Ritalin® 10mg Tablets – patient leaflet, side effects, dosage

1. What Ritalin is and what it is used for

What it is used for

Ritalin is used to treat ‘Attention Deficit Hyperactivity Disorder’ (ADHD).

• It is used in children and young people between the

  ages of 6 and 18.

• It is used only after trying treatments which do

  not involve medicines. Such as counselling and behavioural therapy.

Ritalin is not for use as a treatment for ADHD in children under 6 years of age or in adults. It is not known if it is safe or of benefit in these people.

How it works

Ritalin improves the activity of certain parts of the brain which are under-active. The medicine can help improve attention (attention span), concentration and reduce impulsive behaviour.

The medicine is given as part of a treatment programme, which usually includes:

• psychological
• educational and
• social therapy.

It is prescribed only by doctors who have experience in children or young people’s behaviour problems. Although there is no cure for ADHD, it can be managed using treatment programmes.

About ADHD

Children and young people with ADHD find it:

• hard to sit still and
• hard to concentrate.

It is not their fault that they cannot do these things. Many children and young people struggle to do these things. However, with ADHD they can cause problems with everyday life. Children and young people with ADHD may have difficulty learning and doing homework. They find it hard to behave well at home, at school or in other places. ADHD does not affect the intelligence of a child or young person.

2. Before you take methylphenidate

Do not take methylphenidate if:

• you are allergic (hypersensitive) to methylphenidate or

  any of the other ingredients of Ritalin (listed in Section 6)

• you have a thyroid problem
• you have increased pressure in your eye (glaucoma)

• you have a tumour of your adrenal gland

  (phaeochromocytoma)

• you have an eating problem when you do not feel

  hungry or want to eat - such as ‘anorexia nervosa’

• you have very high blood pressure or narrowing of the

  blood vessels, which can cause pain in the arms and legs

• you have ever had heart problems - such as a heart

  attack, uneven heartbeat, pain and discomfort in the chest, heart failure, heart disease or were born with a heart problem

• you have had a problem with the blood vessels in your

  brain - such as a stroke, swelling and weakening of part of a blood vessel (aneurysm), narrow or blocked

  blood vessels, or inflammation of the blood vessels (vasculitis)

  • you have mental health problems such as:

    • a ‘psychopathic’ or ‘borderline personality’ problem

    • abnormal thoughts or visions or an illness called

      ‘schizophrenia’

    • signs of a severe mood problem like:

      ° feeling like killing yourself

      ° severe depression, where you feel very sad, worthless and hopeless

      ° mania, where you feel unusually excitable, over-active, and un-inhibited.

Do not take methylphenidate if any of the above apply to you. If you are not sure, talk to your doctor or pharmacist before you take methylphenidate. This is because methylphenidate can make these problems worse. Check with your doctor or pharmacist before treatment if:

• During treatment, boys and adolescents may

  unexpectedly experience prolonged erections. This may be painful and can occur at any time. It is important to contact your doctor straight away if your erection lasts for longer than 2 hours, particularly if this is painful.

• you have liver or kidney problems
• you have had fits (seizures, convulsions, epilepsy) or any abnormal brain scans (EEGs)
• you have ever abused or been dependent on alcohol, prescription medicines or street drugs

• you are a girl and have started your periods (see the

  ‘Pregnancy, breast-feeding and contraception’ section below)

• you have hard-to-control, repeated twitching of any parts of the body or you repeat sounds and words
• you have high blood pressure
• you have a heart problem which is not in the ‘Do not take’ section above

• you have a mental health problem which is not in the

  ‘Do not take’ section above. Other mental health problems include:

  • mood swings (from being manic to being

    depressed - called ‘bipolar disorder’)

  • starting to be aggressive or hostile, or your aggression gets worse

  • seeing, hearing or feeling things that are not there

    (hallucinations)

  • believing things that are not true (delusions)
  • feeling unusually suspicious (paranoia)
  • feeling agitated, anxious or tense
  • feeling depressed or guilty.

Tell your doctor or pharmacist if any of the above apply to you before starting treatment. This is because methylphenidate can make these problems worse. Your doctor will want to monitor how the medicine affects you. Checks that your doctor will make before you start taking methylphenidate

These checks are to decide if methylphenidate is the correct medicine for you. Your doctor will talk to you about:

• any other medicines you are taking
• whether there is any family history of sudden unexplained death

• any other medical problems (such as heart problems)

  you or your family may have

• how you are feeling, such as feeling high or low, having strange thoughts or if you have had any of these feelings in the past
• whether there is a family history of ‘tics’ (hard-to- control, repeated twitching of any parts of the body or repeating sounds and words)
• any mental health or behaviour problems you or other family members have ever had. Your doctor will discuss whether you are at risk of having mood swings (from being manic to being depressed - called ‘bipolar disorder’). They will check your mental health history, and check if any of your family have a history of suicide, bipolar disorder or depression. It is important that you provide as much information as you can. This will help your doctor decide if methylphenidate is the correct medicine for you. Your doctor may decide that other medical tests are needed before you start taking this medicine. Taking other medicines

Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.

