What is Ritalin?

Chemical name of Ritalin is Methylphenidate, which is primarily used for attention-deficit/hyperactivity disorder (ADHD). This is included for treating the children suffering from ADHA and provides positive outcomes. The selected dose of Ritalin to treat ADHD is 10 to 60 mg/day.

This variation is depending on the child’s age and the response towards the therapy. Ritalin is a CNS stimulant. Other included therapeutic approaches of Ritalin in depression treatment, brain injury, narcolepsy, pain, cancer and cognitive impairments and to treat patients with HIV infection. (1)

History

The Ciba-Geigy Pharmaceutical Company was the first marketed Ritalin in 1954, though Methylphenidate is synthesized in 1944. In present ear, instant release and sustained release Methylphenidate is available under Novartis Pharmaceuticals Corporation. Both formulations can be taken orally and have approval obtained from the FDA. (1)

Side effects of Ritalin

Ritalin has low hazardous side effects in therapeutic dose and may not frequently occur in every patient.  Included side effects are

• Stomach ache
• Headache
• Insomnia (sleep disturbance),
• Anorexia (low appetite)

The range of side effects is quite different and dangerous for abusers, when they take Ritalin at overdose. (1,5)

Mechanism of action

Like cocaine, Ritalin also stimulate dopamine receptors, though not followed the same pathway. dopamine receptor is present in  the striatum (part of the brain). In overdose Ritalin causes euphoria due to the activation of the D1 dopamine receptors present in the nucleus accumbency and striato-orbitofrontal cortex. (1)

Dosage

The therapeutic dose of the treatment of ADHD for children varies from 20 to 30 mg/day, though in rare cases, it exceeds up to 60mg/day. The many theoretical approach suggested that daily dose should not go above 60 mg, but no clinical evidence found from the trial’s results.

The dose exceeds 1 mg/kg/day for treating adult patient with ADHD, though in some cases, lower dose also suggested depending upon the patient condition. The mode of administration of the drug is oral for therapeutic purposes, as Ritalin is absolutely absorbed from the GI tract. The intranasal abuse dose of Ritalin is 200 mg, whereas in case of intravenous route, the dose range varies from 40 mg to 1000 mg. (1,2)

Overdoing of Ritalin and it’s symptoms

Usually abusers of Ritalin face the problem of overdosing. The excessive stimulation of the CNS occurs due to overdose of the Ritalin. The overdose effect arises due to acute toxicity of the Ritalin  and provide a similar effect like toxic effect of amphetamine, as they follow similar effect on the brain.

The reported effect of acute intoxication of Ritalin include euphoria, confusion, delirium, hallucinations and toxic psychosis, which are same as amphetamines. The overdose of the Ritalin cause psychosis and that also same as amphetamine abuse.

Psychiatric symptoms include tremendous annoyance with threats of violent activities may occur in Ritalin abuse. An overdose of Ritalin produce aggressiveness,  hallucinations, delirium and panic states. The overdosing of  Ritalin  may contribute exceedingly dangerous effect even fatal outcomes. (1,2,3)

Symptoms of Ritalin Overdose

The associated symptoms of overdose of Ritalin are:

• Vomiting
• Agitation
• Tremors (an involuntary quiver movement)
• Hyperreflexia (overactive reflex)
• Muscletwitching
• Convulsions may be followed by coma
• Euphoria (feeling of happiness)
• Confusion
• Hallucinations (Apparent perception without existing in real world)
• Delirium (restlessness)
• Sweating
• Flushing
• Headache
• Hyperpyrexia (high fever)
• Tachycardia (increased heart beat)
• Palpitations
• Cardiac arrhythmias
• Hypertension
• Mydriasis (increased pupil size)
• Dryness of the mouth
• Rhabdomyolysis(uncontrolled movement or imbalance due to damage in voluntary muscles) (2,3,4)

The duration of overdose effect of Ritalin

Usually, depending upon the formulation the duration of the psychoactive effect of Ritalin varies, like instant release formula provide 3 to 4 hours of effect, whereas it extends up to 8 hours for a sustained release product.

ADHA patient when treated with Ritalin, if the dose of the Ritalin cannot control ADHD symptoms immediately consult with a doctor, it may relate with incorrect dose. Apart from excessive dosing, concurrent administration of certain other types of medication like antidepressant, anticonvulsive and anticoagulant medication provides life-threatening outcomes. Certain types of antacids increase the bioavailability of Ritalin and contributes overdose effect by taking together of both the drugs at a time.

Prolonged used of Ritalin cause tolerance, in which the offered dose cannot produce desired effect due to development of the physiological tolerance. (1,3,4)

Treatment of Ritalin Overdose

The immediate measure after emergency overdose effect of the Ritalin need gastric lavage to evacuate the excess amount of the drug from the stomach in case of oral intake. Usually the procedure needs careful intervention by providing a very accurate calculative dose of  short-acting barbiturate before proceeding the gastric lavage. Otherwise, this will create severe drug- drug interaction.

Other detoxification measure through GI tract include administration of activated charcoal and a cathartic.

The patient may need intensive care unit support like monitoring and supportive care for proper maintaining of adequate circulation and respiration; measure for decreasing the body temperature for hyperpyrexia.

Diuretics  and even hemodialysis may perform to eliminate the excess Ritalin. (2,4)

References

1. W. Alexander Morton, and Gwendolyn G. Stockton, Methylphenidate Abuse and Psychiatric Side Effects; Prim Care Companion J Clin Psychiatry. 2000 Oct; 2(5): 159–164; Retrieve from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC181133/
2. Ritalin; Retrieve from: http://www.drugs.com/ritalin.html
3. Can you overdose on Ritalin? (2014); Retrieve from: http://prescription-drug.addictionblog.org/can-you-overdose-on-ritalin/
4. Methylphenidate Overdose Symptoms and Treatment; Retrieve from: http://www.projectknow.com/research/methylphenidate-overdose/
5. Ritalin Overdose; Retrieve from: http://www.drug-overdose.com/ritalin.htm

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