Brand names include: Ritalin, Concerta, Methylphenidate XR ARX, Methylphenidate-teva Xr

What is it?

Methylphenidate is a prescription-only medication that contains the active ingredient methylphenidate hydrochloride. It is a psychostimulant commonly prescribed in the treatment of Attention Deficit Hyperactivity Disorder (ADHD)1. It is prescribed usually as an oral medication but also comes in patch or injection form.

How does it work?

Methylphenidate’s primary mechanism of action is on the central nervous system2. It leads to increased dopamine and norepinephrine levels within the brain which has effects of cognition, executive function and emotional regulation1,4. Specifically, it works to increase attention and decrease hyperactivity and impulsivity in patients with diagnosed ADHD3

What are it’s uses?

Methylphenidate is a first-line medication used in the treatment of ADHD which is one of the most common childhood disorders and can continue through adolescence and adulthood. Other uses of the medication include for the treatment of Narcolepsy.

What are the side effects and risks?

The adverse effects of Methylphenidate include but are not limited to3,4:

decreased appetite or weight loss (may be used for performance enhancement in aesthetic or weight making sports)

  • headache
  • abdominal pain
  • anxiety
  • insomnia
  • psychosis
  • paranoia
  • seizures
  • palpitations
  • tachycardiac (high heart rate)
  • chest pain
  • arrhythmias (irregular heart rate)
  • sudden cardiac death or stroke.

The risk to athletes in particular with misuse of a stimulant medication include effects on the cardiovascular system with increases in both heart rate and blood pressure1,2. This may put increased stress on the cardiac system of an exercising athlete.

This substance meets at least two of the following three criteria, as determined by the World Anti-Doping Agency (WADA):

  • It has the potential to enhance or does enhance sports performance.
  • It poses an actual or potential health risk to the athlete.
  • It violates the spirit of sport (as defined in The Code).

The Prohibited List is updated yearly after consultation with scientific, medical, and anti-doping experts to ensure that it aligns with the latest medical and scientific evidence and doping trends.

What if an athlete has been prescribed methylphenidate as treatment for a medical condition?

Due to the potential performance enhancing effects of Methylphenidate in sport, higher level athletes require a Therapeutic Use Exemption (TUE) to use the medication In Competition. If an athlete is prescribed Methylphenidate by a medical practitioner, they may be eligible for a TUE.

The TUE application for Methylphenidate must include:

  • A completed TUE application form signed by the treating doctor and athlete.
  • Detailed clinical letter(s) from treating specialist(s) that includes:
    • diagnosis – including diagnostic tools used (must refer to DSM V criteria)
    • age of onset of ADHD symptoms and of diagnosis
    • outcome of trials of alternative medications, or behaviour modification therapy, and
    • current treatment, including medication/s, dose and route of administration.
  • Copies of any ADHD diagnostic tests or rating scales (e.g. Connors, DIVA). If the clinical letters do not contain adequate detail, you will need to supply supplementary reports (if available) that support the diagnosis from:
    • a treating psychologist a schoolteacher other practitioner, and/or a parent/guardian.
    • The opinion of a second specialist will be necessary if the initial diagnosis is made after the age of 18 years, and the medical and supplementary reports cannot verify the onset of symptoms in childhood.
  • More information for prescribing practitioners can be found on these WADA TUE Physician Guidelines [PDF 80KB]

References:

1 Faraone S.V. The pharmacology of amphetamine and methylphenidate: relevant to eh neurobiology of attention-deficit/hyperactivity disorder and other psychiatric comorbidities. Neurosci Biobehav Rev 2018;87:255-270.

2 Garcia-Argibay M, Burkner P-C, Lichtenstein P et al. Methylphenidate and short-term cardiovascular risk. JAMA Netw Opne 2024;7(3): e241349.

3 NPS Medicine wise. Full Product Information Methylphenidate XR ARX - Methylphenidate XR ARX - NPS MedicineWise

4 Berezanskaya J, Cade W, Best TM et al. ADHD prescription medications and their effect on athletic performance: a systematic review and meta-analysis. Sports Med Open 2022;8:5.