Methylphenidate for children

About methylphenidate for children

Methylphenidate belongs to a group of medicines, called stimulants. They work by increasing activity in the brain, particularly in areas that help control attention and behaviour.

Methylphenidate is used to treat children with attention deficit hyperactivity disorder (ADHD). It helps with hyperactivity and impulsive behaviour, and allows them to concentrate better. It is also used to treat adults with ADHD or narcolepsy (a sleep disorder).

Methylphenidate is only available on prescription. It comes as standard (immediate release) tablets and capsules and slow release (also called extended, modified or prolonged release) tablets and capsules.

Some children may need to take both slow release and standard methylphenidate to help improve their ADHD.

For adults aged 18 and over, read our information on methylphenidate for adults.

Key facts

• Methylphenidate is a controlled drug, which means that you may have to prove your identity when collecting your prescription. Collect your prescription within 28 days.
• If your child takes slow release methylphenidate, give it to them once a day. If they are taking standard tablets or capsules, your doctor may recommend giving it up to 3 times a day.
• It's best to stick to the same brand, particularly if your child has slow release methylphenidate. Different brands work differently in how they release the medicine into the body, and this can affect how they work to manage your child's symptoms.
• Methylphenidate makes your child less hyperactive and impulsive, and helps them concentrate.
• Methylphenidate for children is also known by the brand names Matoride, Tranquilin, Xaggitin and Xenidate.

Who can and cannot take methylphenidate

Methylphenidate can be taken by most children aged 4 and over, although, it is not suitable for all children. Tell your child's doctor before they start taking this medicine if:

• they have ever had an allergic reaction to methylphenidate or any other medicine
• they have difficulty swallowing, as some brands may not be suitable
• they have heart problems
• they have an overactive thyroid
• have a tumour in the adrenal gland (phaeochromocytoma)
• they have mental health problems (or a close family member has mental health problems)
• they have high blood pressure or problems with their blood vessels, such as vasculitis
• they have epilepsy
• they have sudden muscle twitches in their face or body (tics), or there is a close family member with Tourette's syndrome
• either they or a a close family member has glaucoma

How and when to give methylphenidate to children

Always follow the advice of your child's doctor and the instructions that come with the medicine. Different brands of methylphenidate tablets and capsules may have different instructions.

Dosage

The usual dose of methylphenidate depends on whether your child has standard or slow release medicine. In some cases, the specialist may prescribe both.

Although standard tablets and capsules are sometimes called immediate release, they can still take a while to start working.

Slow release tablets and capsules are sometimes called extended release, modified release, or prolonged release. These tablets and capsules let the medicine pass into your child's body gradually.

Dose for standard tablets and capsules

The usual starting dose for children is 5mg, given once or twice a day. Your doctor may increase your child's dose gradually (usually weekly) until they find the dose that works best. Your child may need to take it 2 or 3 times a day.

Give your child their methylphenidate first thing in the morning. If they have a second dose, give it to them at around lunchtime (early afternoon) and, if prescribed, a third dose in the late afternoon or evening.

Try to leave at least 4 hours between doses. If your child has a third dose, try to give it to them at least 4 hours before bedtime so it does not affect their sleep.

Although they are called immediate release, it can still take a while for the medicine to work. You may not see any changes in behaviour straight away.

Let your child's school know if they need to take their medicine during the school day.

Dose for slow release tablets and capsules

Slow release tablets and capsules start to work with a first release of the medicine into the body. After that, the medicine continues to release into the body more slowly.

The usual starting dose for:

• tablets is 18mg, given once in the morning - your child's doctor may gradually increase the dose by 18mg at a time (usually weekly, up to 54mg max) until they find the dose that works well for your child.
• capsules is 10mg, given once in the morning - your child's doctor may increase the dose gradually (usually weekly, up to 60mg max) until they find the dose that works well for your child.

Check the leaflet that comes with the medicine for when to give it and whether it should be taken with food.

If your child is taking Equasym XL, give them their medicine about 30 minutes before breakfast. If they're taking Medikinet XL, give it to them with or after breakfast.

How to give children tablets or capsules

Give your child the tablets or capsules with a drink of water, milk or juice. Tell them to swallow the medicine whole, not chew it.

If your child has problems swallowing pills, then it's OK to crush standard tablets (Medikinet or Ritalin). Mix the crushed tablets with a small amount of soft food such as yogurt, honey or jam.

Important

Do not crush or break slow release tablets because the medicine will not work properly.

However, if your child takes slow release capsules, you can open the capsule and mix the contents with a small amount of soft food such as yogurt, honey or jam.

Give your child the mixture straight away and tell them to swallow it without chewing.

Will their dose go up or down?

Your child will usually start on a low dose of methylphenidate, taken once or twice a day. The doctor will increase the dose gradually, until they find the dose that works best for your child.

If your child starts on standard methylphenidate, the doctor may later switch them to slow release methylphenidate. They only have to take this once a day.

How long will they take it for?

