1 Ritalin tablet methylphenidate hydrochloride 10 mg immediate release tablets SR 20 mg slow release tablets Consumer Medicine Information What is in this leaflet This leaflet answers some common questions about Ritalin tablets. It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist. The information in this leaflet was last updated on the date listed on the final page. More recent information on the medicine may be available. You should ensure that you speak to your pharmacist or doctor to obtain the most up to date information on the medicine. You can also download the most up to date leaflet from Those updates may contain important information about the medicine and its use of which you should be aware. All medicines have risks and benefits. Your doctor has weighed the risks of you or your child taking this medicine against the benefits they expect it will provide. If you have any concerns about this medicine, ask your doctor or pharmacist. Keep this leaflet with the medicine. You may need to read it again. What Ritalin is used for Ritalin tablets contain the active ingredient methylphenidate hydrochloride. Methylphenidate hydrochloride is a central nervous system stimulant. Like all medicines containing central nervous system stimulants, Ritalin will be given to you only under close medical supervision and after diagnosis. Ritalin tablets have two uses. They are used to treat: Attention Deficit Hyperactivity Disorder (ADHD); and Narcolepsy Your doctor may have prescribed it for another purpose. This medicine should not be used to prevent or treat normal fatigue. ADHD ADHD or hyperkinetic disorder is a behavioural disorder in children, adolescents, and adults. About 3% of children suffer from ADHD, which makes them unable to sit still or concentrate on tasks for any length of time. They may have trouble learning and doing school work. They frequently become difficult to manage, both in school and at home. Ritalin is thought to work by regulating specific chemicals in the brain that affect behaviour. It helps to focus attention, shut out distraction and allows impulsive people to think before they act. If successful, it will enhance an inattentive person's natural ability. Ritalin is part of a treatment program which usually includes physiological, educational, and social therapy. Narcolepsy Narcolepsy is a sleep-attack disorder. It is not a normal fatigue state. People with narcolepsy have recurring attacks of irresistible daytime sleepiness in spite of having enough sleep at night. It can be diagnosed by a doctor by recording wake-sleep patterns. Ask your doctor if you have any questions about why this medicine has been prescribed for you or your child. This medicine is only available with a doctor's prescription and your doctor has special permission to prescribe it. There is not enough information to recommend its use in children under 6 years old. Note: Ritalin is a controlled drug B2. It should be kept in a secure place and under no circumstances should it be given to anyone else. Before you/your child take Ritalin When you must not take it Do not take Ritalin if you or your child are allergic (hypersensitive) RITALIN tablets 1
2 to methylphenidate (the active ingredient in Ritalin) or to any of the other ingredients listed at the end of this leaflet. Some of the symptoms of an allergic reaction may include shortness of breath, wheezing or difficulty breathing; swelling of the face, lips, tongue or other parts of the body; rash, itching or hives on the skin. Do not take Ritalin if you or your child have any of the following medical conditions: periods of severe anxiety, tension or agitation Tourette s syndrome (a condition with uncontrolled speech and body movements or tics) or you have a family history of this disorder glaucoma (increased pressure in the eye) an overactive thyroid or other thyroid problems heart problems such as heart attack, irregular heartbeat, chest pain (angina), heart failure, heart disease or if you were born with a heart problem very high blood pressure (hypertension) or narrowing of the blood vessels (arterial occlusive disease, that can cause pain in the arms and legs) severe depression or other mental illness pheochromocytoma (a rare tumour of the adrenal gland, which sits near the kidney) If you are not sure whether any of the above medical conditions apply to you or your child, check with your doctor. Do not take Ritalin if you or your child are taking a medicine called a monoamine oxidase inhibitor (MAOI) or have been taking it within the past 14 days. Taking Ritalin together with MAOI medicines may cause a serious reaction with a sudden increase in body temperature, extremely high blood pressure and severe convulsions. Ask your doctor or pharmacist if you are not sure if you or your child have been taking one of these medicines. Do not take this medicine after the expiry date printed on the pack or if the packaging is torn or shows signs of tampering. In that case, return it to your pharmacist. Before you/your child start to take