RITALIN

DESCRIPTION / DEFINITIONS: Ritalin® (methylphenidate hydrochloride) is a mild central nervous system (CNS) stimulant used to treat the set of symptoms known as attention deficit disorders and Narcolepsy. It is similar to cocaine, and has been called ‘legal cocaine.’

ABUSE:   Ritalin has a high potential for abuse. 

ADDICTION / DEPENDENCE:  Ritalin is defined as a Schedule II drug by the Drug Enforcement Administration (DEA). It can lead to severe psychological addiction or physical dependence.  See more information below, as well as info on half-life and metabolism.

SIDE EFFECTS: Side effects can include headaches, abnormal heart rhythms and blood pressure, insomnia, nervousness and much more. See list below.

WITHDRAWAL SYMPTOMS: Intense anxiety, nausea, exhaustion, and insomnia are among the withdrawal symptoms. See a more complete list below.

TREATMENT: Treatment depends on how long it has been used, at what dosage, whether addiction or physical dependence is involved, and how the person reacts to the drug and to withdrawal. 

 

Ritalin increases certain chemicals in the brain and speeds brain activity. It was created in 1944, and approved for use in adults in 1955. It was first used to treat depressed and geriatric patients. In the late 1960s, psychiatrists decided that the set of symptoms that include getting easily distracted or bored, not paying attention, lack of focus, having a hard time remembering things or following instructions – then known as hyperkinetic impulse disorder and, later, as attention deficit disorders such as Attention Deficit Disorder (ADD), Attention Deficit Hyperactivity Disorder (ADHD) – should be classified as mental illness. Ritalin, along with other central nervous stimulants, became the treatment. Children as young as seven were primarily given the drug, but adults were given the diagnosis, and the drug, as well.

 

Although Ritalin was previously used only by people who were depressed and geriatric, and then on those with attention deficit disorders, it has now become a common drug to use as a study aid for young adults in high school and college.

Students use Ritalin to help them stay awake and improve their focus and concentration, especially while cramming for exams. Ritalin can enhance performance by speeding up mental processing and physical responses. It can also produce euphoria.

Students often get Ritalin illegally through their friends or through drug dealers rather than through a doctor who has examined them and diagnosed them with a condition for which Ritalin is prescribed.

These students can wind up taking more than a doctor would have prescribed, and sometimes chewing or crushing the tablets to boost the effect, and even injecting the pills once they are crushed.

They also sometimes combine Ritalin with alcohol or with other pills. Some combinations can be deadly.

There are several circumstances under which taking Ritalin can be dangerous even when prescribed. But without a doctor visit and thorough checkup, people with pre-existing conditions or conditions in their family history – whether the person taking Ritalin knows about them or not – are really risking their health.

For example, if someone has anxiety, tension, agitation, glaucoma, motor tics, a family history or diagnosis of Tourette’s syndrome, Ritalin can cause severe and dangerous side effects and exacerbate the problems. 

Anyone with heart problems of any sort – including high blood pressure or high heart rate – is also at risk.

There can also be severe reactions between Ritalin and other drugs. Antidepressants, medication for seizures, blood thinner medicines, blood pressure medicines, or cold or allergy medicines that contain decongestants are just a few.

As with other drugs, someone taking Ritalin can also react badly to other, inactive ingredients. These ingredients in Ritalin are D&C Yellow No.10 (5-mg and 20-mg tablets), FD&C Green No.3 (in 10-mg tablets), lactose, magnesium stearate, polyethylene glycol (used in medicine but also the main ingredient in antifreeze), starch (in 5-mg and 10-mg tablets), sucrose, talc, and tragacanth (20-mg tablets).

 

Ritalin is defined as a Schedule II drug by the Drug Enforcement Administration (DEA). Schedule II drugs and other substances are described by the DEA as:

  • A drug or other substance has a high potential for abuse.
  • A drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions.
  • Abuse of the drug or other substances may lead to severe psychological or physical dependence.

When someone experiences euphoria and increased focus while using Ritalin, they sometimes want to continue to have those feelings even when it has nothing to do with study, exams, and so on. They feel it improves their life.

Anyone who is predisposed to addiction – having difficulties in life of any kind that they are unable to resolve – should stay away from Ritalin and other drugs.

HALF LIFE AND METABOLISM

The biological half life of a substance is the time it takes for a drug to lose half of its pharmacologic activity. This is significant because it affects how soon withdrawal symptoms may appear.