If methylphenidate is working well to control your child's symptoms, they might need to take it for several months or even years. However, it's not usually a life-long medicine.

Your doctor will usually monitor how your child is every 6 months. This gives them a better idea about how your child is getting on with their medicine and whether they still need it.

What if my child is sick?

If your child is sick (vomits) less than 30 minutes after taking their methylphenidate, give them the same dose again.

If it’s more than 30 minutes after taking their medicine, do not give your child another dose, just wait until their next dose is due.

If your child is sick again, ask your doctor or pharmacist for advice.

What if I forget to give a dose?

If you forget to give your child their medicine, skip the missed dose and wait until it’s time for the next dose. Give them the next dose as usual.

Never give them a double dose to make up for a forgotten dose.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to give your child their medicine.

What if they take too much?

The amount of methylphenidate that can lead to an overdose varies from person to person.

Call 999 or go to A&E if:

Take the methylphenidate packet, or the leaflet inside it, plus any remaining medicine with you.

Contact 111 for advice now if:

Important

Keep methylphenidate in a cupboard. Make sure children cannot see or reach this medicine.

Side effects

Like all medicines, methylphenidate can cause side effects, although not everyone gets them.

Common side effects

These common side effects may happen in more than 1 in 100 people:

• headaches
• feeling aggressive, irritable, depressed, anxious or tense
• trouble sleeping (insomnia)
• loss of appetite – this can lead to weight loss or poor weight gain
• stomach ache
• dry mouth
• feeling or being sick (nausea or vomiting)

Keep giving your child the medicine, but tell your doctor if they bother your child or do not go away:

Serious side effects

Serious side effects are uncommon and happen in less than 1 in 100 people.

Tell your doctor straight away if your child:

• has changes in mood or personality
• has thoughts about harming themselves
• has a fast or irregular heartbeat (palpitations) – your child may feel their heart is beating much faster than normal or may say it is racing
• starts seeing, feeling or hearing things that are not real (hallucinations)
• has started to get facial tics – these are quick, little movements in the muscles of the face that cannot be controlled and are sudden, if this starts happening, their doctor will stop your treatment

Methylphenidate can also cause a small increase in blood pressure and pulse rate. For this reason, your doctor will usually measure your child’s blood pressure and pulse every 6 months.

Growth in children

If your child takes methylphenidate for longer than a year, it can slow down their growth. However this happens in less than 1 in 10 children.

Your doctor will check your child’s height, weight and appetite every 6 months to make sure they are growing OK.

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to methylphenidate.

These are not all the side effects of methylphenidate. For a full list, see the leaflet inside the medicine packet.

How to cope with side effects of methylphenidate

What to do about:

• headaches – make sure your child rests and drinks plenty of fluids. Painkillers such as paracetamol (Calpol) can help. Talk to your doctor if your child's headaches are severe or do not go away.
• feeling aggressive, irritable, depressed, anxious or tense – this may go away as your child gets used to the medicine. If it does not, speak to your doctor. They may want to recommend a lower dose or try a different medicine.
• trouble sleeping – if your child is finding it hard to sleep, try giving the last dose at least 6 hours before bedtime. Speak to your doctor if this does not help. They may want to try slow release instead.
• loss of appetite – it may help to give them methylphenidate with a meal. You may notice they lose some weight during the first few months of treatment. Your child will probably put this weight back on once they are used to the medicine. If you notice they are losing a lot of weight speak to your doctor.
• dry mouth – this usually improves quite quickly. It may help to give them small sips of water and citrus fruits like oranges or satsumas.
• feeling or being sick – stick to simple meals and do not give your child rich or spicy food if they feel sick. It might help to give them their methylphenidate with or after a meal or snack. If they are being sick, encourage them to take small, frequent sips of water or squash to avoid dehydration. If your child keeps being sick or having severe stomach pains, see a doctor.

Cautions with other medicines

There are some medicines that can affect the way methylphenidate works.

If your child is taking any of the following medicines, talk to your doctor or pharmacist before giving them methylphenidate:

• medicines to treat depression or other mental health problems
• medicines for epilepsy
• blood pressure medicines
• medicines that treat or prevent blood clots
• medicines for coughs and colds

Some cough and cold medicines can affect blood pressure so speak to your pharmacist or doctor if you're buying these for your child. It’s important to check whether they are OK for them to have while taking methylphenidate.

Mixing methylphenidate with herbal remedies and supplements

There's very little information about taking herbal remedies and supplements while taking methylphenidate. Check with your doctor or pharmacist before giving any to your child.

Some studies have suggested that omega-3 and omega-6 supplements can help with ADHD. However, the evidence is limited and more research is needed.

Common questions about methylphendiate for children

How does methylphenidate work? How long does it take to work? How long will my child take it for? Is it safe to take for a long time? What will happen if my child stops taking it? Is it addictive? Does my child need to stick to the same brand of methylphenidate? Can my child take it with painkillers? Is there any food or drink they need to avoid? Are medicines the first treatment option for children with ADHD? What if methylphenidate is not helping my child? Can taking supplements help ADHD?