it child are allergic to any other medicines, foods, dyes or preservatives. Your doctor will want to know if you or your child are prone to allergies. child have intolerance to lactose or gluten. This medicine contains lactose and wheat starch. child have any of the following medical conditions or behaviours: any heart defects (e.g. structural cardiac abnormality) a family history of sudden death or irregular heart beat hardening of the arteries any other current or previous heart problems any disorders of the blood vessels in the brain, e.g. weakening of the blood vessel (aneurysm), stroke, or inflammation of blood vessels (vasculitis) severe depression, bipolar disorder or other mental illness epilepsy (seizures, convulsions, or fits) high blood pressure alcoholism drug abuse or dependence tics (muscle twitching which is usually in the face or shoulders) or if your brothers or sisters have tics acute mental disorders that cause abnormal thinking and perceptions (psychosis) or feeling unusually excited, over-active and un-inhibited (acute mania) your doctor will have told you if you have this psychotic symptoms such as seeing or feeling things that are not really there (hallucinations) aggressive behaviour suicidal thoughts or behaviour. Your doctor may want to take special precautions if you or your child have any of the above conditions. child are going to have surgery. If you or your child are going to have an operation, tell the doctor that you are on treatment with Ritalin. You should not take Ritalin on the day of your operation if a certain type of anaesthetic is used. This is because there is a chance of a sudden rise in blood pressure during the operation. Tell your doctor if you are pregnant or breast-feeding. Ask your doctor about the risks and benefits of taking Ritalin in this case. Ritalin is not to be used during pregnancy unless specifically prescribed by your doctor. This medicine may affect your developing baby if you take it while you are pregnant. Do not breast-feed during treatment with Ritalin. The active ingredient in Ritalin can pass into the breast milk. Taking other medicines child are taking any other medicines, including medicines that you buy without a prescription from a pharmacy, supermarket or health food shop. RITALIN tablets 2
3 Some medicines and Ritalin may interfere with each other. These include: medicines that increase blood pressure alpha 2 agonists like clonidine (used to treat high blood pressure) oral anticoagulants or warfarin (medicines used to prevent blood clots) some anticonvulsants (medicines used to treat epilepsy or fits) medicines used to treat depression, such as tricyclic antidepressants and MAO inhibitors phenylbutazone (a medicine used to treat pain or fever) medicines that influence the dopaminergic system (used to treat Parkinson s disease or psychosis). You or your child may need to take different amounts of your medicines or you or your child may need to take different medicines. Your doctor and pharmacist have more information. If you have not told your doctor about any of these things, tell him/her before you or your child start taking this medicine. Your doctor and pharmacist have more information on medicines to be careful with or avoid while taking Ritalin. How to take Ritalin Follow all directions given to you by your doctor and pharmacist carefully. They may differ from the information contained in this leaflet. If you do not understand the instructions on the label, ask your doctor or pharmacist for help. How much to take Your doctor will decide on the most suitable dosage according to the individual patient s medical need and response. For children and adolescents, the maximum daily dose of Ritalin tablet(s) is 60 mg. For adults, the maximum daily dose of Ritalin tablet(s) is 60 mg for narcolepsy and 80 mg for ADHD. Do not exceed the recommended dose. Children aged 6 or over Ritalin tablet 10 mg The usual starting dose is 5 mg (half a tablet) once or twice each day. If necessary, the dose can be increased by 5 or 10 mg each week up to a maximum of 60 mg (6 tablets) each day. If the dose is one-half tablet, there is a break-line on the tablet to help you cut it. You can buy a tablet cutter from your pharmacist to make sure the dose is accurate. Ritalin SR tablet 20 mg Your doctor will decide on the most suitable dosage. The usual dose is 20 mg once daily. Adults Ritalin tablet 10 mg The usual dose is 20 to 30 mg (2-3 tablets) each day but some people may need more or less than that. Ritalin SR tablet 20 mg Your doctor will decide on the most suitable dosage. How to take it Take Ritalin SR immediately after meals and preferably after a substantial breakfast. Do not crush or chew Ritalin SR tablets. You can take Ritalin tablets with or without food (e.g. at breakfast and/or lunch). Swallow the tablet(s) with a full glass of water or other liquid. If the tablet(s) upset you or your child's stomach, you or your child can take them with food, but always take them in the same way (e.g. always with food or