Methylphenidate hydrochloride

• a central nervous system stimulant - it is structurally related to amphetamine but has milder central nervous system stimulant properties (1,2)
  • has been advocated as part of a comprehensive treatment programme for children with severe Attention Deficit / Hyperactivity Disorder (ADHD)
  • Hyperkinetic Disorder (HKD) is broadly similar to ADHD

NICE guidance states (3)

• offer methylphenidate (either short or long acting) as the first line pharmacological treatment for children aged 5 years and over and young people with ADHD
  • consider switching to lisdexamfetamine for children aged 5 years and over and young people who have had a 6‑week trial of methylphenidate at an adequate dose and not derived enough benefit in terms of reduced ADHD symptoms and associated impairment
• offer lisdexamfetamine or methylphenidate as first-line pharmacological treatment for adults with ADHD
  • consider switching to lisdexamfetamine for adults who have had a 6‑week trial of methylphenidate at an adequate dose but have not derived enough benefit in terms of reduced ADHD symptoms and associated impairment

An updated review (212 RCTs; n=16,302) found methylphenidate vs placebo/ no‐intervention may improve teacher‐rated ADHD symptoms and general behaviour in children and adolescents with ADHD and may increase risk of non-serious adverse events (e.g. sleep problems, decreased appetite) (4).

Prescribers and dispensers should use caution if switching patients between different long-acting formulations of methylphenidate (Concerta XL, Medikinet XL, Equasym XL, Ritalin LA, and generics) as different instructions for use and different release profiles may affect symptom management (5):

• Advice to healthcare professionals: Advice to provide to patients or parents and caregivers:
• 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
• there are differences between long-acting methylphenidate medicines in how they release the medicine to manage ADHD symptoms and in the instructions on how to take them
• we have asked doctors and pharmacists to be cautious when switching patients between different long-acting formulations of methylphenidate
• carefully read and follow the advice in the Patient Information Leaflet that comes with your medicine and speak to a healthcare professional if you are concerned about side effects or are concerned about your child’s health or medicines
• it is especially important to follow advice on how much methylphenidate to take and to follow instructions on when and how to take it – these can affect how well the medicine works for your ADHD

The Summary of Product Characteristics should be consulted before prescribing this drug.

Reference:

1. NICE (March 2006). Methylphenidate, atomoxetine and dexamfetamine for attention deficit hyperactivity disorder (ADHD) in children and adolescents
2. Drug and Therapeutics Bulletin (2001), 39 (7), 52-54.
3. NICE (March 2018). Attention deficit hyperactivity disorder: diagnosis and management.
4. Storebø OJ, Storm MR, Pereira Ribeiro J, Skoog M, Groth C, Callesen HE, Schaug JP, Darling P, Huus C-ML, Zwi M, Kirubakaran R, Simonsen E, Gluud C. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database of Systematic Reviews 2025, Issue 12. Art. No.: CD009885. DOI: 10.1002/14651858.CD009885.pub4. Accessed 13 January 2026.
5. MHRA. Methylphenidate long-acting (modified-release) preparations: caution if switching between products due to differences in formulations Drug Safety Update volume 16, issue 2: September 2022: 1.