Medication Monday: Methylphenidate

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It’s Medication Monday! πŸ’Š Today I’m talking about methylphenidate, a central nervous system (CNS) stimulant.

Is it safe when lactating? πŸ‘πŸ»
Is it safe when pregnant? πŸ‘πŸ»πŸ€·πŸΌβ€β™€οΈπŸ‘ŽπŸ»πŸ˜
Is it safe for baby? πŸ‘πŸ»
Is is safe for SUPPLY? πŸ‘πŸ»

Methylphenidate (trade names are Ritalin, Concerta, Metadate CD/ER, etc.) is a CNS stimulant. It’s used for Attention Deficient Hyperactivity Disorder (ADHD) and narcolepsy.

Methylphenidate blocks the reuptake of norepinephrine and dopamine. This allows norepinephrine and dopamine to stick around longer, pass on more messages to neurons, and stimulate the cerebral cortex.

Methylphenidate is available in a variety of formulations and dosages - tablets, capsules, chewable tablets, liquid, and as a patch. The half-life varies from 1.5 to 7 hours due to the different release mechanisms. Immediate release formulations have a half-life of 1.3-7.7 hours (average 3.5 hours) and a peak time of 2 hours.

Methylphenidate can be used in pregnancy in all trimesters depending on the circumstances and after weighing risks versus benefits. It has not been well studied in pregnancy. The available research (a small number of case reports) shows no increased risk of birth defects. However, this research is not strong and is limited. The long-term effects of exposure to methylphenidate in utero are unknown. It is best to avoid the use of methylphenidate during pregnancy if other medications can be used.

Methylphenidate can be used safely in lactation. The relative infant dose is 0.7-0.9%. This dose is probably too low to be clinically significant. Methylphenidate hasn’t been well studied in lactation, but available research (case reports) demonstrates no adverse effects in infants exposed via breastmilk. Normal physical and mental growth up to 1 year of age was reported in one case report.

If a provider or a lactating individual is concerned about potential exposure, there are several ways to limit any exposure. The lowest dose needed and immediate release formulations should be used. The dose can be taken after a nursing or pumping session to maximize the amount of time before exposure. If pumping, the milk can be mixed with other milk to further dilute the β€œmedicated” milk.

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