Ritalin

Chemical name

Active ingredient: methylphenidate

application areas

Typical areas of application for Ritalin ® are:

• ADS
• ADHD
• Narcolepsy (= urge to sleep, which usually occurs at an inappropriate time (stressful situation) and is also characterized by above-average daytime sleepiness)

for children from 6 years and adolescents, whereby the drug therapy with Ritalin should be integrated into a therapeutic concept (multimodal therapy). Read more about it here: ADHD Therapy and ADD Therapy.

Note

It is currently believed that if Ritalin is clearly diagnosed and taken in accordance with the regulations, the propensity to become addictive Not and therefore there is no addiction-promoting effect of the active ingredient methylphenidate.

effect

The commercial preparation Ritalin® contains the active ingredient methylphenidate. The active ingredient affects the metabolism of the brain.
The effect of Ritalin® is still a controversial topic among experts. Since the mechanisms in the brain are still only partially understood, statements about mechanisms of action are only snapshots.
At the present time it is believed that methylphenidate has a similar effect to cocaine. This means that it inhibits the reuptake of certain messenger substances, such as dopamine and norepinephrine. This results in a higher concentration and activity of these messenger substances in the synaptic cleft. However, Ritalin® has a lower surge time than cocaine. Therefore, it usually does not cause intoxication when taken orally.
How this effect affects each individual in the short term, long term, psychologically and physically, both individually and in everyday life, seems to be very individual. It is supposed to help people with ADHD to focus and concentrate better.

Read more on the topic: Effect of Ritalin®

Effect in adults and people without attention deficit

Many years ago it was found that Ritalin® can also have a beneficial effect on adults with ADHD. However, as in children with ADHD, the effect is very dependent on various factors.
For example, Ritalin® only seems to be useful in adults, in combination with other non-medicinal measures. Since April 2011, the approvals for drugs containing methylphenidate for the treatment of adults with ADHD have been supplemented. Ritalin® adult has been available since May 2014. Due to drug safety, different preparations have been developed for children and adults. The contents of the leaflet, the information on the maximum dose and the times of intake are different. The active principles of the active ingredient are probably similar in adults and children with ADHD.
It is controversial whether the same or the opposite effects occur in healthy people. Experience reports and studies show both equally. It should be noted that this is a prescription drug that should only be used with a corresponding diagnosis.

Does Ritalin® require a prescription?

Ritalin falls under the Narcotics Act and is therefore prescribed by means of a separate BTM prescription. Only a few doctors have a BTM approval.

dosage

Ritalin ® - like the other methylphenidate preparations - is adapted directly to the child. This usually means that the minimum dose is first determined on the basis of body weight and height. It starts with a dose of 5 mg once or twice a day, which corresponds to half a tablet. The medication is gradually increased (weekly increase) - one speaks of “setting” - until the optimum effect occurs. A maximum dose of 60 mg per day, divided into two to three doses, should not be exceeded in children and adolescents.
This increased concentration affects attention and concentration, as well as motivation and mood.
The first effect can be seen about half an hour after ingestion. The active ingredient is then slowly absorbed (broken down) in the body. In order to avoid a rebound effect (worsening of symptoms), attention must be paid to taking the drug regularly. Retard or Slow Release (SR) products release the active ingredient in a dosed manner, so that no further medication is required after taking it once a day.

How does Ritalin® affect learning?

Studies and field reports show that Ritalin® can affect learning in different ways. It seems that the material can be absorbed in a shorter time. It is believed that the changed effect of the messenger substances in the brain increases the ability to concentrate. In some people, Ritalin® also increases drive and mood. Both could have a positive effect on learning behavior.
However, Ritalin® can also inhibit creative thinking. This type of thinking plays a role in certain solution behaviors and is also important in learning. In addition, it is questionable whether the results in the tests are actually better in general. In some cases, Ritalin® can lead to overconfidence, which could have a negative effect on learning behavior.
In healthy people who take Ritalin® without a doctor's indication, strong restlessness can appear. As a result, learning can be difficult or impaired. In addition, it is not known to what extent the learning abilities and thinking structures are permanently influenced by the Ritalin®.

side effect

At this point, what we consider to be the most important side effects is only partially discussed.

