Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (263 page)
(meth-ill-fen′i-date)
Biphentin
, Concerta, Daytrana, Metadate CD, Metadate ER, Methylin, Quillivant XR, Ritalin, Ritalin LA, Ritalin SR
Func. class.:
Cerebral stimulant
Chem. class.:
Piperidine derivative
Do not confuse:
methylphenidate
/methadone
Increases release of norepinephrine, dopamine in cerebral cortex to reticular activating system; exact action not known
Attention deficit disorder (ADD), attention-deficit/hyperactivity disorder (ADHD); narcolepsy (except Concerta, Metadate CD, Ritalin LA)
Children <6 yr, hypersensitivity, anxiety, history of Gilles de la Tourette’s syndrome; glaucoma, anorexia nervosa, tartrazine dye hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, hypertension, depression, seizures
Black Box Warning:
Substance abuse
Calculator
• Adult:
PO
20-30 mg/day, range 10-60 mg/day in 2-3 divided doses, 30-45 min before meals
• Child ≥6 yr:
PO
5 mg bid initially, increase 5-10 mg/day weekly, usual dose 0.3-2 mg/kg/day, max 60 mg/day
• Adult/adolescent/child ≥6 yr:
PO
max 20-30 mg tid
• Adult:
PO
18-36 mg/day initially then adjust by 18 mg/wk, max 72 mg/day
• Adolescent:
PO
18 mg/day initially then adjust by 18 mg/wk, max 72 mg/day
• Child ≥6 yr:
PO
18 mg/day initially then adjust by 18 mg/wk, max 54 mg/day
• Adult/adolescent/child ≥6 yr:
PO
20 mg daily in
AM
initially, adjust by 10 mg/wk, max 60 mg/day
• Adult/adolescent/child ≥6 yr:
PO
20 mg/day in
AM
, adjust by 20 mg/wk, max 60 mg/day
• Adolescent/child ≥6 yr:
TD
wk 1: 10 mg/day (9-mg patch); wk 2: 15 mg/day (9-mg patch); wk 3: 20 mg/day (9-mg patch); wk 4: 30 mg/day (9-mg patch)
Extended-release once-daily capsules: Metadate CD
• Adult/adolescent/child ≥6 yr:
PO
give no more than total daily dose of other forms, may adjust by 20 mg/wk, max 60 mg/day
• Adult/adolescent/child ≥6 yr:
PO
give no more than total daily dose of other forms, may adjust by 10 mg/wk, max 60 mg/day
• Adult/adolescent/child ≥6 yr (currently on 10-15 mg/day):
PO
18 mg every
AM
initially, adjust by 18 mg/wk, max 72 mg/day (adult); max 72 mg/day, 2 mg/kg/day (adolescent); 54 mg/day (child) mg/day
• Adult/adolescent/child ≥6 yr (currently receiving 20-30 mg/day):
PO
36 mg every
AM
, adjust by 18 mg/wk, max 72 mg/day (adult); 72 mg/day, 2 mg/kg/day (adolescent); 54 mg/day (child)
• Adult/adolescent/child ≥6 yr (currently receiving 30-45 mg/day):
PO
54 mg every
AM
, adjust by 18 mg/wk, max 72 mg/day (adult); 72 mg/day, 2 mg/kg/day (adolescent); 54 mg/day (child)
• Adult/adolescent/child ≥6 yr (currently receiving 40-60 mg/day):
PO
72 mg every
AM
, 72 mg/day
• Adolescents/child ≥6 yr:
PO
give in
AM
, increase in 10-20 mg increments q week
• Adult:
PO
20-30 mg/day, range 10-60 mg/day in 2-3 divided doses
• Child ≥6 yr:
PO
5 mg bid, may increase by 5-10 mg/wk, max 60 mg/day
• Adult/adolescent/child ≥6 yr:
PO
max 20 mg tid
• Adult and geriatric:
PO
(immediate rel tabs) 2.5 mg bid, may increase by 2.5-5 mg q2-3days
Available forms:
Tabs 5, 10, 20 mg; ext rel tabs 10, 20, mg; ext rel tabs (Concerta) 18, 27, 36, 54 mg; ext rel caps 10, 20, 30, 40 mg; oral sol 5 mg, 10 mg/ml; chew tabs (Methylin) 2.5, 5, 10 mg; transdermal patch 12.5 cm
2
(10 mg), 18.75 cm
2
(15 mg), 25 cm
2
(20 mg), 37.5 cm
2
(30 mg); ext rel oral susp 300 mg/60 ml, 600 mg/120 ml, 750 mg/150 ml, 900 mg/180 ml
•
Do not crush, chew ext rel product; caps may be opened, beads sprinkled over spoonful of applesauce; give without regard to meals
•
Gum, hard candy, frequent sips of water for dry mouth
•
