Treatment must be initiated under the supervision of a specialist in childhood and/or adolescent behavioural disorders.buy ritalin online

Pre-treatment screening:

Prior to prescribing, it is necessary to conduct a baseline evaluation of a patient’s cardiovascular status including blood pressure and heart rate. A comprehensive history should document concomitant medications, past and present co-morbid medical and psychiatric disorders or symptoms, family history of sudden cardiac/unexplained death and accurate recording of pre-treatment height and weight on a growth chart (see sections 4.3 and 4.4).

Ongoing monitoring:

Growth, psychiatric and cardiovascular status should be continuously monitored (see section 4.4).

• Blood pressure and pulse should be recorded on a centile chart at each adjustment of dose and then at least every 6 months

• Height, weight and appetite should be recorded at least 6 monthly with maintenance of a growth chart

• Development of de novo or worsening of pre-existing psychiatric disorders should be monitored at every adjustment of dose and then at least every 6 months and at every visit

Patients should be monitored for the risk of diversion, misuse and abuse of methylphenidate. buy ritalin online

Posology

Methylphenidate is taken once or twice daily.

Dose titration

Careful dose titration is necessary at the start of treatment with methylphenidate. Dose titration should be started at the lowest possible dose.

The maximum daily dose is 60 mg.

Other strengths of this medicinal product and other methylphenidate-containing products may be available.

Paediatric population over 6 years

Begin with 5 mg once or twice daily (e.g. at breakfast and lunch), increasing the dose and frequency of administration if necessary by weekly increments of 5 – 10 mg in the daily dose. Doses above 60 mg daily are not recommended. The total daily dose should be administered in divided doses. Methylphenidate is not indicated in children less than 6 years of age.

The last dose should, in general, not be given within 4 hours before bedtime in order to prevent disturbances in falling asleep.

However, if the effect of the drug wears off too early in the evening, disturbed behavior and/or inability to go to sleep may recur. A small evening dose may help to solve this problem.

The pros and cons of a small evening dose versus disturbances in falling asleep should be considered.buy ritalin online

Long term (more than 12 months) use in children and adolescents

The safety and efficacy of long term use of methylphenidate has not been systematically evaluated in controlled trials. Methylphenidate treatment should not and need not, be indefinite. Methylphenidate treatment is usually discontinued during or after puberty. The physician who elects to use methylphenidate for extended periods (over 12 months) in children and adolescents with ADHD should periodically re-evaluate the long term usefulness of the drug for the individual patient with trial periods off medication to assess the patient’s functioning without pharmacotherapy. It is recommended that methylphenidate is de-challenged at least once yearly to assess the child’s condition (preferable during school holidays). Improvement may be sustained when the drug is either temporarily or permanently discontinued.buy ritalin online

Dose reduction and discontinuation

Treatment must be stopped if the symptoms do not improve after appropriate dosage adjustment over a one-month period. If paradoxical aggravation of symptoms or other serious adverse events occur, the dosage should be reduced or discontinued.

Adults

Methylphenidate is not licensed for use in adults with ADHD. Safety and efficacy have not yet been established in this age group.buy ritalin online

Elderly population

Methylphenidate should not be used in the elderly. Safety and efficacy has not been established in this age group.

Paediatric population under 6 years of age

Methylphenidate should not be used in children under the age of 6 years. Safety and efficacy in this age group has not been established.

Hepatic impairment

Methylphenidate has not been studied in patients with hepatic impairment. Caution should be exercised in these patients.

Renal impairment

Methylphenidate has not been studied in patients with renal impairment. Caution should be exercised in these patients.

Method of administration

Methylphenidate should be taken with a drink of water.buy ritalin online