Cognimeth ER 18 mg

Indications

Methylphenidate Hydrochloride is a central nervous system stimulant used as part of a full treatment programme for attention deficit hyperactivity disorder (ADHD) in children aged 6 years and over, teenagers and adults. It helps improve attention, concentration and self-control and reduces hyperactivity and impulsive behaviour. It is also sometimes used to treat narcolepsy (sudden, uncontrollable daytime sleep). It is a controlled medicine available only on a specialist's prescription.

How It Works

Methylphenidate blocks the reabsorption of two brain chemicals, dopamine and noradrenaline, so more of them remain active between nerve cells. These chemicals are important for attention, motivation and controlling behaviour. Raising their activity in the parts of the brain that manage focus and impulse control helps reduce ADHD symptoms.

Dosage and Administration

Take exactly as prescribed. The specialist starts with a low dose and adjusts it gradually according to response and side effects. Immediate-release tablets are usually taken 2 to 3 times a day; extended-release (ER) tablets once in the morning. Swallow ER tablets whole; do not crush or chew them. Take the last dose early enough in the day to avoid sleep problems. Treatment is reviewed regularly, and breaks may be advised. Do not stop suddenly after long use without medical advice.

Interactions

• Do not use with MAO inhibitors (such as Selegiline or Linezolid) or within 2 weeks of stopping them; dangerous high blood pressure can occur.
• It may reduce the effect of blood pressure medicines.
• It can raise levels of Warfarin, some anticonvulsants (Phenytoin, Phenobarbital) and some antidepressants.
• Avoid alcohol, which can worsen side effects and, with some ER products, release the dose too quickly.
• Use with care with Clonidine, Risperidone and other medicines that affect the heart or brain.

Contraindications

• Allergy to Methylphenidate
• Glaucoma
• Overactive thyroid or phaeochromocytoma (a rare adrenal tumour)
• Severe high blood pressure, serious heart or blood vessel disease, heart rhythm problems, or recent stroke
• Severe depression, psychosis, mania, anorexia nervosa or suicidal thoughts
• Use of MAO inhibitors in the last 2 weeks
• Children under 6 years

Side Effects

• Reduced appetite, weight loss, slowed growth in children
• Difficulty sleeping, nervousness, irritability
• Headache, stomach ache, nausea, dry mouth
• Fast heartbeat, raised blood pressure
• Dizziness, mood swings, tics

Get urgent medical help if you have chest pain, fainting, a very fast or irregular heartbeat, shortness of breath, signs of stroke (sudden weakness, numbness, speech difficulty), seeing or hearing things that are not there, severe anxiety, aggression or suicidal thoughts, a painful erection lasting more than 4 hours, fingers or toes turning pale or blue, or signs of a serious allergic reaction.

Pregnancy and Lactation

There is limited information on safety in pregnancy; use only if the specialist decides the benefit clearly outweighs the risk. Methylphenidate passes into breast milk; discuss with your doctor before breastfeeding and watch the baby for poor feeding, sleep problems or irritability.

Precautions and Warnings

• Heart health, blood pressure, pulse, height and weight are checked before and during treatment.
• It can be misused or cause dependence; keep it secure and never share it.
• Watch for new or worsening mood or behaviour changes.
• Use with care in epilepsy, tic disorders or Tourette syndrome, and a history of substance misuse.
• It may affect driving ability; check with your doctor.

Overdose

Overdose can cause vomiting, agitation, tremor, muscle twitching, fits, confusion, hallucinations, sweating, high fever, very fast heartbeat and high blood pressure. Call emergency services or go to hospital immediately.

Therapeutic Class

Central nervous system stimulant, ADHD treatment (controlled medicine)

Storage

Store below 30°C in a dry place, away from light, in a secure place out of the reach of children and others.