The most common side effects of Ritalin include increased heart rate, increased blood pressure, inability to sleep, headache, and anxiety, among others. Additional mild side effects of Ritalin include dry mouth, upset stomach, and decreased appetite. Rarely, a person may experience serious Ritalin side effects, such as chest pain, shortness of breath, and slowed growth in children.
What Is Ritalin & How Is it Used?
Ritalin is commonly used as an FDA-approved medication to treat disorders such as:1,2
- Attention-deficit hyperactivity disorder (ADHD) in adults and children and adolescents ages 6 and older
- Narcolepsy in adults
Ritalin may also have off-label (non-FDA-approved) uses for treating:
- Severe fatigue in cancer-related or palliative care setting3
- Major depressive disorder (MDD) in medically ill, palliative care, terminal illness, or elderly patients4,5,6
An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
Ritalin is also available in a long-acting formulation known as Ritalin LA. Ritalin LA is only approved for treating ADHD in children ages 6 to 12. This article will focus on Ritalin. If you have questions about Ritalin LA, you should talk with your healthcare provider.
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Mild Side Effects of Ritalin
Mild side effects of Ritalin are often temporary and manageable by lifestyle changes or dose adjustments by your provider. Some side effects, such as dry mouth, can occur for as long as a person takes the medication. It is important to talk to your doctor if you or your child is experiencing frequent or bothersome side effects.
Mild side effects of Ritalin include:1,2
- Dry mouth
- Upset stomach or stomach pain
- Decreased appetite
- Nausea
- Nervousness
- Headache
Severe Side Effects of Ritalin
Severe side effects have occurred when using Ritalin. If you or your child are experiencing any of these severe side effects, it is important to seek medical attention right away to avoid potentially lasting damage. Tell your medical provider if circulation problems in fingers and toes occur. This can look like fingers or toes becoming numb, feeling pain, and changing skin color (e.g. blue). Call your doctor right away if there are any unexplained wounds on the fingers and toes while taking Ritalin.1,2
Some risk factors for severe side effects include a history of heart issues, pre-existing psychosis, manic or mixed mood bipolar disorder, or substance use disorders. These risks can be avoided by talking to your provider to make sure this medication is right for you.1,2
Severe side effects of Ritalin may include:
- Allergic reactions include rash, itching, swelling, severe dizziness, or difficulty breathing.
- Signs of heart problems such as chest pain
- Increased blood pressure
- Rapid heartbeat or significantly increased heart rate
- Difficulty breathing or shortness of breath
- Hallucinations or other unusual sensory perceptions
- Uncontrolled movements, such as twitching or uncontrollable shaking
- Painful and prolonged erections (priapism)
- Signs of circulation problems, such as numbness, discoloration, or coldness in the extremities
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Common Side Effects of Ritalin
Common side effects such as insomnia can be managed, but others may require medical attention. It is important to talk to your doctor if you or your child is experiencing frequent or bothersome side effects.1,2
Common side effects of Ritalin include:1,2
- Heart problems: You may experience a fast heartbeat or your heart skipping a beat. This medication can potentially cause you to feel your heartbeat or make it more noticeable.
- Inability to sleep: You may become drowsy and tired during the day. This may cause you to have poor memory or trouble learning.
- Headache: This can feel like a sharp, dull, or throbbing pain.
- Anxiety: Symptoms include sweating, shaking, chest pain, and shortness of breath. When taking this medication, people may experience anxiety even if they are not in a stressful situation.
- Increased Sweating: Increased sweating or sweating more than normal may occur.
- Weight loss: Because it is an appetite suppressant, taking Ritalin may result in weight loss.
- Decreased appetite: You may feel less hungry or feel full quicker.
- Dry Mouth: Your body may not make enough saliva. This can cause difficulty chewing and a dry or sore throat.
- Nausea: You may feel weak and sweaty. This may increase your urge to vomit.
