Ritalin hydrochloride and Ritalin-SR methylphenidate hydrochloride sustained-release tablets are the registered trademarks of Novartis Pharmaceutical Corporation, East Hanover, New Jersey. Ritalin is a mild central nervous system (CNS) stimulant, available as 5-, 10-, and 20-mg tablets for oral administration. Ritalin SR is available in 20-mg tablets. Methylphenidate hydrochloride is methyl-a-phenyl-2-piperineacetate hydrochloride with the structural formula: C14H19NO2-HCl.

The actual method of action in humans is not completely known, but it presumably activates the brainstem arousal system and cortex to produce its stimulant effect. Ritalin is indicated for ADHD as a part of an integral total treatment program that includes other remedial measures such as psychological, educational, and social interventions. It is indicated for people with the following group of inappropriate symptoms: moderate-to-severe distractibility, short attention span, hyperactivity, emotional lability, and impulsivity.

Several warnings are included in the package insert:

- Ritalin should not be used in children under 6, because safety and efficacy in this age group have not been established.

- Sufficient data on long-term use of Ritalin in children are not yet available. Although a causal relationship has not been established, suppression of weight gain and height has been reported with long-term use of stimulants in children.

- Ritalin should not be used for severe depression or in psychotic children, and it may worsen the condition.

- The drug should not be used for the prevention or treatment of normal fatigue states.

- Some clinical evidence exists that Ritalin may lower cause seizures in people with a prior history of seizures.

- Patients with hypertension should be monitored if using Ritalin.

- Symptoms of blurring of vision and other visual disturbances have been reported in rare cases.

- Ritalin should not be used with coumarin or other anticoagulants, drugs for depression, or anticonvulsants such as phenobarbital.

- Ritalin should not be prescribed for women of child-bearing age unless the physician determines the benefits outweigh the risks.

Ritalin can be used as effective treatment in some patients; however, the person must be constantly monitored for adverse side effects.

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