The German Journal of Psychiatry

Vol. 16 (2013) - Issue 1

Methylphenidate and Its Under-recognized, Under-explained, and Serious Drug Interactions: A Review of the Literature with Heightened Concerns
Robert M. Nevels, Nicole H. Weiss, Alyssa E. Killebrew, Samuel T. Gontkovsky

Abstract:
Methylphenidate arguably is the most successful psychiatric medication in history. Response rates in some studies are as high as 78%, and, despite opposition to medicating children with psychostimulants, the use of methylphenidate in the treatment of Attention-Deficit/Hyperactivity Disorder in both pediatric and adult populations has dramatically increased over the last decade. Along with this increased use, and in conjunction with black box warnings on antidepressants and psychostimulants, has come an increased awareness of the risks associated with the use of methylphenidate and other stimulants including seizures, heart attacks, strokes, and precipitation of mania or psychosis. Serious drugdrug interactions, with the exceptions of interactions with monoamine oxidase inhibitors, warfarin, and meperidine, rarely are attributed to methylphenidate, possibly due to its success and longevity. Many Cytochrome P450 isoenzyme (CYP450) drug interaction charts generally do not list methylphenidate either as a substrate or an inhibitor of particular enzymes. Yet, this review reveals a number of CYP450 interactions, many potentially serious, between methylphenidate and commonly prescribed medications in nearly every class. Further, these interactions and their known or hypothesized mechanisms imply that more such interactions will come to light in the near future. Such interactions can be more carefully anticipated and are predictable from the known pharmacodynamics and pharmacokinetics of methylphenidate (German J Psychiatry 2013; 16(1): 29-42).

Keywords: methylphenidate; drug interactions; psychopharmacy; ADHD

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