This is not a complete list of possible side effects of Ritalin. You should talk with your healthcare provider about all potential risks with Ritalin before starting the medication.
How to Manage Side Effects
Some side effects of Ritalin, such as anxiety, insomnia, and weight loss, can be managed through lifestyle changes or timing of your dose. Talk to your medical provider if you cannot manage these symptoms on your own or if it becomes severe.
Anxiety
Anxiety, a feeling of nervousness, worry, or fear, is normal in stressful situations or different environments than you are used to. As a side effect of this medication, people may experience this even when they are not in those situations. If you already have anxiety, it may make your symptoms more intense. Anxiety symptoms can be mild to moderate or severe in cases of an anxiety attack. Some symptoms include sweating, shaking, chest pain, and shortness of breath.7
If you are experiencing anxiety as a side effect of Ritalin you can manage the symptoms with lifestyle changes. Meditation can help you relax and decrease the amount of stress you feel. Regular exercise can improve your stress and prevent health problems. Decreasing the amount of caffeine, you take can be beneficial to prevent anxiety since it is also a stimulant. Talk to your doctor if you are not able to manage these symptoms, as therapy and changes in medications can also help.7
Insomnia
Insomnia is the inability to fall asleep or remain asleep. This can cause you not to get a full night’s rest and become drowsy and tired during the day. This may cause you to have poor memory or trouble learning if you are experiencing insomnia. Over time insomnia can affect your physical health as well as your mental health, so it is important to take steps to manage it.8
If you take extended-release (long-acting) Ritalin, it is important to take it in the morning to avoid insomnia. Instant release Ritalin taken later in the day can also cause you to have trouble sleeping. If this does occur, you can take your instant release earlier to avoid insomnia. Lifestyle changes can also help, such as reducing your screen time 1-2 hours before bed, blocking out light, avoiding laying in bed when not going to bed, and avoiding caffeine and nicotine.8
Weight Loss
Decreased appetite can result in weight loss due to eating less throughout the day. If you are experiencing weight loss due to decreased appetite, you can try to eat more when you have an appetite. You may experience more appetite in the morning before the medication begins to work or in the evening when it wears off. You can also manage weight loss with frequent snacking.9
Weight loss, sodium and alcohol restriction, dietary potassium supplementation, and physical activity are efficacious methods to ameliorate hypertension and tachycardia, which can be caused by Ritalin.10
Constipation
Ritalin can cause constipation, which should be attempted to manage with a high-fiber diet before supplementing with psyllium or PEG.11
Important Reminder: Side effects of medications can vary from person to person, and this brief list may not encompass all possible reactions. To make an informed decision, consult your healthcare provider who can provide a thorough understanding of potential side effects specific to your situation. Prioritizing an open conversation with your doctor will ensure you have accurate knowledge about the medication and its potential effects on your well-being.
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What Are the Side Effects of Ritalin in Children Vs. Adults?
Ritalin is approved for ages six years and older.1 There is limited research comparing the side effects of Ritalin between adults and children.
The most notable side effects of Ritalin are experienced by adults and children alike. The exception is the extended use of Ritalin has shown a risk of slowing growth and decreasing appetite in children. Since adults have typically finished growing, this is mostly observed in children. While Ritalin can still cause weight loss in adults, the risk of malnutrition is greater in children.1
Allergic Reactions
Any true allergy to a stimulant like Ritalin is extremely rare. After a severe reaction, however, emergency medical attention is necessary, and repeated exposure is generally not recommended. If a reaction is mild, medical attention may not be necessary, and the risks must be weighed against the benefits of whether the drug is to be continued.
