Issues for Surgery |
Risk of exacerbation of attention deficit hyperactivity disorder (ADHD) if omitted. Risk of perioperative hypertension and arrhythmias if continued (see Interaction(s) with Common Anaesthetic Agents). Risk of antagonising effect of sedative drugs if continued (see Interaction(s) with Common Anaesthetic Agents). |
Advice in the Perioperative period |
Elective Surgery Omit dose(s) on day of operation1, 2, 3, 4, 5, 6, 7, 8, 9. Emergency Surgery If dose(s) already taken on day of operation warn session Anaesthetist to avoid halogenated anaesthetics (see Interaction(s) with Common Anaesthetic Agents below). Monitor blood pressure (BP) closely. Post-operative Advice Restart on first post-operative day. Patients with Dysphagia Patients with Restricted Gastrointestinal Lumen |
Interaction(s) with Common Anaesthetic Agents |
Inhalational Anaesthetics Methylphenidate is an indirectly-acting sympathomimetic, and might be expected to increase the risk of hypertension and arrhythmias if used with inhalational anaesthetics11, 12. Manufacturers of various brands of methylphenidate advise withholding on the day of surgery if use of halogenated anaesthetics (e.g. sevoflurane) is planned due to the potential for a hypertensive reaction1, 2, 3, 4, 5, 6, 7, 8, 9. Antagonism of Sedative Drugs Methylphenidate increases the analgesic effects of opioids, including morphine, hydromorphone and oxycodone, but reduces the sedative and respiratory depressant effects11. A case report describes difficulty sedating a child taking methylphenidate despite administration of midazolam and ketamine. Methylphenidate may possibly antagonise the effect of sedative drugs, and may also be associated with an increased incidence of vomiting11 - hence withholding methylphenidate on the day of surgery may be prudent for any form of sedation or general anaesthesia7, 11. CNS Excitation (Serotonin Syndrome) The manufacturers note that serotonin syndrome has been reported when methylphenidate has been co-administered with serotonergic medications1. They recommend monitoring for symptoms of serotonin syndrome with concomitant use of serotonergic products and discontinuing methylphenidate if serotonin syndrome is suspected1. There are no case reports describing interactions between methylphenidate and serotonergic drugs in the literature so the clinical relevance of this is not known; however, amphetamines are known to increase serotonin release so bear the possibility in mind if co-prescribing opioids that are weak serotonin reuptake inhibitors (e.g. fentanyl, pethidine). |
Interaction(s) with other Common Medicines used in the Perioperative Period |
Linezolid Concomitant treatment with methylphenidate and linezolid is predicted to increase the risk of elevated blood pressure – avoid concomitant use1, 10. Seizure threshold Methylphenidate may lower the seizure threshold1, 11; concurrent use with other drugs that lower the seizure threshold (e.g. tramadol) might result in additive effects11. CNS Excitation (Serotonin Syndrome) The manufacturers note that serotonin syndrome has been reported when methylphenidate has been co-administered with serotonergic medications1. They recommend monitoring for symptoms of serotonin syndrome with concomitant use of serotonergic products and discontinuing methylphenidate if serotonin syndrome is suspected1. There are no case reports describing interactions between methylphenidate and serotonergic drugs in the literature so the clinical relevance of this is not known; however, amphetamines are known to increase serotonin release so bear the possibility in mind if co-prescribing serotonergic medications (e.g. ondansetron, methylthioninium chloride). |
Further Information |
Withdrawal Abrupt cessation is not recommended10; careful supervision is needed as withdrawal may unmask depression and chronic over-activity1. |
References |
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