Do not take methylphenidate if you:

• are taking a medicine called a ‘monoamine oxidase inhibitor’ (MAOI) used for depression, or have taken an MAOI in the last 14 days. Taking an MAOI with methylphenidate may cause a sudden increase in your blood pressure.

If you are taking other medicines, methylphenidate may affect how well they work or may cause side effects. If you are taking any of the following medicines, check with your doctor or pharmacist before taking methylphenidate:

• other medicines for depression
• medicines for severe mental health problems
• medicines for epilepsy
• medicines used to reduce or increase blood pressure
• some cough and cold remedies which contain medicines that can affect blood pressure. It is important to check with your pharmacist when you buy any of these products
• medicines that thin the blood to prevent blood clots If you are in any doubt about whether any medicines you are taking are included in the list above, ask your doctor or pharmacist before taking methylphenidate. Having an operation

Tell your doctor if you are going to have an operation. You should not take methylphenidate on the day of your surgery if a certain type of anaesthetic is used. This is because there is a chance of a sudden rise in blood pressure and heart rate during the operation. Drug testing

This medicine may give a positive result when testing for drug use. This includes testing used in sport. Taking methylphenidate with food and drink

Taking methylphenidate with food may help to stop stomach pains, feeling sick or being sick.

Taking methylphenidate with alcohol

Do not drink alcohol while taking this medicine. Alcohol may make the side effects of this medicine worse. Remember that some foods and medicines contain alcohol. Pregnancy, breast-feeding and fertility

Available data do not suggest an increased risk of overall birth defects, whilst a small increase in the risk of malformations of the heart when used during the first three months of pregnancy could not be ruled out. Your doctor will be able to give you more information about this risk.. No effects on fertility have been seen in animals. Tell your doctor or pharmacist before using methylphenidate if you (or your daughter) are:

• having sex. Your doctor will discuss contraception with you
• pregnant or think you may be pregnant. Your doctor will decide whether you should take methylphenidate.

• breast-feeding or planning to breast-feed. It is possible that methylphenidate is passed into human breast milk. Therefore, your doctor will decide whether you should breast-feed while taking methylphenidate.

  % How do I take my medicine (tablets)?

• Swallow your medicine with water.

• Your doctor will tell you how many times a day you

  should take your medicine

• Do not stop taking the medicine without talking to

  your doctor first.

Possible side effects

Side effects are the unwanted things that can happen when you take a medicine. If any of the following happen or if you have any concerns about other possible side effects tell an adult you trust straight away. They can then talk to your doctor. The main things that could affect you are:

• Feeling or being sick, having tummy pains or

  having a dry mouth. These may only happen when you first start taking the medicine. It is best to take the medicine with food

• Feeling worried or nervous
• Feeling shaky, trembling or being unusually active
• Feeling dizzy, or getting head aches

• Being very depressed and unhappy or wanting to

  hurt yourself

• Being very sweaty

• Having different moods than usual, not being able

  to get to sleep

• Skin rashes, bruising easily, getting out of breath

  or chest pains

• The medicine can also make you feel sleepy.

  If you feel sleepy, it is important not to do outdoor sports like riding a horse or bike, swimming or climbing trees. You could hurt yourself and others.

  • Your heart beating faster than usual.

If you feel unwell in any way while you are taking your medicine please tell an adult you trust straight away. Other things to remember

• Make sure you keep your medicine in a safe place, so that no one else takes it, especially younger brothers or sisters.
• The medicine is special for you - do not let anyone else have it. It may help you, but it could hurt someone else.
• If you forget to take your medicine don’t take two tablets the next time. Just take one tablet at the next normal time.
• If you do take too much medicine, tell your mum, dad or carer right away.
• It is important not to take too much medicine or you will get ill.
• Don’t stop taking your medicine until your doctor says it’s OK.

Who should I ask if there is anything I don’t understand?

Your mum, dad, carer, doctor, nurse or pharmacist will be able to help you.

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POM CD

RML61 V5 Driving or using machines

You may feel dizzy, have problems focussing or have blurred vision when taking methylphenidate. If these happen it may be dangerous to do things such as drive, use machines, ride a bike or horse or climb trees. Important information about some of the ingredients of Ritalin

Lactose:

This medicine contains lactose (a type of sugar). If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.