always without food). That way the effect will always be the same. When to take it If you find that you or your child have trouble sleeping, talk to your doctor about the best time to take the last dose of Ritalin for the day. Each dose is usually taken 1 or 2 hours before the greatest effect is needed. For example, a child may take a dose at 7:00 a.m. so that improved concentration begins when school starts. If the child tends to misbehave during the lunchtime play period, the next dose can be taken before the lunch break. It may be necessary to take a combination of the slow release 20 mg tablets with the immediate release 10 mg tablets to achieve the best results. In some patients Ritalin may cause sleeplessness. To avoid difficulty in falling asleep, the last dose of Ritalin tablets should be taken before 6 p.m. unless the doctor recommends otherwise. The effects of slow release 20 mg tablets are maximised when taken with a meal. Check carefully with your doctor when and how to take this combination. How long to take Ritalin Continue taking Ritalin tablet / Ritalin SR tablet for as long as your doctor tells you. This medicine helps to control your or your child's symptoms but does not cure your condition. Your doctor will check your or your child's progress to make sure the medicine is working and will discuss with you how long your treatment should continue. If you are unsure, talk to your doctor. RITALIN tablets 3
4 Treatment for ADHD varies in length from patient to patient. During treatment for ADHD, your doctor may stop Ritalin every so often (e.g. over weekends or school holidays and long vacations) to see whether it is still needed. Breaks from treatment also help to prevent a slowdown in growth that sometimes happens when children take this medicine for a long time. If you/your child forget to take it If you or your child forget to take a dose of Ritalin, take the dose as soon as you remember. Then make sure to wait the same amount of time as usual before you or your child take the next dose. For example, if there are usually 4 hours between doses, wait 4 hours before taking the next dose and so on for the rest of that day. On the next day go back to your usual times. Do not take a double dose to make up for the one that you or your child missed. Your chance of an unwanted side effect may be increased if you do. If you have trouble remembering when to take your medicine, ask your pharmacist for some hints. If you/your child take too much (overdose) Immediately telephone your doctor or the National Poisons Information Centre, Dunedin (telephone 0800 POISON or ) for advice, or go to Accident and Emergency Department at your nearest hospital if you think that you or anyone else may have taken too much Ritalin. Do this even if there are no signs of discomfort or poisoning. Keep the telephone numbers for these places handy. Some of the symptoms of an overdose may include vomiting, agitation, headache, tremors, muscle twitching, irregular heartbeat, flushing, fever, sweating, dilated pupils, breathing problems, confusion and seizures. While you are taking Ritalin Things you must do Take Ritalin exactly as your doctor has prescribed. Like all stimulants, this medicine may become habit-forming and can be abused by some people. If you or your child take it correctly as instructed by your doctor, abuse or dependence should not be a problem, either now or later in life. Be sure to keep all of your doctor's appointments so that your or your child's progress can be checked. Your doctor will want to check blood pressure, height, weight and do blood tests from time to time to prevent unwanted side effects from happening. If your child is not growing or gaining height or weight as expected treatment with Ritalin may need to be interrupted. If you become pregnant while taking Ritalin, tell your doctor. Your doctor can discuss with you the risks and benefits of taking it while you are pregnant. If you/your child are about to be started on any new medicine, remind your doctor and pharmacist that you/your child are taking Ritalin. Tell any doctor, dentist or pharmacist who treats you/your child that you are taking Ritalin. Things you must not do Do not drink alcohol whilst you are taking Ritalin. Remember that some foods and medicines contain alcohol. Alcohol can worsen some of the unwanted effects of this medicine, such as dizziness and drowsiness. Do not stop treatment without first checking with your doctor. If you/your child suddenly stop taking this medicine, your condition may reappear or you may get unwanted effects such as depression. To prevent this, your doctor may want to gradually reduce the amount of medicine you take each day before stopping it completely. You will need medical supervision after having interrupted the treatment. Do not change the dose without talking to your doctor. If you have the impression that the effect of Ritalin is too strong or too weak, talk to your doctor. Do not take this medicine to treat any other complaints unless your doctor tells you