Methylphenidate for children

Methylphenidate is suitable for most children aged 4 years old and over. But always check before giving it to your child.

Methylphenidate is not suitable for some children. If they have epilepsy or heart problems, for example, ask their doctor first.

Methylphenidate comes as tablets and capsules that are taken 1 to 3 times a day. Follow the instructions that come with the packet.

Side effects of methylphenidate include headaches. More serious side effects can happen in rare cases.

It can cause problems to take methylphenidate with some other medicines, such as medicines for depression or epilepsy.

Most children aged 4 years old and over can be given methylphenidate.

Methylphenidate is not suitable for all children. Check with your child's doctor before they start taking this medicine if they have:

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

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

Dosage

Your child's dose of methylphenidate depends on whether they've been prescribed standard or slow release medicine. In some cases, the specialist may prescribe both.

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

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

Standard tablets

The usual starting dose for children is 5mg, given once or twice a day.

Your child's doctor may increase their 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.

Slow release tablets and capsules

The usual starting dose for:

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

How to give your child methylphenidate

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

Depending on what type of methylphenidate your child needs, they'll need to take it at different times. If your child is taking slow release methylphenidate, such as:

• Equasym XL, give it to them before breakfast
• Medikinet XL, give it to them with or after breakfast

For other types of methylphenidate, give your child their dose first thing in the morning. If they have 2 doses a day, give the next dose around lunchtime (early afternoon). If they've been prescribed 3 doses, they can take the last dose in the late afternoon or evening.

Try to leave at least 4 hours between doses.

If your child has 3 doses, try to give them the last one at least 4 hours before bedtime so it does not affect their sleep.

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

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

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.

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

Check the leaflet that comes with the medicine for when to take it and whether to take it with food.

These common side effects of methylphenidate may happen in more than 1 in 100 children. There are things you can do for your child to help them cope with them:

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.

If your child is finding it hard to sleep, try giving them their last dose at least 6 hours before bedtime. Speak to their doctor if this does not help. They may want to try slow release tablets or capsules instead.

It may help to give your child 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 their doctor.

Try to get your child to rest and relax. It can help if they eat and drink slowly and have smaller and more frequent meals. Putting a heat pad or covered hot water bottle on their stomach may also help.

If they're in a lot of pain, or it does not go away, speak to a pharmacist or their doctor.

This usually gets better quite quickly. It may help to give your child small sips of water and citrus fruits like oranges or satsumas.

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're 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.

Keep giving your child the medicine, but tell your child's doctor if the advice on how to cope does not help and these side effects bother your child or do not go away.

Some medicines can affect the way methylphenidate works and increase the risk of side effects.

Talk to their doctor or a pharmacist before giving them methylphenidate if your child is taking any other medicines, including:

• medicines to treat depression or other mental health conditions
• 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 a pharmacist or doctor before buying these for your child. It's important to check if they're OK to have while taking methylphenidate.

These are not all the medicines that may cause problems if your child takes them with methylphenidate. For a full list, see the leaflet inside the medicine packet.