Give immediate rel dose 30-45 min before meals
•
Chew tab
with adequate water to prevent choking; contains phenylalanine
•
Avoid metadate CD on day of surgery
•
Shake bottle well, use calibrated dosing dispenser provided, give in
AM
without regard to meals, reconstitute as per manufacturer
•
Place on clean, dry area of hip; avoid waist; remove 9 hr after application; fold after removal, flush down toilet
•
If patch falls off, apply new patch to different site; total wear time should be 9 hr
CNS:
Hyperactivity, insomnia, restlessness, talkativeness
, dizziness, drowsiness, toxic psychosis, headache, akathisia, dyskinesia, masking or worsening of Tourette’s syndrome,
seizures,
hallucinations,
malignant neuroleptic syndrome,
aggression;
cerebral vasculitis, hemorrhage, stroke (rare)
CV:
Palpitations, tachycardia
, B/P changes, angina,
dysrhythmias
ENDO:
Growth retardation
GI:
Nausea, anorexia, dry mouth, weight loss, abdominal pain
HEMA:
Leukopenia, anemia, thrombocytopenic purpura
INTEG:
Exfoliative dermatitis,
urticaria, rash, erythema multiforme,
hypersensitivity reactions
MISC:
Fever, arthralgia, scalp hair loss
PO:
Onset 1/2-1 hr, duration 4-6 hr, metabolized by liver, excreted by kidneys, half-life 3-4 hr
•
Hypertensive crisis: MAOIs or within 14 days of MAOIs, vasopressors
Increase:
effects of tricyclics, SSRIs, anticonvulsants, SNRIs, CNS stimulants
Decrease:
effect of antihypertensives
Increase:
CNS stimulation—cola nut, guarana, horsetail, yerba maté, yohimbe
Increase:
stimulation—caffeine
•
ADHD:
attention span, decreased hyperactivity
Black Box Warning:
Substance abuse: There is a high potential for abuse, use caution in those with history of substance abuse
•
VS, B/P; may reverse antihypertensives; check patients with cardiac disease more often for increased B/P
•
CBC with differential, platelets, LFTs, urinalysis; in diabetes: blood glucose, urine glucose; insulin changes may have to be made because eating will decrease
•
Height, growth rate q3mo in children; growth rate may be decreased, but normal growth will resume when product is discontinued
•
Mental status: mood, sensorium, affect, stimulation, insomnia, aggressiveness
Withdrawal symptoms:
headache, nausea, vomiting, muscle pain, weakness, usually not associated with drug holidays
•
Appetite, sleep, speech patterns
•
Narcolepsy:
identify frequency, length of narcoleptic episodes
•
Therapeutic response: decreased hyperactivity (ADHD); increased ability to stay awake (narcolepsy)
•
To decrease caffeine consumption (coffee, tea, cola, chocolate), may increase irritability, stimulation; not to use guarana, yerba maté, cola nut
•
To avoid OTC preparations unless approved by prescriber
•
To taper off product over several weeks because depression, increased sleeping, lethargy will occur
•
To avoid driving, hazardous activities if dizziness, blurred vision occur
•
To avoid alcohol
•
To avoid hazardous activities until stabilized on medication
•
To get needed rest; patients will feel more tired at end of day
•
That shell of Concerta tab may appear in stools
•
To take regular tab at least 6 hr prior to sleep, 10 hr for ext rel, use dosing syringe to measure liquid; do not use household teaspoon
•
Transdermal:
after tray is opened, use within 2 mo; do not store patches without protective patch, notify prescriber if skin irritation or rash occurs
Administer fluids; hemodialysis or peritoneal dialysis; antihypertensive for increased B/P; administer short-acting barbiturate before lavage
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert