Dexmethylphenidate Patient Tips

Medically reviewed by Carmen Pope, BPharm. Last updated on Sep 23, 2025.

1. How it works

• Dexmethylphenidate is used to treat Attention Deficit Hyperactivity Disorder (ADHD).
• Dexmethylphenidate is one of two mirror-image forms (isomers) found in regular methylphenidate. Regular methylphenidate contains both the d-form (dexmethylphenidate) and the l-form, but the d-form is much more pharmacologically active and potent than the l-form.
• Dexmethylphenidate works by blocking the reuptake of dopamine and norepinephrine in the brain, particularly in the prefrontal cortex. This increases concentrations of these neurotransmitters at synapses, improving attention and reducing hyperactivity/impulsiveness in ADHD patients. It primarily targets dopamine transporters while having less effect on other mechanisms compared to amphetamines.
• Dexmethylphenidate belongs to the drug class called central nervous system (CNS) stimulants.

2. Upsides

• Used to treat ADHD (Attention Deficit Hyperactivity Disorder) in adults and children 6 years and older.
• Use in addition to other nonpharmacological treatments such as psychotherapy, education, and social integration advice.
• Dexmethylphenidate is available as immediate-release tablets (2.5 mg, 5 mg, and 10 mg) and extended-release capsules (5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, and 40 mg).
• Generic dexmethylphenidate is available.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• A headache, abdominal pain, decreased appetite, nausea, nervousness, and fever. May also cause muscle twitching, sleeplessness, increased blood pressure, and a fast heartbeat.
• Dexmethylphenidate carries a Boxed Warning for a high abuse potential that can lead to addiction, overdose, and death. Your healthcare provider will assess your risk before prescribing, educate about risks and proper storage, and continuously monitor you for abuse signs throughout treatment. The risk of dependence is greater with the extended-release capsules and in people with a history of drug dependence and alcoholism. Psychotic episodes have also been reported, particularly with overuse. Periodically re-evaluate the need for dexmethylphenidate.
• May impair judgment or reaction skills. Exercise caution before driving or operating machinery until the full effects of dexmethylphenidate are known.
• Screen people before prescribing dexmethylphenidate for the presence of cardiac disease. Ask about their cardiovascular history and family history of sudden death or ventricular arrhythmia, and conduct a physical exam.
• May aggravate preexisting symptoms of anxiety, tension, and agitation. May precipitate the emergence of psychotic thoughts such as hallucinations, delusions, or mania in people without a prior history of such thoughts. Discontinuation of treatment may be appropriate.
• May not be suitable for people with certain heart conditions, glaucoma, a history of tics or a family history of Tourette's syndrome, certain psychiatric disorders, a history of alcohol overuse, or drug dependence. Has been associated with an increased risk of sudden death in people with structural heart abnormalities or other serious heart problems; may also increase the risk of a stroke or heart attack in adults.
• May increase the risk of seizures and peripheral circulatory problems and cause visual problems.
• Reports indicate some temporary slowing of growth may occur when long-term dexmethylphenidate is given to children. Doctors should monitor height and weight and consider treatment interruption if growth suppression is suspected.
• Rare cases of priapism (painful erections lasting more than 6 hours) have been reported.
• May interact with some other medications including monoamine oxidase inhibitors (MAO inhibitors) (do not use within 14 days of discontinuation of an MAO inhibitor), halogenated anesthetics (do not take dexmethylphenidate on the day of surgery), coumarin anticoagulants, anticonvulsants, antidepressants, and drugs used to treat high blood pressure.
• Alcohol may contribute to the side effects of dexmethylphenidate and should be avoided.
• Classified as a Schedule II controlled substance, meaning that dexmethylphenidate has a high potential for abuse. Keep personal supplies of dexmethylphenidate in a safe place, out of view of potential drug seekers.
• Tablets should be administered twice daily, at least 4 hours apart.
• Should not be used in children under the age of six.
• Only use in pregnant women if the potential benefits justify the risks. There are no adequate controlled studies in humans of use during pregnancy, animal studies have not shown any evidence of a teratogenic effect; however, delayed fetal skeletal ossification and post-weaning body weight gain in male offspring have been observed. It is unknown if dexmethylphenidate is excreted into human breast milk, and a breastfeeding infant should be monitored if dexmethylphenidate tablets are administered to a breastfeeding woman.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

