Methylphenidate

Stimulant medicines for ADHD, such as methylphenidate, can be more complex than other medicines because of special prescribing, dispensing and funding rules that apply to them.

Methylphenidate is a controlled drug

In Aotearoa New Zealand methylphenidate is a controlled drug, which means it's carefully monitored and regulated to make sure it’s used safely. This is because it affects the brain and can be addictive or misused if not taken properly. Because of this, prescribers need to follow special rules when prescribing it, and pharmacies must keep records when they dispense it.

• You can get a prescription with repeats that cover up to 3 months, depending on your prescriber’s decision, but pharmacies can only dispense methylphenidate in 30-day supplies at a time.
• You usually need to pick up the medicine within 7 days of it being dispensed, or the prescription may expire or require reauthorization.
• Once your first supply of a methylphenidate-containing medicine is dispensed at a particular pharmacy, all repeat supplies of the medicine must be dispensed and collected from the same pharmacy.
  
  

Methylphenidate is funded under a Special Authority

In Aotearoa New Zealand methylphenidate is funded under a Special Authority, for people who meet the criteria.

• The term 'Special Authority' refers to a specific kind of approval needed for funding certain subsidised medicines by Pharmac.
• Pharmac is the government agency in New Zealand that decides which medicines and medical devices are publicly funded. Pharmac uses this process to ensure medicines are funded for people who will benefit most from the treatment. Read more about Special Authority.

There are two Special Authorities, depending on the brand: One approval is for brands that are usually tried first and are lower cost such as Ritalin (immediate release), Rubifen (immediate release), Rubifen SR, Methylphenidate Sandoz XR and Methylphenidate ER – Teva. A separate approval is needed for other brands that cost more or are generally used if the first options haven’t worked well or are not suitable such as Concerta and Ritalin LA.

Who can apply? Applications for Special Authority for stimulant medicines used to treat ADHD can be made by specialists such as a paediatrician or psychiatrist, who can apply directly. General practitioners (GPs) or nurse practitioners can also apply, provided they have a written recommendation from a paediatrician or psychiatrist.

Does the Special Authority expire? For stimulant medicines used to treat ADHD, the Special Authority does not expire, as the renewal criteria were removed in 2024, making the approval valid for the patient’s lifetime.

Methylphenidate is available in several forms. Check with your pharmacist which form you're taking.

• Always follow the advice of your healthcare provider and the instructions that come with the medicine. Different brands of methylphenidate tablets and capsules may have different instructions. 
• The dose of methylphenidate will be different for different people, depending on the brand you're taking and your response to the medicine.

Rubifen (5 mg, 10 mg, 20 mg), Rubifen SR (20 mg) or Ritalin (10 mg) tablets

• These are usually given 2 or 3 times each day. 
• This should be in the morning, then around midday and, if necessary, late afternoon. Ideally, these times are about 4 hours apart.
• If you have problems sleeping, take the last dose at least 6 hours before bedtime.
• Swallow the tablets with a glass of water, milk or juice.
• Some tablets can be crushed and mixed with a small amount of soft food such as yogurt, honey or jam. Ask your pharmacist if this is possible with your tablets before doing this.
• If you forget to take your dose, take it as soon as you remember. But if it's nearly time for your next dose, just take the next dose at the right time. Don't take double the dose.

Concerta®, Teva® or Ritalin LA®

• These are usually given once each day, usually in the morning.
• Swallow the tablets or capsules whole, with a glass of water. Don't crush or chew them, as they won't work properly.
• The Ritalin LA capsule can be opened and the contents mixed with a small amount of soft food such as yogurt, honey, jam, or cold apple sauce. Swallow the mixture straight away, without chewing.
• If you forget to take your dose, take it as soon as you remember. But if it's nearly time for your next dose, just take the next dose at the right time. Don't take double the dose.

Here are some things to know when you're taking methylphenidate. Other things may be important as well, so ask your healthcare provider what you should know about.

• If you're taking the Concerta brand of methylphenidate: You may notice the tablet shell in your poo. This is normal because the shell of the tablets doesn't dissolve completely in your gut, but the medicine is still absorbed by your body.  
• Limit or avoid drinking alcohol while you're taking methylphenidate: Alcohol can make the effects of methylphenidate greater and it can make the side effects worse. 
• Be careful when driving or using tools until you know how this medicine affects you: Methylphenidate may give you blurred vision, make you feel dizzy, or affect your focus when you start taking it. 
• Taking other medicines: Methylphenidate interacts with some medicines, herbal supplements and rongoā Māori, so check with your healthcare provider or pharmacist before starting methylphenidate and before starting any new products.

There are supply issues and shortages of methylphenidate in New Zealand because the global demand for ADHD stimulant medicines has risen sharply and is higher than what manufacturers can produce.

• The shortages mostly impact extended-release and modified-release forms of methylphenidate, such as Concerta and Methylphenidate ER – Teva, as well as some sustained-release products like Rubifen SR and Ritalin LA.
• Immediate-release options, like Ritalin IR and Rubifen IR, tend to be easier to find, although availability can still vary and sometimes be limited depending on the region.
• Visit the Pharmac website for information on methylphenidate supply issues(external link).

Note: Even if your medicine shows as available nationally on the supply website, it doesn’t guarantee your local pharmacy will have it. Stock is spread across pharmacies, so availability can vary and some may run out even if others don’t. If your usual brand isn’t available, talk to your healthcare provider or pharmacist about other options such as a different brand, formulation, or dose to help keep your treatment on track.

You may need to take methylphenidate for several months or years, depending on your individual response and needs.

Regular check-ups: You'll have regular check-ups, usually every 6 months or so, to see how well the medicine is working and if any changes are needed.

Medicine holiday: Your doctor may recommend stopping methylphenidate for a while, or reducing the dose. For children, this will normally be during the school holidays and can be called “a medicine break”. This is to check whether it’s still helping.

Teenage reassessment: As your child gets to puberty, or just after, they will be assessed to see if the medicine is still needed, The doctor may stop their methylphenidate. But if the medicine is still helping, they may recommend that your child keeps taking it, even as an adult.

Don't stop methylphenidate suddenly: Talk to your doctor first, it might be best to reduce the dose gradually. This reduces the risk of having extra side effects when you stop taking this medicine.

Like all medicines, methylphenidate can cause side effects, although not everyone gets them. If you're concerned about any symptoms, talk to your healthcare provider. The following information offers some guidance but doesn't include all possible side effects.

Common side effects

Tell your healthcare provider if these side effects bother you.

• Indigestion, tummy pain, nausea (feeling sick).
• Trouble sleeping: Take your methylphenidate dose in the morning. If you're taking more than 1 dose per day, the second or third dose needs to be taken by early afternoon.
• Headache, muscle or joint pains.
• Reduced appetite, weight loss.
• Sweating.
• Dry mouth.
• Blocked nose.
  
  

Tell your healthcare provider immediately or phone Healthline free on 0800 611 116 if these occur

• Anxiety, nervousness, irritability, changes in mood.
• Chest pain, seizures or feelings of increased heart rate.
• Suicidal feelings or behaviour such as agitation, aggression, self-harm, worsening of low mood.

Read more about medicines and side effects and reporting a reaction you think might be a side effect.