Ritalin Side Effects, Use, and Risks

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Ritalin, the brand name for methylphenidate, is classified as a central nervous system (CNS) stimulant.¹ Ritalin is federally approved for the treatment of attention-deficit/hyperactivity disorder (ADHD) in adults and children, but some people misuse this medication by taking it without a prescription, mixing it with other drugs, or taking it in a way other than prescribed. Like all medications, you may experience some side effects but the risk of Ritalin side effects increases exponentially with misuse.

What is Ritalin and How is It Used?

Ritalin is a norepinephrine-dopamine reuptake inhibitor.² It is prescribed to help treat hyperactivity and impulse control, commonly seen in ADHD. It is believed that Ritalin helps stimulate dopaminergic activity, thereby increasing dopamine levels. The increased levels of dopamine then increase the ability to increase levels of motivation and attention, thereby reducing distractibility and motor hyperactivity.²

Ritalin can come in a few different forms. Regardless of the form, all are taken orally. These formulations include:³

An immediate-release tablet
A chewable tablet
A liquid solution
A long-acting extended-release liquid
An intermediate-acting extended-release tablet
A long-acting extended-release capsule
A long-acting extended-release tablet
A long-acting extended-release chewable tablet
A long-acting extended-release orally disintegrating tablet

The tablets and chewable tablets, along with the solution, are typically taken two to three times per day by adults, and twice a day by children. It is preferred that Ritalin is taken approximately 35 to 45 minutes prior to meals. Intermediate-acting tablets are taken once or twice a day, and long-acting is taken once a day.

Make sure to consult with your physician if you are pregnant or planning to become pregnant. If you are breastfeeding, tell your doctor if you notice your baby has increased agitation, any sleeping or feeding problems, or has difficulty gaining weight.³

Ritalin Side Effects

Even if you take Ritalin as directed by your doctor, it can produce some side effects, such as:³

Dizziness
Nausea and vomiting
Anxiety/nervousness
Diarrhea
Stomach pain
Heartburn
Sleep disturbances
Drowsiness
Headache
Dry mouth
Weight loss
Restlessness
Back pain
Sweating

If these Ritalin side effects do not dissipate, talk to your doctor and they may adjust your dose or switch your medication to something you can tolerate better. However, if you misuse Ritalin to get high, study longer, or stay awake to keep drinking, your risk of experience side effects is much higher. You also run the risk of experiencing more dangerous Ritalin side effects, such as:^1,³

Dangerously high body temperature
Irregular heartbeat
Heart disease and attack
Seizures
Aggression
Depression
Blurred vision
Difficulty swallowing or breathing
Irregular heartbeat
Fever
Painful erections
Hallucinations
Hives or rash
Paranoia
Shortness of breath
Psychosis
Slow or difficult speech
Swelling of the throat, tongue, mouth, lips, face, or eyes
Weakness or numbness in extremities

While taking Ritalin, avoid the use of alcohol and driving or other activities. This is especially important because Ritalin can mask the depressant effects of alcohol, increasing the risk of alcohol overdose.¹

Risks of Ritalin Use

There are several risks associated with the use of Ritalin, some of which can be decreased by providing your physician with a thorough background of your health. You will want to notify your doctor if you or anyone in your family has experienced:³

Abnormal brain wave test (EEG)
Epilepsy
Mental health disorders, especially bipolar disorder, depression, or suicidal thoughts and behaviors
Muscle twitches or motor tics
Problems with blood circulation in the hands or feet
Problems with the intestines, stomach, or esophagus
Seizures
Substance use disorders, including alcohol
Tourette’s syndrome

If you are prescribed an MAO inhibitor or have taken one within the past 14 days, do not take Ritalin as a dangerous drug interaction can occur. Additionally, Ritalin may cause new or worsening symptoms of psychosis, a risk which is increased if you have a history of bipolar disorder, depression, or other mental health disorders.³

Ritalin use, especially misuse, can increase the risk of serotonin syndrome. These symptoms include:³

Agitation
Diarrhea
Fever
Hallucinations
Increased heart rate
Loss of coordination
Muscle stiffness
Nausea
Shivering
Sweating
Twitching
Vomiting

In addition to the risk of side effects, there is a risk of Ritalin overdose and addiction.