Wheat starch (containing gluten):

This medicine contains only very low levels of gluten (from wheat starch) and is very unlikely to cause problems if you have coeliac disease.

One Ritalin 10 mg tablet contain no more than 4.8 micrograms of gluten.

If you have wheat allergy (different form coeliac disease) you should not take this medicine.

3. How to take Ritalin

How much to take

Always take Ritalin exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure.

• your doctor will usually start treatment with a low dose

  and increase it gradually as required.

• the maximum daily dose is 60 mg.

• take Ritalin once or twice daily (e.g. at breakfast or/and

  lunchtime).

• the tablets should be swallowed with a drink of water.
• you can break the tablets to make it easier to swallow. If you do not feel better after 1 month of treatment.

If you do not feel better, tell your doctor. They may decide you need a different treatment.

Not using Ritalin properly

If Ritalin is not used properly, this may cause abnormal behaviour. It may also mean that you start to depend on the medicine. Tell your doctor if you have ever abused or been dependent on alcohol, prescription medicines or street drugs. This medicine is only for you. Do not give this medicine to anyone else, even if their symptoms seem similar. If you take more Ritalin than you should

If you take too much medicine, talk to a doctor or call an ambulance straight away. Tell them how much has been taken. Signs of overdose may include: being sick, feeling agitated, shaking, increased uncontrolled movements, muscle twitching, fits (may be followed by coma), feeling very happy, being confused, seeing, feeling or hearing things that are not real (hallucinations), sweating, flushing, headache, high fever, changes in heart beat (slow, fast or uneven), high blood pressure, dilated pupils, dry nose and mouth, muscle spasms, fever, red-brown urine which could be possible signs of abnormal breakdown of muscles (rhabdomyolysis). If you forget to take Ritalin

Do not take a double dose to make up for a forgotten dose. If you forget a dose, wait until it is time for the next dose. If you stop taking Ritalin

If you suddenly stop taking this medicine, the ADHD symptoms may come back or unwanted effects such as depression may appear. Your doctor may want to gradually reduce the amount of medicine taken each day, before stopping it completely. Talk to your doctor before stopping Ritalin.

Things your doctor will do when you are on treatment Your doctor will do some tests

• before you start - to make sure that Ritalin is safe and

  will be of benefit.

• after you start - they will be done at least every 6

  months, but possibly more often. They will also be done when the dose is changed.

• these tests will include:

  • checking your appetite
  • measuring height and weight
  • measuring blood pressure and heart rate

  • checking whether you have any problems with your

    mood, state of mind or any other unusual feelings. Or if these have got worse while taking Ritalin. Long-term treatment

Ritalin does not need to be taken for ever. If you take Ritalin for more than a year, your doctor should stop treatment for a short time, this may happen during a school holiday. This will show if the medicine is still needed.

If you have any further questions on the use of this product, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, methylphenidate can cause side effects, but not everybody gets them. Although some people get side effects, most people find that methylphenidate helps them. Your doctor will talk to you about these side effects.

Some side effects could be serious. If you have any of the side effects below, see a doctor straight away: Common (affects less than 1 in 10 people)

• uneven heartbeat (palpitations)
• mood changes or mood swings or changes in personality
• excessive teeth grinding (bruxism)

Uncommon (affects less than 1 in 100 people)

• thinking about or feeling like killing yourself

• feeling, or hearing things that are not real, these are

  signs of psychosis

• uncontrolled speech and body movements (Tourette’s)

• signs of allergy such as rash, itching or hives on the skin,

  swelling of the face, lips, tongue or other parts of the body, shortness of breath, wheezing or trouble breathing Rare (affects less than 1 in 1,000 people)

• feeling unusually excited, over-active and

  un-inhibited (mania)

Very rare (affects less than 1 in 10,000 people)

• heart attack
• fits (seizures, convulsions epilepsy)
• skin peeling or purplish red patches

• muscle spasms which you cannot control affecting

  your eyes, head, neck, body and nervous system -due to a temporary lack of blood supply to the brain

• paralysis or problems with movement and vision,

  difficulties in speech (these can be signs of problems with the blood vessels in your brain)

• decrease in number of blood cells (red cells, white

  cells and platelets) which can make you more likely to get infections, and make you bleed and bruise

  more easily

• a sudden increase in body temperature, very high

  blood pressure and severe convulsions (‘Neuroleptic Malignant Syndrome’). It is not certain that this side effect is caused by methylphenidate or other drugs that may be taken in combination with methylphenidate.

