METHYLIN

DESCRIPTION / DEFINITIONS: Methylin® (methylphenidate HCl) is a central nervous system (CNS) stimulant prescribed for attention deficit disorders and Narcolepsy.

ABUSE: Methylin has a high potential for abuse. It is a schedule II drug, and has a boxed warning regarding drug abuse, addiction and dependence.

ADDICTION / DEPENDENCE: The black box warning on the Methylin label, as required by the FDA, cautions  that one can develop a physical dependence on the drug, as well as an addiction. See below for more information. See also half life and metabolism.

SIDE EFFECTS: Nervousness and insomnia are among the most common side effects, but Methylin can also cause various heart problems – like tachycardia and palpitations – as well as abnormal liver function and anorexia. See more complete list below.

WITHDRAWAL SYMPTOMS: These include blood pressure and pulse changes, cardiac arrhythmia, and severe depression. It is recommended that withdrawal is done under careful medical supervision.

TREATMENT: Treatment varies depending on the dosage, frequency and length of time the person has been taking Methylin, as well as their individual reaction to the drug and to stopping it.

 

Methylin is a central nervous system stimulant  prescribed for Attention Deficit disorders and Narcolepsy.

Although it is not understood how Methylin (methylphenidate) works, it is thought to block the reuptake of norepinephrine and dopamine – which means that any norepinephrine and dopamine that would normally go back into the neurons that produced them to be used at a later time (this is the reuptake process) would instead be blocked from reuptake and, consequently, would create an excess. Both norepinephrine and dopamine are neurotransmitters that effect mood and behavior. This same function is also the mechanism of some antidepressants.

 

Abuse of Methylin can have dangerous consequences, which is why the FDA has ordered that a black box warning be on all labels.

 DRUG ABUSE AND DEPENDENCE

Methylin should be given cautiously to emotionally unstable patients, such as those with a history of drug dependence or alcoholism, because such patients may increase dosage on their own initiative.

Chronically abusive use can lead to marked tolerance and psychic dependence with varying degrees of abnormal behavior. Frank psychotic episodes can occur, especially with parenteral [by injection] abuse. Careful supervision is required during drug withdrawal, since severe depression as well as the effects of chronic overactivity can be unmasked. Long-term follow-up may be required because of the patient’s basic personality disturbances.”

 

There are several factors that can contribute to addiction to and dependence on Methylin. First, you can build a tolerance to the drug, which means you need to take more and more to achieve the same effect as when you first started taking it.

Eventually, the body might need it just to function normally.

The physical dependence can also become psychological – you start to panic when you don’t have it when you need it. If it reaches the point of withdrawal symptoms, you need it even more.

When you take too much, you can feel intensely euphoric. You might also start being erratic, and having violent thoughts. 

If someone is getting the drug legally – from a doctor who has thoroughly examined them and who keeps a close watch on his patients – they have someone to go to for help if they need it.

But for those who get Methylin or similar drugs from friends, dealers – or doctors they lied to to get prescriptions from but with whom they have no other contact – they could get into real trouble. 

In addition to the side effects in the black box warning and on the list below, Methylin can have other serious side effects, such as:

  • abnormal thoughts
  • aggression
  • agitation
  • blood flow problems in the fingers or toes
  • blurred vision
  • coldness
  • fast or irregular heartbeat
  • mood swings
  • numbness
  • pain
  • skin color changes
  • sudden outbursts of words or sounds that are hard to control
  • thoughts of suicide
  • uncontrolled muscle movements
  • unusual wounds on the fingers or toes

All of the serious side effects above should be checked by a doctor, but the following require immediate attention.

  • confusion
  • fainting
  • pain in the chest or left arm
  • seizure
  • shortness of breath
  • slurred speech
  • sudden vision changes,
  • unusual sweating
  • weakness on one side of the body

 

HALF LIFE AND METABOLISM

Methylin has a relatively short half-life of about 2.7 hours if a patient is administered a 20-milligram dose. Some patients, however, will experience a longer half-life if they have a slower metabolism.

Everyone’s body is different. Many factors, including your age, metabolism, organ function, drug dosage levels and how long you’ve been taking a drug can affect half-life and the length of time a drug stays in your body.

