the heart and raises the blood pressure, and may rarely cause stroke or heart attack. If you notice chest pain, pounding heart, high blood pressure, shortness of breath, severe headache, have trouble speaking or moving, or feel faint, call your doctor right away.

Tell your doctor right away if you develop any tics, twitches, tremors, hallucinations (seeing or hearing things that aren't there), unusual thoughts or behavior such as hostility, suspiciousness, mania, aggression, or other signs of losing touch with reality. . Your doctor may need to change your medicine or stop the drug.

If you notice blisters or swelling of the skin where you have used a methylphenidate skin patch, call your doctor.

Don't stop taking methylphenidate all at once if you have taken it for a long time. Withdrawal symptoms that may occur after prolonged use include extreme tiredness, mental depression, changes in sleep. Do not change your dose without talking to your doctor or nurse.

Check with your doctor, nurse, or pharmacist before starting or stopping any medicine or supplement while you are taking methylphenidate.

This is a controlled substance, and may be habit-forming. Take it only as directed by your doctor. Methylphenidate may cause psychological dependence (which can lead to addiction). Some signs of psychological dependence are a strong desire to keep taking the medicine, and wanting to take larger doses. Talk with your doctor if you think this has happened to you.

If you are taking methylphenidate along with pain medicines for chronic cancer pain, keep in mind that most cancer pain can be controlled. Keep your doctor or nurse informed about how well your pain medicines are working and any side effects you are having. Your cancer team may need to adjust your medicines several times before they find the medicines that work best for you.

If you have chronic (long term) cancer pain, talk with your doctor or nurse about taking your pain medicines on a regular schedule to keep it from worsening. If you wait until the pain is bad, it takes more medicine to get it under control. If pain comes back between doses, talk to your cancer team about changing your medicine or adding an extra one for "breakthrough" pain.

If you think you or someone else may have taken an overdose of methylphenidate, get emergency help right away. Symptoms of overdose may include: nausea, vomiting, diarrhea, tremors, cramps, high blood pressure, fast or irregular heartbeat, hallucinations, agitation, confusion, high temperature, seizures, and eventually low blood pressure, fainting, and coma.

• nervousness
• trouble sleeping
• headache
• stomach pain
• poor appetite

• mood changes (such as anxiety, irritability, restlessness, hostility)
• sweating
• nausea
• vomiting
• dry mouth
• dizziness*
• slowed growth when used in children for long periods
• increase in blood pressure*

• tics or twitching (repeated unintended movements or sounds)
• blurred vision
• tremors
• low white blood cell count, with increased risk of infection (usually with long term use)
• low red blood cell count (anemia) with low energy, tiredness (usually with long term use)
• allergic reaction with swelling of the mouth or throat, dizziness, trouble breathing, hives and itching
• liver damage (usually gets better when medicine is stopped)
• hallucinations or other symptoms of severe mental illness
• withdrawal symptoms if drug is suddenly stopped after prolonged use*
• skin irritation (from patch)*
• sudden stroke or heart attack*
• sudden death during exercise (in those with heart problems)
• seizures (usually in those who have had them before)

*See "Precautions" section for more detailed information.