Other side effects (how often they happen is not known)

• unwanted thoughts that keep coming back

• unexplained fainting, chest pain, shortness of breath

  (these can be signs of heart problems)

• Prolonged erections, sometimes painful, or an

  increased number of erections

If you have any of the side effects above, see a doctor straight away.

Other side effects include the following, if they get serious, please tell your doctor or pharmacist: Very common (affects more than 1 in 10 people)

• headache
• feeling nervous
• not being able to sleep.

Common (affects less than 1 in 10 people)

• joint pain
• dry mouth
• high temperature (fever)
• unusual hair loss or thinning
• feeling unusually sleepy or drowsy
• loss of appetite or decreased appetite
• decreased weight
• itching, rash or raised red itchy rashes (hives)
• cough, sore throat or nose and throat irritation
• high blood pressure, fast heart beat (tachycardia)
• feeling dizzy, movements which you cannot control, being unusually active
• feeling aggressive, agitated, anxious, depressed, irritable and abnormal behaviour
• stomach pain, diarrhoea, feeling sick, stomach discomfort and being sick . These usually occur at the beginning of treatment and may be reduced by taking the medicine with food.

Uncommon (affects less than 1 in 100 people)

• constipation
• chest discomfort
• blood in the urine
• shaking and trembling
• double vision or blurred vision
• muscle pain, muscle twitching
• shortness of breath or chest pain
• increases in liver test results (seen in a blood test)
• anger, feeling restless or tearful, excessive awareness of surroundings, problems sleeping.

Rare (affects less than 1 in 1,000 people)

• changes in sex drive
• feeling disorientated
• dilated pupils, trouble seeing
• swelling of the breasts in men
• excessive sweating, redness of the skin, red raised skin rash

Very rare (affects less than 1 in 10,000 people)

• heart attack
• sudden death
• muscle cramps
• small red marks on the skin
• inflammation or blocked arteries in the brain
• abnormal liver function including liver failure and coma
• changes in test results – including liver and blood tests
• suicidal attempt, abnormal thinking, lack of feeling or emotion, doing things over and over again, being obsessed with one thing
• fingers and toes feeling numb, tingling and changing colour (from white to blue, then red) when cold (‘Raynaud’s phenomenon’)

Other side effects (how often they happen is not known):

• migraine
• very high fever
• slow, fast or extra heart beats
• a major fit (‘grand mal convulsions’)
• believing things that are not true, confusion
• severe stomach pain, often with feeling and being sick
• problems with the blood vessels of the brain (stroke, cerebral arteritis or cerebral occlusion)
• erectile dysfunction
• excessive uncontrolled talking
• inability to control the excretion of urine (incontinence)
• spasm of the jaw muscles that makes it difficult to open the mouth (trismus)
• stuttering
• nosebleed

Effects on growth

When used for more than a year, methylphenidate may cause reduced growth in some children. This affects less than 1 in 10 children.

• There may be lack of weight gain or height growth.
• Your doctor will carefully watch your height and weight, as well as how well you are eating.
• If you are not growing as expected, then your treatment with methylphenidate may be stopped for a short time. Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed on this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects, you can help provide more information on the safety of this medicine.

5. How to store Ritalin

Keep out of the sight and reach of children

Make sure you keep your medicine in a safe place, so that no one else takes it, especially younger brothers or sisters. Do not use Ritalin after the expiry date which is stated on the label. The expiry date refers to the last day of that month. Do not store above 25°C. Store in the original package. If the medicine becomes discoloured or shows any other signs of deterioration, you should seek the advice of your pharmacist who will tell you what to do.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

6. Further information

What Ritalin contains

The active substance is methylphenidate hydrochloride. Each tablet contains 10 mg methylphenidate hydrochloride.

The other ingredients are: calcium phosphate, lactose monohydrate, wheat starch, gelatin, magnesium stearate and talc.

What Ritalin looks like and contents of the pack

Ritalin 10 mg tablets are white, round flat tablet with bevelled edges. One side bears the imprint ‘CG’ the other side has a score line ‘A’ on one side of the scoreline and ‘B’ on the other side of the scoreline.

Ritalin 10mg Tablets is available in blister packs containing 30 tablets.

PLGB No: 41103/0047

This product is manufactured by Novartis Farma S.p.A., Via Provinciale Schito 131, 80058 Torre Annunziata NA, Italy and procured from within the EU and repackaged by the Product Licence Holder: Community Pharmacy Supplies Limited, Unit 20/21 Easter Park, Ferry Lane South, Rainham, Essex RM13 9BP.

Leaflet Revision date: 21.06.2024

Ritalin^® is a registered trademark of Novartis AG Blind or partially sighted? Is this leaflet hard to see or read? Call 01708 528 900 to obtain the leaflet in a format suitable for you.