Methylphenidate interactions to avoid

Drug interactions | Food interactions | Other interactions | Avoiding interactions | When to see a doctor

Methylphenidate is a medication commonly known by its brand names Ritalin, Metadate, and Daytrana. Healthcare providers typically prescribe it to manage attention deficit hyperactivity disorder (ADHD) and narcolepsy. It is classified as a central nervous system (CNS) stimulant and affects certain brain chemicals that may contribute to impulse control and hyperactivity.

For many people, methylphenidate is a useful drug that can help them carry out daily activities. Despite its effectiveness, the use of methylphenidate does come with a risk of potential drug interactions that may lead to serious side effects, such as high blood pressure (hypertension) and serotonin syndrome. Individuals who take other medications may need to use caution and consult a healthcare provider before starting methylphenidate. 

Continue reading to learn more about drug interactions involving methylphenidate, the potential side effects, and how to prevent them. 

Methylphenidate drug interactions

Methylphenidate is known to have interactions with various types of medications, including other prescription drugs, over-the-counter (OTC) medications, and herbal supplements. These interactions can affect how methylphenidate or other medications work and might lead to increased side effects or decreased efficacy.

High blood pressure medications

Methylphenidate may increase blood pressure and can intensify the effects of blood pressure medications. Doctors recommended to monitor blood pressure and heart rate regularly if you’re taking these medications with methylphenidate. If you experience symptoms like severe headache or chest pain, contact a healthcare provider. Examples of high blood pressure medications include:

• Norvasc (amlodipine)
• Tenormin (atenolol)
• Lasix (furosemide)
• Lotensin (benazepril)

Vasopressors

Vasopressors are drugs that healthcare providers may prescribe to raise blood pressure during medical emergencies. However, vasopressors may have their effects increased when taken with methylphenidate. This interaction could cause an excessive increase in blood pressure. Still, in many emergency cases, the benefits of a vasopressor may outweigh the risks of a serious interaction. Examples include:

• Epipen (epinephrine) 
• Dopamine (dopamine hydrochloride)

Monoamine oxidase inhibitors

Methylphenidate should not be taken with monoamine oxidase inhibitors (MAOIs) or within 14 days of stopping treatment with an MAOI. Serious and possibly life-threatening side effects like a dangerous spike in blood pressure, known as a hypertensive crisis, may occur. Common MAOIs include:

• Nardil (phenelzine)
• Marplan (isocarboxazid)
• Parnate (tranylcypromine)
• Eldepryl (selegiline)
• Zyvox (linezolid)

Although formally classified as an antibiotic, linezolid also has MAOI properties.

Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors (SSRIs) can interact with methylphenidate, potentially leading to increased serotonin in the brain. As a result, this interaction may increase the risk of serotonin syndrome. Symptoms to look out for include agitation, hallucinations, and rapid heart rate. A healthcare provider might adjust dosages or suggest other medications as alternatives. Examples include:

• Prozac (fluoxetine) 
• Zoloft (sertraline) 
• Celexa (citalopram)

Tricyclic antidepressants

Methylphenidate may increase the levels of tricyclic antidepressants (TCAs) in the blood, which can increase the chance of side effects such as dry mouth, constipation, or urinary retention. Combining methylphenidate with TCAs may also increase the risk of heart rhythm problems. Examples of TCAs include:

• Tofranil (imipramine) 
• Anafranil (clomipramine)
• Norpramin (desipramine)

Warfarin

Methylphenidate may block the metabolism or processing of warfarin. As a result, combining methylphenidate with warfarin may lead to increased bleeding effects. Patients may need to check their blood clotting status regularly, and any unusual bleeding or bruising should be reported to a healthcare provider.

Anticonvulsants

Methylphenidate may also block the metabolism of some anticonvulsants, which may lead to increased blood levels and side effects of the anticonvulsants. If you take anticonvulsants for seizures, you may need to monitor for signs of toxicity and potentially adjust the dosages of the medications with a healthcare provider. Examples include: 

• Dilantin (phenytoin) 
• Luminal (phenobarbital)
• Mysoline (primidone)

Risperidone

Mixing methylphenidate with risperidone, especially when changing the dosage of either medication, can raise the chances of experiencing movement-related side effects, known as extrapyramidal symptoms (EPS). You may need to watch for signs like muscle stiffness, tremors, twitching, or uncontrolled muscle movements. 

Halogenated anesthetics

Halogenated anesthetics and methylphenidate may increase the risk of sudden blood pressure and heart rate changes during surgery. Some reports have found that methylphenidate can also reverse the effects of anesthesia, which may disrupt sedation during a procedure. Tell your healthcare provider if you’re taking methylphenidate before surgery, as they may recommend skipping a dose on the day of surgery. Examples include:

• Sevoflurane (sevoflurane) 
• Isoflurane (isoflurane)

Methylphenidate food interactions

Methylphenidate immediate-release and extended-release tablets can generally be taken with or without food, as food typically does not affect the absorption of the drug. Some people find it more convenient to take methylphenidate with meals, as it helps them remember to take their medication regularly and may also help reduce stomach upset. 