Metabolism is primarily through deesterification to alpha-phenylpiperidine acetic acid (PPA, ritalinic acid).

 

The following information is taken from the Methylin label:

  • abdominal pain
  • angina
  • anorexia
  • blood pressure and pulse changes, both up and down
  • cardiac arrhythmia
  • dizziness
  • drowsiness
  • dyskinesia – impairment of voluntary movements resulting in fragmented or jerky motions (as in Parkinson’s disease)
  • headache
  • hair loss, on the scalp
  • hypersensitivity (including skin rash, urticaria (hives), fever, arthralgia (joint pain), exfoliative dermatitis (redness and peeling of the skin over large areas of the body), erythema multiforme (a rash that can consist of dozens of target-shaped (bull’s-eye pattern) lesions that develop over a 24-hour period. The lesions can start on the backs of hands and tops of feet before spreading to the trunk. They may also develop on the face and neck and arms and legs, concentrated on the elbows and knees. A more severe form (erythema multiforme major), can also seriously affect any of the body’s mucous membranes, most often the lips and the interior of the cheeks. It can also affect the bottom of the mouth, palate and gums, the eyes, genitals and anus, trachea – breathing tube – and digestive tract. Lesions in these areas may cause swelling and redness with blisters. The blisters also break, leaving painful, large, irregularly shaped ulcers covered with a whitish membrane. When the lips are affected, they’re swollen and covered with a bleeding crust. There can be difficulty speaking and swallowing because of pain.
  • insomnia
  • instances of abnormal liver function
  • isolated cases of cerebral arteritis and/or occlusion (blockage of blood vessels) – inflammation of the blood vessel wall, involving the brain and occasionally the spinal cord. It can lead to rupture of the arteries and smaller blood vessels, resulting in stroke, headache and impairment of brain function.
  • leukopenia and/or anemia – a decrease in white or red blood cells
  • libido changes
  • loss of appetite
  • nausea
  • nervousness
  • palpitations
  • priapism – a persistent, usually painful, erection, in adults or children that lasts for more than four hours and occurs without sexual stimulation. If the condition is not treated immediately, it can lead to scarring and permanent erectile dysfunction.
  • Rhabdomyolysis – destruction of certain types of muscles in various areas of the body, including skeletal muscle and heart muscle.
  • scalp hair loss
  • serotonin syndrome – when taken with serotogenic drugs. Serotonin syndrome is a group of side effects that include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea, associated with serotonergic drugs. Serotonergic drugs are used to treat migraine, depression and other mood disorders.
  • neuroleptic malignant syndrome (NMS) – the symptoms of NMS are fever, altered mental status, muscle rigidity, and autonomic dysfunction (which includes symptoms such as dizziness and fainting upon standing up) or orthostatic hypotension, an inability to alter heart rate with exercise, or exercise intolerance, and is usually a reaction to antipsychotic drugs. This occurs primarily with people who are already on drugs that treat NMS and then take amphetamine type drugs a well.
  • tachycardia – abnormally rapid heart rate. If the person already has tachycardia, it may occur more frequently.
  • Tourette’s syndrome
  • toxic psychosis
  • transient depressed mood
  • weight loss during prolonged therapy

 

WITHDRAWAL SYMPTOMS

Abrupt cessation of stimulant drugs – usually known as quitting ‘cold turkey’ – such as methylphenidate drugs can cause extreme fatigue and severe, even suicidal, depression in adult patients.

Some of the other withdrawal symptoms of Methylin can include:

  • “binge crashing” – going through cycles of several days without sleep, followed by a period of heavy sleeping
  • crankiness
  • depression
  • extreme hunger
  • nightmares
  • panic attacks
  • tiredness

 

Quitting Methylin should always be done as recommended by a medical practitioner. They may suggest you gradually decrease the dose, or they may suggest that you attend a medical detox program. What they recommend is dependent upon how long you’ve been taking the drug, at what dosage, how you react to the drug and to withdrawal, and more. If help is needed to cope with the symptoms of withdrawal, a medically-supervised drug detox can help. Call us for more information.