Ritalin Side Effects, Use, and Risks

Jessica Payne, LMSW, CAADC Info icon
Calendar icon Last Updated: 05/16/2022

Reading Time: 6 minutes

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 800-926-9037 (Info iconWho Answers?) to review the best treatment options for your needs.

Resources

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