Allergic reactions to Ritalin include (rare):12,13,14,15,16,17,18,19,20,21
- Inability to breath
- Itching and swelling
- Severe rash
- Toxic epidermal necrolysis (TEN) causes peeling and blistering skin on the mouth, eyes, and genitals
- Skin changes like blue discoloration
- Stroke
- Brain bleed
Ritalin Warnings & Precautions
Precautions for taking Ritalin include:
- Potential for misuse and addiction: Ritalin has a high potential for misuse and addiction. Ritalin should be used cautiously for patients with a history of drug dependence or alcoholism.22
- History of an allergy or hypersensitivity: If someone has had a previous hypersensitivity or allergic reaction to methylphenidate, the active ingredient in Ritalin, they should not take Ritalin.
- Interactions with monoamine oxidase inhibitor (MAOIs) antidepressants: Using Ritalin and MAOIs like phenelzine together can cause a blood pressure crisis. If patients reach this blood pressure crisis, potential outcomes include death, stroke, heart attack, eye complications, eclampsia, build-up of fluid in the lungs, and kidney failure.2 Patients taking MAOIs should not take Ritalin.
- Withdrawal symptoms: Withdrawal symptoms after abruptly stopping Ritalin include unhappy mood, tiredness, vivid or unpleasant dreams, insomnia, feeling excessively tired throughout the day, increased appetite, or agitation.1
- Blood pressure and heart rate: Ritalin causes an increase in blood pressure and heart rate.1
- Psychological: Ritalin can make mania or psychosis worse. Patients should be screened for bipolar disorder prior to starting Ritalin. Ritalin should be avoided in bipolar patients.1
- Priapism (prolonged and painful erections): Has been reported with Ritalin products in both pediatric and adult patients.1
- Growth Suppression: Ritalin has been associated with weight loss and slowing growth rates in children.1
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Questions to Ask Your Healthcare Provider About Ritalin Side Effects
Before starting Ritalin, be sure to ask your doctor, psychiatrist, and therapist about side effects and any questions you have. Online psychiatry services may be a good option if you need to change prescribers.
Questions to ask your care team about Ritalin side effects include:
- How long will it take for me to adjust to taking Ritalin?
- Am I at risk for more severe side effects if I am already taking medication for anxiety, depression, or other mental health conditions?
- Will a previous history of addiction make me more susceptible to dependency?
- What is the best dosage to ensure fewer side effects?
- Are there drugs I am taking that could have negative interactions?
- When should I reach out to you if I am experiencing side effects?
- Is there anything I should tell my therapist about this new medication?
- What are the common side effects associated with Ritalin, and how long do they typically last?
- Are there any potentially serious or rare side effects of Ritalin that I should be aware of?
- How likely am I to experience side effects based on my specific medical history and current medications?
- Are there any specific side effects that might require immediate medical attention or discontinuation of the medication?
- Can the side effects of Ritalin interfere with my daily activities, such as work, school, or driving?
- Are there any strategies or lifestyle adjustments that can help minimize or manage the side effects of Ritalin?
- Is it possible for the side effects of Ritalin to diminish or resolve over time as my body adjusts to the medication?
- Are there any long-term or permanent side effects associated with Ritalin that I should be aware of?
- Are there any specific side effects that are more common in certain age groups or populations?
- Can Ritalin interact with any other medications or substances I am currently taking, potentially increasing the risk of side effects?
In My Experience
In my experience, the most common side effects of Ritalin are decreased appetite and insomnia. It is important to talk to your doctor about this topic and follow their guidance. If you are noticing side effects, your provider will likely change your dose to decrease the risks of these common, mild, and severe side effects.
It may take a few tries to get the right dose of Ritalin so it is important to honestly communicate the effects of Ritalin to your provider to get the right dosing for you or your child. If patients come to me experiencing side effects of Ritalin, as a pharmacist, I will work with their providers to optimize their dosing.
Additional Resources
To help our readers take the next step in their mental health journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy is compensated for marketing by the companies included below.
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Plushcare There are many effective medications for ADHD, including Strattera, which a Plushcare doctor can prescribe. In as little as 15 minutes, you can speak with a board-certified doctor from PlushCare to receive ADHD treatment. Plushcare DOES NOT prescribe controlled substances. Visit Plushcare
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