There are various side effects that occur during therapy but can also go away again. These include, for example Difficulty sleeping, loss of appetite and eventual Stomach discomfort. Sleep disorders in particular are often based on the rebound effects that can be caused by the diminishing effect of the drugs.
In the context of Ritalin therapy, it can be partially due to the stimulating effect of the drug increased blood pressure and pulse raten come. Furthermore are Dry mouth, diarrhea and / or constipation and weight loss, such as Joint pain and allergic reaction (Rash, itching, ...) conceivable. Partly is the Motor skills impaired (disruption of movement).

Since it is part of the Long term therapy occasionally too Growth retardation and weight loss it is advisable to check both values, for example through regular weighing and measuring, possibly also as part of the medical check-ups.

In particular one Overdose of the drug can lead to a Overexcitation of the central nervous system (= CNS) lead, beyond are cramps, such as Muscle twitching, cardiac arrhythmias, sweating (Fever, hot flashes) possible.

Because through one sudden withdrawal of the drug Rebound effects may occur, among other things Circulatory disorders, depression, emotional upsets, food cravings and enormous need for sleep can cause a drug only discontinued by a doctor become. The same applies to increasing or decreasing dosages. This belongs in the hands of an experienced depression doctor!

interaction

There is a possibility that a Drug interaction occurs that are administered to treat hypotension (= blood pressure that is too low).
In addition, drug interactions are the Epilepsy therapy (Carbamazepine) possible.
Ritalin can help break down Anticoagulants, schizophrenia drugs or antidepressants inhibit, so that this must be taken into account urgently in terms of dosage when taken at the same time.
Ritalin must not be taken during therapy with MAO inhibitors (MAO = monoamine oxidase; Antidepressants), or after therapy with these preparations (at least two weeks between taking both preparations).

Contraindication

Ritalin is counter-indexed with heavy Tourette syndrome (Gilles de la Tourette) and, in the acute case, one Stroke.
In the event of mild to moderate Tourette syndrome, Ritalin should only be administered under close medical supervision.
There are also restrictions on use in epileptics and in the case of emotionally unstable patients.
In patients with anorexia Ritalin should not be taken as the drug inhibits appetite in a special way (loss of appetite).
Likewise, Ritalin must not be taken at Cardiac arrhythmias and with a tendency to (medium) difficult high blood pressure, just like Angina pectorisHyperthyroidism and increased intraocular pressure (glaucoma).
The use of Ritalin is also contraindicated schizophrenia and Anxiety disorders.
In addition, Ritalin is allowed in the pregnancy and at Hypersensitivity the main active ingredient methylphenidate and the side active ingredients are not taken.

price

Since there is always talk of cost pressure in the healthcare system, I think it is important to find out the prices for drugs. (Prices are exemplary and not recommended):

Ritalin® 10 mg Novartis Pharma 20 tablets (N 1) € 16.12

Ritalin® 10 mg Novartis Pharma 40 tablets (N 2) € 26.30

What are the alternatives to Ritalin®?

The commercial preparation Ritalin® should only ever be prescribed in combination with other non-medicinal measures.
Before administering medication, all other options should always be exhausted. Specialists can be consulted for this. Advice and guidance on other methods of behavior control and other pedagogical strategies should be shown and tried out.
Resource-oriented psychotherapy could have a supportive effect on everyday life. If necessary, family therapy would also be indicated. The self-esteem in affected children, adolescents or adults could be strengthened through group therapies / meetings.
Furthermore, the expansion of parent training is another important component. Self-instruction and self-management programs can be worked out with people with ADHD. There is also the option of so-called neurofeedback therapy. This form of therapy appears to be effective for some people with ADHD.
In addition, some authors recommend homeopathic remedies or recommend the use of omega-3 fatty acid capsules. Some authors and doctors also recommend caffeine based on experience reports.
Furthermore, occupational therapy and physiotherapy can provide support to strengthen psychomotor, action-related and cognitive resources in people with ADHD.

What are the long-term consequences?

The long-term consequences cannot yet be fully assessed. Long-term use could trigger psychoses, mental disorders and tics. The risk of these long-term consequences is higher for people with a corresponding disposition.
Weight loss or weight gain can occur. The appetite often seems very low during the day and often very pronounced in the evening hours. Depending on your eating habits and your metabolism, you could gain or lose weight permanently.
Growth disorders with long-term use are controversial. There are also assumptions that long-term use could have a damaging effect on the thinking functions. There is also controversial discussion as to whether Ritalin® leads to addiction. In addition, it is difficult to assess whether long-term income will lead to permanent personality changes.