The half life of Ritalin is about 2 to 3 hours or 3 to 8 hours for sustained release.

Ritalin (methylphenidate hydrochloride) is metabolized into ritalinic acid by liver carboxylesterase 1, also known as carboxylesterase 1 (CES1, hCE-1 or CES1A1). CES1A1 is an enzyme that in humans is encoded by the CES1 gene.

 

Ritalin has a number of side effects. Some are minor, but many are serious and even life-threatening. They include.

  • abdominal pain
  • abnormal liver function, ranging from mild to severe
  • aggressive behavior
  • angina
  • anorexia – generally described as being so concerned about weight (even if the person is very thin) that they refuse to eat
  • arthralgia – pain in the joints 
  • blood pressure and pulse changes, both up and down
  • cardiac arrhythmia – the heart beat is too fast, too slow, or irregular
  • dizziness
  • drowsiness
  • dyskinesia – abnormal or impaired voluntary movement 
  • erythema multiforme – an often painful or itchy skin disease with bull’s eye pattern rashes or lesions, possibly including mouth ulcers, fever and generally feeling ill. It is usually associated with an infection or medication. It can be mild or severe. The more severe types can be life-threatening.
  • exfoliative dermatitis – a serious skin condition manifested as redness and peeling of the skin over large areas of the body
  • eye sight changes or blurred vision
  • fever
  • headache
  • hypersensitivity 
  • insomnia
  • cerebral arteritis and/or occlusion – 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 reduction of white or red blood cells
  • libido changes 
  • loss of appetite 
  • nausea
  • nervousness
  • palpitations
  • rare reports have been received about 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 Ritalin as well. 
  • rhabdomyolysis – destruction of certain types of muscles associated with various areas in the body, including skeletal muscle and heart muscle.
  • priapism – painful and prolonged erections.  This can happen to children and adults and needs to be seen by a doctor immediately to prevent lasting damage. 
  • scalp hair loss
  • serotonin syndrome – 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. The symptoms are experienced when these drugs are mixed with Ritalin.
  • skin rash
  • slowing of growth (height and weight) in children
  • stomach ache
  • tachycardia – abnormally rapid heart rate
  • thrombocytopenic purpura – a rare blood disorder characterized by blood clots forming in small blood vessels throughout the body. The clots can limit or block the flow of oxygen-rich blood to the body’s organs, such as the brain, kidneys, and heart. As a result, serious health problems can develop.
  • Tourette’s syndrome
  • toxic psychosis 
  • transient depressed mood
  • urticaria – a rash of very itchy round, red welts on the skin. It is sometimes accompanied by dangerous swelling and is generally an allergic reaction.
  • weight loss during prolonged therapy

Note that Ritalin is especially dangerous for people with existing heart problems. Some have had strokes and heart attacks, increased blood pressure and heart rate, and even sudden death.

Also, anyone with mental problems may see them getting worse on Ritalin. They may experience new or worsened:

  • aggressive behavior or hostility 
  • behavior and thought problems
  • bipolar illness
  • psychotic symptoms such as hearing voices, believing things that are not true, being paranoid or new manic symptoms

 

Ritalin can be a very difficult drug to stop taking. 

Ritalin is a stimulant, and it causes an increase in two neurotransmitters in the brain, dopamine and noradrenaline, When you suddenly stop taking Ritalin, the levels of these neurotransmitters in the brain drop significantly.

That’s when the withdrawal symptoms start.

It can take weeks or months for the brain to go back to normal operation. As long as the brain is trying to adjust to functioning without the Ritalin, the withdrawal symptoms will continue, although they will decrease with time. 

Withdrawal symptoms can include:

  • abdominal cramps
  • agitation
  • exhaustion
  • extreme cravings for Ritalin
  • nausea
  • overwhelming depression and intense anxiety
  • pronounced hunger
  • severe fatigue and being incapable of even getting out of bed. Some people go through cycles of insomnia and then not being able to wake up
  • unusual dreams
  • weight gain

 

Withdrawal from Ritalin should only be done under the advice of a medical practitioner. Treatment depends on how long it has been used, at what dosage, whether addiction or physical dependence is involved, and how the person reacts to the drug and to withdrawal. Consult a professional to help determine the best way for you to get off Ritalin. A drug detoxification program may be helpful. Give us a call for more information.