Methylphenidate and alcohol

Mixing methylphenidate with alcohol is generally ill-advised. The stimulant effects of methylphenidate may mask the depressant effects of alcohol, which may cause you to drink more than you should and increase the risk of alcohol poisoning. In addition, combining methylphenidate with alcohol may increase the medication’s side effects, such as nervousness and anxiety. Patients should typically avoid or at least limit alcohol consumption while taking methylphenidate.

Methylphenidate and caffeine

Caffeine, like methylphenidate, is a CNS stimulant. Consuming caffeine while taking methylphenidate may increase side effects like jitteriness, insomnia, increased heart rate, and anxiety. While moderate caffeine intake may be acceptable for some people, monitoring for potential side effects is important. Reducing or limiting caffeine-containing products, such as coffee, tea, chocolate, and some soft drinks, may be recommended to prevent potential interactions.

Other methylphenidate interactions

Methylphenidate may interact with other substances besides prescription medications, especially certain herbal supplements. These interactions may include the following herbal remedies:

St. John’s wort

St. John’s wort can interfere with how Ritalin is processed in the body, potentially increasing its levels in the blood and intensifying its effects. Taking St. John’s wort alongside methylphenidate may increase side effects like restlessness and aggression. Medical professionals do not recommend combining this herbal supplement with methylphenidate. 

Caffeine-containing herbs

Herbal supplements containing caffeine, like guarana and yerba mate, can interact with methylphenidate, leading to increased stimulant effects, such as hyperactivity, muscle twitching, and heart rhythm problems (arrhythmias). Those with a family history of heart conditions or people who have experienced heart attacks may need to use extra caution.

Other supplements may interact with methylphenidate, so it’s essential to discuss them with a healthcare provider before taking methylphenidate. 

Other considerations

People with certain medical conditions may also need to consider potential complications while taking methylphenidate. There may be an increased risk of certain health issues while taking methylphenidate. 

• Serious heart problems: People with severe heart conditions, including those with abnormal heart structures or irregular heartbeats, should typically avoid methylphenidate because of the possible risks of complications.
• High blood pressure: Monitoring blood pressure is recommended, as methylphenidate may cause increases in both blood pressure and heart rate.
• Bipolar disorder: People should be screened for bipolar disorder before starting methylphenidate because it may increase the risk of new manic symptoms; methylphenidate is generally stopped if mania or psychosis arises.
• Seizures: Those with a history of seizures should be cautious, as methylphenidate may lower the convulsive threshold. If seizures occur, the medication may need to be discontinued.
• Children: Growth should be monitored in pediatric patients on methylphenidate, as it could suppress growth. If a child or adolescent is not growing or gaining weight as expected, treatment may need to be paused or stopped altogether.
• Glaucoma or other eye problems: Patients at risk of acute angle closure glaucoma should be evaluated, and those with increased intraocular pressure or open-angle glaucoma should only take methylphenidate if the benefits outweigh the risks.
• Tourette’s syndrome: Before taking methylphenidate, tell your healthcare provider if you have a history of tics or Tourette’s syndrome and monitor for any new or worsening symptoms.

Recognizing how methylphenidate can affect people with these conditions may be useful for managing the potential risks.

How to minimize methylphenidate interactions

Whether you’re taking extended-release or immediate-release methylphenidate, it’s possible to manage and reduce the risk of drug interactions. Here are some steps you can take:

• Consult your healthcare professional before starting or stopping any medication, including methylphenidate. They can provide medical advice on safely managing medication interactions. They can also recommend specific timing of doses and whether the medication should be taken with food.
• Maintain an up-to-date medication list that you can share with your healthcare provider, including prescription drugs, OTC medications, herbal supplements, and vitamins. Download our free medication list template to help keep track of all of your medications.
• Be mindful of potential food and drink interactions, specifically products containing alcohol or caffeine, as these interactions could lead to potentially serious adverse effects.
• If you are caring for a child taking methylphenidate, work with a specialist experienced in pediatric care. Children and adolescents have different needs, and medications may need to be adjusted accordingly.
• Monitor for any changes in health. If you experience unusual side effects or changes in medication effectiveness, contact your healthcare provider immediately. These changes might include new or worsening symptoms and unexpected reactions when combined with other substances.

By taking these steps, you may be able to lower the risk of drug interactions with methylphenidate and keep your treatment on the right track.

When to talk to a healthcare provider about methylphenidate interactions

It’s recommended to discuss potential interactions with a healthcare provider, particularly because methylphenidate can have several drug interactions and cause various side effects. You should consult a healthcare provider or seek immediate medical attention if you experience:

• Side effects that are severe or concerning, such as heart rate changes, extreme weight loss, or prolonged erections
• Any signs of an allergic reaction, including but not limited to hives, swelling, or difficulty breathing

It is also important to communicate if you are:

• Taking any ADHD medications, other prescription medicines, or OTC drugs
• Using any herbal or dietary supplements
• Pregnant or breastfeeding

• Allergic to any medications 

The above is not a list of all possible methylphenidate interactions. Consult your healthcare provider before starting any new medications. They can determine the appropriate course of action based on your other medications and medical conditions.