Overdose Risk and Signs

Ritalin overdose is characterized by dangerous symptoms associated with using a toxic amount of this stimulant. Signs of Ritalin overdose may include:³

Abnormally rapid breathing
Agitation
Anxiety
Blurred vision
Coma
Confusion
Dilated pupils
Dizziness
Fainting
Fever
Flushing
Hallucinations
Increased heart rate
Lightheadedness
Muscle pain and/or weakness
Muscle twitches
Pounding in your neck and/or ears
Rapid breathing
Restlessness
Seizure
Sweating
Tremor
Vomiting

Ritalin Withdrawal, Dependence, and Addiction

Ritalin has a “Black Box” warning label, meaning that it has been found to carry a significant risk of adverse effects, including severe psychological or physical dependence.² Research has also suggested that there is a possibility that individuals can develop a tolerance to Ritalin, needing to take a larger dose to achieve the same effects.

Over time, your body may become dependent on Ritalin and need it to function normally. This can happen even if you take your medication as prescribed. In this case, dependence is normal and not a sign of addiction. If you want to quit taking Ritalin, talk to your doctor so they can taper you off the medication to avoid Ritalin withdrawal symptoms.

Conversely, if you misuse Ritalin, you will likely develop more severe dependence. If you suddenly stop using this stimulant, you’ll experience unpleasant and distressing withdrawal symptoms.

Physiological withdrawal symptoms include:^2,4

Chills
Dehydration
Dulled sensations
Extreme fatigue
Extreme hunger
Hypersomnia
Lethargy
Insomnia
Weight gain

Psychological withdrawal symptoms include:^2,4

Anxiety
Crankiness
Craving for Ritalin or alike substances
Drug-related dreams
Dysphoric or depressed mood
Impaired memory
Intense dreams
Irritability
Isolation from others
Loss of interest
No longer finding pleasure in things once enjoyed
Panic attacks
Nightmares
Suicidality
Tiredness

Ritalin Addiction

Diagnostic criteria for a substance use disorder, specifically for stimulants like Ritalin, indicate that a Ritalin addiction may be present within the last 12 months if at least two of the following are true:⁵

Used Ritalin in a larger amount or have used it longer than intended
Had a goal to cut down or control Ritalin use and has been unsuccessful when attempted
Spent a significant amount of time in trying to obtain Ritalin, use it, and/or recover from its effects
Experienced a strong desire to use Ritalin, or had a craving for it
Failed to meet major role obligations, such as employment or family due to Ritalin use
Continued to use Ritalin despite it having harmful effects on social and interpersonal relationships
Given up, or reduced recreational, social, or occupational activities
Been placed in physically hazardous situations due to Ritalin use
Continued to use despite any other psychological problems, such as anxiousness or depression
Developed tolerance, meaning you needed a higher dose to feel the desired effects
Experienced withdrawal symptoms when you suddenly stopped taking this stimulant

Regardless of the diagnostic criteria, there are several other common symptoms of chronic stimulant use, including:⁴

Cardiovascular damage
Extreme fatigue
Hair loss
Hopelessness
Impaired sexual performance
Muscle pain
Nutritional disorders, such as extreme weight loss and anemia
Paranoia
Poor hygiene and self-care
Problematic behaviors (e.g., stealing, taking more doses of medication than prescribed, needing prescriptions early, doctor shopping)
Skin disorders

Another risk for addiction is due to the euphoric high that Ritalin can produce in addition to its effect on improving concentration and alertness.⁶ This is why it is also referred to as a “smart pill” on college campuses, frequently misused during exam periods.

Individuals seeking a high from Ritalin may choose the immediate-release forms, as those tablets are easier to be crushed and administered intranasally compared to other versions. Ritalin, especially the extended-release formulations, is more difficult to administer intranasally or via injection. This may also be a good indicator of a developing addiction and dependency, as Ritalin is intended only for oral administration.

Reduce Ritalin Side Effects and Risks

You can do several things to reduce your risk of negative effects of Ritalin, including:⁷

Becoming well educated on Ritalin
Having your prescriber limit your prescription and consider implementing pill counts
Opting for extended-release medications instead of immediate-release formulas
Using a medication contract with your primary care physician
Communicating with your provider about any side effects or unpleasant reactions

If you feel you, or a loved one, have developed an addiction to Ritalin and are interested in treatment, call us at 800-681-1058 (Who Answers?) to review the best treatment options for your needs.

Resources

National Institute on Drug Abuse. (2020). Commonly Used Drug Charts.
Sherzada, A. (2012). An analysis of ADHD drugs: Ritalin and Adderall.
National Library of Medicine. (2022). Methylphenidate.
Substance Abuse and Mental Health Services Administration. (2021). Treatment for stimulant use disorders.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Substance Abuse and Mental Health Services Administration. (2021). Key substance use and mental health indicators in the United States.
Substance Abuse and Mental Health Services Administration. (2015). Adults with attention deficit hyperactivity disorder and substance use disorders.