to. Do not give it to anyone else, even if their condition seems similar to yours. Things to be careful of Be careful driving, operating machinery or doing jobs that require you/your child to be alert while you are taking Ritalin until you know how it affects you. This medicine may cause hallucinations, dizziness, drowsiness, blurred vision, or other central nervous system side effects which can affect concentration in some people. If you experience any of these symptoms, do not drive, use machines, or do anything else that needs quick reactions or could be dangerous. Ritalin may give a false positive result when testing for drug use. This includes testing used in sport. Some children taking Ritalin for a long time may have slower than normal growth, but they usually catch up once the treatment is stopped. RITALIN tablets 4
5 Stomach upset, loss of appetite and difficulty sleeping are common, especially at the start of treatment. Your doctor can usually help to reduce these symptoms by lowering the dose of Ritalin or changing the times when the tablets are taken. Side effects Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking Ritalin. All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects. Do not be alarmed by these lists of possible side effects. You may not experience any of them. Ask your doctor or pharmacist to answer any questions you may have. Tell your doctor if you notice any of the following and they worry you: nausea (feeling sick) stomach pain, upset stomach, or indigestion loss of appetite loss of weight and slower growth in children feeling nervous restlessness or inability to sleep dry mouth headache drowsiness dizziness mood changes such as depression or irritability blurred vision or problems focussing your eyes muscle cramps hair loss hives joint pain toothache excessive sweating feeling jittery excessive emotional distress, or emotional excitement Tell your doctor immediately or go to Accident and Emergency at your nearest hospital if you notice any of the following: signs of allergy such as swelling of the face, lips or tongue, shortness of breath, wheezing or troubled breathing as these are signs of a severe allergic reaction weakness or paralysis of limbs or face, difficulty speaking, or unexplained fainting skin rash, itching, red blotches, blisters or peeling of the skin sudden increase in body temperature, sweating, fast heartbeat, chest pain, muscle stiffness and fluctuating blood pressure, which may lead to coma constant "flu-like" symptoms such as chills, fever, sore throat and runny nose, swollen glands, aching muscles or joints abnormal heart rhythm palpitations unusual bleeding or bruising unusual tiredness, shortness of breath when exercising, dizziness, pale skin tremor or involuntary shaking of the body uncontrollable twitching, jerking or writhing movements seizures (fits) or unexplained fainting pain or tightness in the chest fast or irregular heartbeat yellow colour to the skin or eyes, dark coloured urine or light coloured bowel motions vomiting confusion, delusions or hallucinations (seeing or feeling things that are not really there) excitement, overactivity and uninhibited behaviour new or worsening aggressive behaviour severe or persistent headache uncontrolled speech and body movements (Tourette s syndrome) abnormal liver function including liver coma low red blood cell count (anaemia) low platelet count (symptoms are bleeding or bruising more easily than normal) The above side effects may be serious. You may need urgent medical attention. Additional side effects that occurred with other medicines containing the same drug substance of Ritalin: Decrease in number of blood cells (red cells, white cells and platelets) Swelling of the ears (a symptom of allergic reaction); Feeling irritated, aggression, mood changes, abnormal behaviour or thinking, anger, thoughts or attempts of suicide (including completed suicide), excessive awareness of surroundings, feeling unusually excited, over-active and uninhibited (mania), feeling disorientated, changes in sex drive, lack of feeling or emotion, doing things over and over again, being obsessed with one thing, confusion, addiction Temporary muscle weakness, loss of skin sensation or other functions of the body due to a temporary lack of blood supply to the brain (reversible ischemic neurological deficit), migraine Double vision, dilated pupils, trouble seeing Stopped heartbeat, heart attack; fingers and toes feeling numb, tingling and changing colour (from white to blue, then red) RITALIN tablets 5
