Methylphenidate (Quillivant® ER) belongs to a group of medications called stimulants.
What is this medication used for?
Health Canada has approved methylphenidate for use in children and adolescents age 6 years and older. It can help improve mental and behavioural symptoms of attention-deficit/ hyperactivity disorder (ADHD), including difficulties paying attention, impulsive behaviour and hyperactivity. Sometimes, methylphenidate is also used for other reasons. When potential benefits outweigh risks, methylphenidate may be prescribed “off-label.” Learn more about off-label medication use: http://bit.ly/KMH-off-label-use
Tell your doctor or pharmacist if you:
- Have allergies or bad reactions to a medication
- Take (or plan to take) other prescription or non- prescription medications, including over-the-counter and natural medicines). Some medications interact with methylphenidate. Your doctor may adjust medication doses or monitor for side effects
- Have a history (or family history) of heart disease, heart abnormalities or irregular heartbeat
- Have a history (or family history) of seizures, anxiety, bipolar disorder, thyroid disease or glaucoma
- Miss a menstrual period, are pregnant, breast-feeding or planning a pregnancy
- Use alcohol or drugs. Taking methylphenidate together with certain substances may cause a bad reaction. Ingesting high concentrations of alcohol may make methylphenidate release faster than expected from Quillivant® ER. Learn more at www.DrugCocktails.ca
When will the medication start to work?
You (or your family members) may notice improvements within the first couple of days of starting methylphenidate. However, symptoms of ADHD will only improve when there is enough medication in the body. Once the medication wears off at the end of a dose or at the end of the day, ADHD symptoms can return. You and your doctor may have to adjust the timing of doses according to your needs. For example, a dose may be timed so that there is enough medication in
your body for an important class or activity.
When used properly, this medication is not addictive, and doesn’t increase the risk of substance misuse.
How do I take this medication?
Quillivant® ER is available as chewable tablets or as a liquid suspension taken by mouth. The chewable tablets and suspension release medication differently and are not interchangeable. Take Quillivant® ER first thing in the morning. If you wake up late, you may have to skip your dose. Avoid taking Quillivant® ER later in the day, in the evening or at night unless specifically directed by your doctor as this can cause difficulty sleeping. Usually, you will start with a low dose and slowly increase this dose over several days to weeks, based on how you tolerate it. Quillivant® ER chewable tablets are cherry flavored. Chew them completely before swallowing. If needed, you may break the chewable tablet in half. You may take your dose with or without food. Quillivant® ER suspension is banana flavored. Shake the bottle well for 10 seconds before taking a dose. Then, use the provided oral syringe to measure your dose. You may take your dose with or without food. Discard any unused suspension 4 months after the date the suspension was prepared by your pharmacy.
Possible common or serious side effects:
Side effects may be more common when first starting a medication or after a dose increase. Talk to your doctor, nurse or pharmacist if any side effect concerns you.
- Loss of appetite or weight loss
- Nausea, vomiting, stomach ache or constipation
- Dry mouth
- Trouble sleeping
- Irritation, nervousness or feelings of agitation
- Headaches
- Increased heart rate or an uncomfortable awareness of your heartbeat
Contact your doctor immediately if you experience:
- Thoughts of hurting yourself, hostility or suicide
- Unusual changes in mood such as ongoing sadness or seeing, hearing or feeling things that are not there
- Worsening vocal or motor tics such as shrugging, blinking, head turning, muscle twitches or throat clearing
- Skin rash
- Prolonged (more than 4 hours), inappropriate and/or painful erection of the penis
What precautions should my doctor and I be aware of when taking this medication?
- Methylphenidate can mask symptoms of extreme tiredness. Do not drive a car or operate heavy machinery when you have not had sufficient rest, even if you feel awake and alert.
- This medication (and medications like it) can cause a rare side effect called “serotonin syndrome,” especially when used in combination with other serotonergic drugs such MAO inhibitors, triptans used for treatment of migraine and most antidepressants. Symptoms include diarrhea, sweating, increased heart rate, tremors, severe muscle stiffness and increased agitation.
- Methylphenidate is associated with a temporary slowing of growth rate in children and adolescents, with an average decrease of 2cm in height and 2.7kg in weight following 3 years of continuous treatment. Some children may experience a more significant impact on growth. While taking methylphenidate, your growth should be monitored regularly.
- Quillivant® ER chewable tablets contain aspartame and should not be taken by persons with phenylketonuria. The suspension does not contain aspartame.
How does this medication work?
Like other stimulants, methylphenidate increases levels of the brain chemicals dopamine and to a lesser extent, norepinephrine. These brain chemicals activate areas of the brain that control impulsive actions, attention and body movements, thereby improving symptoms of ADHD. Quillivant® ER chewable tablets release 30% of the dose right away and the rest of the dose later in the day. Quillivant® ER suspension releases 20% of the dose right away and the rest of the dose later in the day. Quillivant® ER chewable tablets and suspension usually work for up to 8-12 hours.
What special instructions should I follow while using this medication?
- Keep all appointments with your doctor and the lab.
- Your doctor may order physical exams, or assessments such as ADHD rating scales and reports from your teachers, before or after starting methylphenidate. This is to make sure it is working well for you and monitor for side effects.
- Do not allow anyone else to use your medication.
What should I do if I forget to take a dose of this medication?
If you forget to take a dose of Quillivant® ER, take the missed dose as soon as you remember. However, if it is more than 4 hours after your scheduled dose, skip the missed dose and continue with your regular schedule. DO NOT double your next dose to try to ‘catch up’.
How do I store this medication?
Keep methylphenidate in the original container, stored at room temperature away from moisture and heat and protected from light. Keep methylphenidate out of reach and sight of children.
How well does the medication work in children and adolescents?
Methylphenidate has been studied and found to improve core symptoms of ADHD (impulsive behaviour, inattention and hyperactivity) in approximately 75% of children and adolescents. It is expected that you may experience functional improvements, including how you handle frustrations and engage in social and peer relationships. If you do not experience a significant improvement with methylphenidate at a younger age, this does not mean that it will not work for you later in life. Whenever possible, the addition of behavioral management strategies (such as rewarding good behaviour and teaching problem-solving techniques) can increase the potential for benefit.
How long should I take the medication for?
Different people take methylphenidate for different lengths of time. From time to time, your doctor should evaluate whether you need ongoing treatment with this medication. Some people only require methylphenidate treatment during particular times of their life such as when they are in school. Other people benefit from ongoing treatment for many years. Your doctor may suggest that you take a “drug holiday” from the methylphenidate treatment for holidays or a period of time in the summer to see if you still need this medication, to allow for growth and to reduce the chance of your body adapting to the effects of this medication and getting reduced benefit from it over time.
