Methylphenidate is used as part of a comprehensive treatment programme for attention deficit hyperactivity disorder (ADHD) in children and adolescents aged between 6 and 18 years and in adults
- is authorised only after other treatment measures, such as counselling and behavioural therapies, have proven insufficient to manage symptoms
- methylphenidate is available in the UK in immediate-release and long-acting formulations taken orally (tablets or capsules)
- long-acting medicines are those labelled as prolonged-release, modified-release, or sustained-release formulations
Advice to healthcare professionals in the UK (1):
- caution should be used if long-acting formulations of methylphenidate are to be used interchangeably due to the differences between formulations in dosing frequency, administration with food, amount and timing of the modified-release component, and overall clinical effect
- follow specific dosage recommendations for each formulation
- if considering a switch to another long-acting preparation:
- consult with the patient (and their parent or caregiver if relevant) to discuss the reasons for this and the possible changes they may experience in symptom management and side effects (and what to do if these occur)
- consider patient preferences such as their individual needs, dose frequency, possible side effects, or other issues related to the patient’s condition
- reiterate the instructions for use for the newly prescribed formulation, especially whether it should be taken with or without food
- clinical guidance advises to prescribe these long-acting formulations of methylphenidate by specifying brand name or by using the generic drug name and name of the manufacturer
- report any suspected adverse drug reactions associated with methylphenidate or other medicines on a Yellow Card
A review considers the issues when prescribing and switching between modified-release methylphenidate (2):
Methylphenidate is available as immediate-release (IR) and modified-release (MR) oral solid dosage forms.
Benefits of MR products (2):
Methylphenidate MR products may be preferred over IR products as they offer:
- convenience
- improved adherence
- reduced stigma related to taking medicine at school or workplace
- reduced issues with storing and administering controlled drugs in a school or workplace setting
- reduced risk of misuse and diversion
- improved control of symptoms in some patients
IR preparations may be suitable if more flexible dosing regimens are needed, or during initial titration to determine correct dosing levels.
Consider product choice on an individual basis depending on the person’s needs and treatment priority.
Prescribe by brand
Best practice guidance is to prescribe methylphenidate MR products by brand.
- different methylphenidate MR products contain differing IR and MR components
- since they are not always equivalent, they should normally be prescribed by brand; or using the generic medicine name, and the name of the manufacturer
Switching between brands
- may be occasions when switching between brands is necessary (for example, due to national or local supply disruption)
- given the differences in the ratios of IR and MR components different products, the MHRA advises caution if switching between MR methylphenidate products as it can alter symptom management.
- revert back to the usual branded product as soon as possible
- involve patients
- product choice should be made on a case-by-case basis with specialist input and by involving the patient in the decision to switch where necessary
- provide relevant counselling (for example, any changes in the timing of doses and food) and advise patients to report any changes to their symptoms or side effects
- reassure the patient that the alternative products belong to the same clinically equivalent group as their usual medicine and that the dose has not changed.
Actions during supply disruption
When switches are necessary due to supply disruption, prescribers and pharmacists should:
- consider bioequivalence as outlined below
- prescribe generically to enable switching between bioequivalent MR products where possible to do so
- avoid mixing between different brands to achieve the required daily dose
- individualise treatment using IR products where bioequivalent MR products are not available
- discuss with patients and provide reassurance that any switching will be temporary and based on clinically equivalent products
- revert to their normal brand prescribing practice during periods in which supply is unaffected
Equivalent MR tablets (2):
- the following MR methylphenidate tablets are considered bioequivalent to one another. Generic prescribing could be undertaken and products switched between using the same dose and quantity were that to be necessary:
- Affenid XL tablets
- Atenza XL tablets
- Concerta XL tablets
- Delmosart tablets
- Matoride XL tablets
- Xaggitin XL tablets
- Xenidate XL tablets
Equivalent MR capsules (2):
- the following MR methylphenidate capsules are considered bioequivalent to one another. Generic prescribing could be undertaken and products switched between using the same dose and quantity were that to be necessary:
- Focusim XL capsules
- Metyrol XL capsules
- Meflynate XL capsules
- Ritalin XL capsules
Note, however, that whilst switches from or to Medikinet XL capsules are also possible, these should be undertaken with particular care since this product is not completely bioequivalent with the other four.
Do not switch Equasym XL capsules
- no other MR products are bioequivalent to Equasym XL capsules and these should not be switched to or prescribed generically
IR preparations
An individualised approach would be required were a switch to IR preparations to be necessary. Equivalence between a number of MR products and IR products is as follows (1):
- Equasym XL 10mg once daily is equivalent to a total daily dose of 10mg IR methylphenidate
- Concerta XL 18mg once daily is equivalent to a total daily dose of 15mg IR methylphenidate
- Medikinet XL 10mg once daily is equivalent to a total daily dose of 10mg IR methylphenidate
- Metyrol XL 10mg once daily is equivalent to a total daily dose of 10mg IR methylphenidate
If a switch from MR to IR products becomes necessary, consider seeking advice or referring back to the specialist who initiated treatment (2)
- additional clinical assessment will be required to ensure tolerability and efficacy
- prescribers should also be aware that there is an increased risk of misuse and diversion with IR products
Reference:
- Drug Safety Update volume 16, issue 2: September 2022: 1.
- NHS Specialist Pharmacy Service (July 11th 2025). Prescribing and switching between modified-release methylphenidate