6 when cold ('Raynaud's phenomenon') Sore throat, shortness of breath; Diarrhoea, constipation; Swelling of face and throat, redness of the skin, large red blotches on the skin appearing within a few hours of taking the medicine; Muscle pain, muscle twitching; Blood in the urine Swelling of the breasts in men Chest pain, tiredness, sudden death Abnormal sounds from heart. Tell your doctor if any of these side effects occur or if you notice anything else that is making you feel unwell. Some people may have other side effects not yet known or mentioned in this leaflet. After taking Ritalin Storage Keep the tablets in the original container until it is time to take a dose. Store Ritalin in a cool dry place, below 30 C. Do not store Ritalin or any other medicine in the bathroom or near a sink. Do not leave it in the car or on window sills. Heat and dampness can destroy some medicines. Ritalin will keep well if it is cool and dry. Keep this medicine where children cannot reach it. A locked cupboard at least one-anda-half metres above the ground is a good place to store medicines. Disposal If your doctor tells you to stop taking this medicine or the expiry date has passed, ask your pharmacist what to do with any medicine you have left over. Product description What it looks like Ritalin 10 mg Round white tablet, marked CG on one side and AB with a break-line on the other; packs of 30 tablets. Ritalin SR 20mg Round white to off white tablet marked CIBA on one side and 16: on the other, packs of 100 tablets Ingredients Ritalin 10 mg tablets contain 10 mg of methylphenidate hydrochloride as the active ingredient. They also contain: lactose calcium phosphate (E341) gelatin magnesium stearate (E572) purified talc (E553b) wheat starch Ritalin SR tablets contain 20mg of methylphenidate hydrochloride as the active ingredient. They also contain: lactose cetostearyl alcohol magnesium stearate (E572) hydroxypropyl methylcellulose (E464) polyoxyl 40 hydrogenated castor oil titanium dioxide talc (E553b) carnauba wax Sponsor Ritalin tablets are supplied in New Zealand by: Novartis New Zealand Limited 109 Carlton Gore Road Newmarket Auckland 1023 PO Box Newmarket Auckland 1149 Telephone = Registered Trademark This leaflet was prepared in October 2014, based on the currently approved data sheet for this product. For Internal Use Only: (rtl291014cnz) based on data sheet (rtl291014inz) RITALIN tablets 6
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Liver Disease & Hepatitis Program Providers: Brian McMahon, MD, Steve Livingston, MD, Lisa Townshend, ANP Primary Care Provider: If you are considering hepatitis C treatment, please read this treatment
MEDICATION INFORMATION FOR PARENTS - STIMULANTS Patient Name is taking Medication Doctor's name If you have any questions about this medicine, please call the office at 631-3510. General Information about
PACKAGE LEAFLET: INFORMATION FOR THE USER ADRENALINE (TARTRATE) STEROP 1 mg/1 ml Solution for injection Adrenaline (Levorenine, Epinephrine) Read all of this leaflet carefully before you start using this
Package Leaflet: Information for the User Zyban 150 mg prolonged release tablets bupropion hydrochloride Read all of this leaflet carefully before you start using this medicine because it contains important
MEDICATION GUIDE ELIQUIS (ELL eh kwiss) (apixaban) tablets What is the most important information I should know about ELIQUIS? For people taking ELIQUIS for atrial fibrillation: People with atrial fibrillation
MEDICATION GUIDE ABSORICA (AB-SORE-I-KAH) (Isotretinoin Capsules) Read the Medication Guide that comes with ABSORICA before you start taking it and each time you get a prescription. There may be new information.
Brand and Generic Names: Trileptal Tablets: 150mg, 300mg, 600mg Liquid Suspension: 300mg/5mL Generic name: oxcarbazepine What is Trileptal and what does it treat? Trileptal (Oxcarbazepine) Oxcarbazepine
New Zealand Consumer Medicine Information DULCOLAX Tablets and Suppositories Bisacodyl What is in this leaflet This leaflet answers some common questions about DULCOLAX. It does not contain all available
St. Luke s MS Center New Patient Questionnaire Name: Date: Birth date: Right or Left handed? Who is your Primary Doctor? Who referred you to the MS Center? List any other doctors you see: Reason you have
MEDICATION GUIDE SYLATRON (SY-LA-TRON) (Peginterferon alfa-2b) Read this Medication Guide before you start taking SYLATRON, and each time you get a refill. There may be new information. This Medication
MEDICATION GUIDE PROCRIT (PROKRIT) (epoetin alfa) Read this Medication Guide: before you start PROCRIT. if you are told by your healthcare provider that there is new information about PROCRIT. if you are
VOLTAREN 50mg Tablets (diclofenac sodium) 75mg SR Tablets (diclofenac sodium) 50mg Dispersible Tablets (diclofenac free acid) What is in this leaflet This leaflet answers some common questions about Voltaren.
CONSUMER MEDICINE INFORMATION What is in this leaflet? This leaflet answers some common questions about Hydrozole It does not contain all the available information. It does not take the place of talking
Anticoagulation in Atrial Fibrillation Patient information RSBAY013 Anticoag A5 V2.indd 1 21/02/2014 17:13 Introduction This leaflet will help you understand your new medicine. Your new medicine is commonly
Patient Information ONZETRA TM (On ze' trah) Xsail TM (Eks'-seil) (sumatriptan nasal powder) 11 mg Read this Patient Information before you start using ONZETRA Xsail and each time you get a refill. There