• Dexmethylphenidate treats ADHD in adults and children 6+ years, and is used alongside psychotherapy and education. Common side effects include headache, appetite loss, nausea, nervousness, and fever. It carries a boxed warning for high abuse potential leading to addiction, overdose, and death. Healthcare providers assess risk, educate patients, and monitor continuously. Extended-release forms pose higher dependence risk, especially in those with substance abuse history. May cause psychotic episodes with overuse and impair driving ability.

5. Tips

• Immediate-release dexmethylphenidate tablets are usually taken twice daily, at least four hours apart. Ensure that the last dose is not taken any later than 6 pm. Extended-release capsules are taken once daily, in the morning.
• May be taken with or without food.
• Take exactly as directed by your doctor and never increase the dosage without his or her advice.
• Swallow extended-release capsules whole with a glass of water; do not chew, divide, or crush. For people who have difficulty swallowing, the capsule may be opened and the contents mixed with applesauce then swallowed immediately.
• Do not drive or operate machinery if dexmethylphenidate impairs your judgment or reaction times.
• Seek medical advice if any new numbness, pain, skin color change, sensitivity, or unexplained wounds occur in fingers or toes.
• Avoid alcohol because it may potentiate the side effects of dexmethylphenidate.
• Seek urgent medical attention if you develop any chest pain, shortness of breath, or if fainting occurs while taking dexmethylphenidate. Call your doctor if you have any new or worsening mental symptoms such as hallucinations, delusions, or hearing voices. Seek medical advice if symptoms persist or worsen despite treatment.
• Seek medical advice if your fingers or toes become numb or painful, the skin changes color, or breaks down. Seek emergency attention if painful, prolonged erections occur.
• Tell your doctor if you are pregnant, intending to become pregnant, or breastfeeding because dexmethylphenidate may not be suitable for you.

6. Response and effectiveness

• Initial peak concentrations of dexmethylphenidate are reached within an hour to an hour and a half.
• Some symptom relief may be noticed after one to two hours; however, it may take up to two weeks before the full effects of dexmethylphenidate are seen.
• Extended-release capsules have a two-phase release system. Half the dose is provided in immediate-release beads and the other half in delayed-release beads. One single extended-release capsule provides the same amount of active ingredient as two immediate-release tablets given four hours apart.
• Dexmethylphenidate is approximately twice as potent as methylphenidate.

7. Interactions

Medicines that interact with dexmethylphenidate may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with dexmethylphenidate. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with dexmethylphenidate include:

• anticoagulants (blood thinners) such as apixaban, dabigatran, heparin, or warfarin
• anticonvulsants, such as phenytoin, phenobarbital, or primidone
• antidepressants, such as amitriptyline, amoxapine, citalopram, clomipramine, desipramine, doxepin, fluoxetine, fluvoxamine, imipramine, isocarboxazid, nortriptyline, paroxetine, phenelzine, protriptyline, sertraline, trimipramine, and venlafaxine. Do not use within 14 days of discontinuation of an MAO inhibitor
• decongestants, such as phenylephrine or pseudoephedrine
• high blood pressure medications, such as ACE Inhibitors, alpha-blockers, ARBs, beta-blockers, calcium channel blockers, or diuretics
• others, such as halogenated anesthetics (do not take dexmethylphenidate on the day of surgery) or guanfacine.

Avoid drinking alcohol or taking illegal or recreational drugs while taking dexmethylphenidate. Antacids should not be taken with the extended-release form of dexmethylphenidate.

Note that this list is not all-inclusive and includes only common medications that may interact with dexmethylphenidate. You should refer to the prescribing information for dexmethylphenidate for a complete list of interactions.

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Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use dexmethylphenidate only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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