Description
Advantages
Because Ritalin is very short acting, it is a good medication to supplement a more long-acting medication (e.g., adding a second dose in the late afternoon or evening when a long- acting preparation might wear off).
Disadvantages
Short acting Ritalin should almost never be used as the sole treatment of ADHD because irritability and other side effects can be caused by multiple, overlapping doses. A dose during the day at school may be needed.
Excerpt from the book: ADHD Medications: Does It Work and Is It Save? Available on Amazon
As far as medications go, Ritalin has a very mixed reputation. For the parents who have seen their child’s self-esteem rise from the depths to sunlight, for those parents who have seen their child’s grades improve overnight from failing to As and Bs, and for those parents who have seen a child’s aggression and impulsivity melt away, Ritalin is a miracle drug. But this neurologic coin has another side. Many parents who have not had direct experiences with the medication will have spoken to a family member, or read a magazine article, or seen something online, so that almost no parent who has come to my office has never heard of Ritalin. Most parents are somewhat familiar with Ritalin, and many parents who have heard of Ritalin before have a negative opinion of it.
What has Ritalin done to garner this dubious reputation? It is not really Ritalin’s fault. The only ingredient in Ritalin is methylphenidate, and methylphenidate is a very short-acting medication. Along with amphetamine, it is the most effective medication to treat ADHD, but from the time that it is swallowed until it ceases to be effective is usually about 3½–4 hours. But children have ADHD all day. Every day. To treat their ADHD by using two or three doses of short-acting meth- ylphenidate exposes a child to potential emotional side effects. As each dose is absorbed, reaches a peak, and then wears off, a roller-coaster effect is created, which leads to emotional volatility throughout the day. This is described in more detail in Chapter 8 on side effects.
And treating a child’s ADHD only during school hours makes no sense either. What about the third grader who takes an hour to complete fifteen minutes of homework? What about the twelve-year-old who has dance practice at 4? Or sees a tutor at 4:30? What about the teenager who is driving home after school and then to a job stocking shelves? Having to take medication three times a day might not only produce the emotional side effects described, but also could lead to a lack of compliance with the medication as prescribed. The teenager driving to his afternoon job at the grocery store forgets to take his afternoon dose of medication and because he is running late, doesn’t go home to get his dose. So, he works without his medication, forgets to stock a whole cart of hamburger buns, and then is fired. If he had been using a longer- acting medication, he might have avoided his termination.
For years, we physicians begged Novartis, the pharmaceutical company that had been producing Ritalin, to come up with a more long-term solution. At the end of the 1990s, Novartis released Ritalin SR. The company combined the raw methylphenidate with cellulose (which is a completely natural ingredient that is the “fiber” in most plants). The cellulose slows the absorption of methylphenidate, pro- ducing a longer-acting medication. Unfortunately, Ritalin SR only extended the effective life of methylphenidate by an hour or two and was discontinued in 2014, but it is still available as a generic.
Ritalin LA (long acting) was released by Novartis in 2005. Ritalin LA comes in a capsule with a mixture of two different beads. Half the beads are simply methylphenidate, released exactly like regular Ritalin. They are absorbed quickly, take effect in 20–30 minutes, and last 3½–4 hours. However, the other half of the beads consist of coated methylphenidate beads using the SODAS® (spheroidal oral drug absorption system) technol- ogy. The methylphenidate in these beads is more slowly absorbed and lasts longer (7–8 hours). The combination of these two beads produces a curve with two peaks (corresponding to the immediate-release beads and the extended-release beads), but it is a much smoother curve than two doses of Ritalin (see Figure 10.1),1 avoiding the “ups and downs” of regular methyl- phenidate and, thus, significantly reducing emotional lability.2
Brand-name Ritalin LA is expensive (more than $400 for sixty brand-name pills or approximately $300 with a GoodRx coupon). A generic is available for much less. The brand name is not prescribed very often anymore because there are so many other better, extended- release options. However, if Ritalin LA is one of the few long-acting medications that your insurance company covers, it is a good medica- tion with which to initiate treatment. The drawback is that the benefi- cial effects last about 7–8 hours. If it is taken early (7 a.m.), it will start wearing off around 3, necessitating an additional dose of the short- acting methylphenidate to last through homework, soccer, tutoring, and after-school jobs.
