Methylphenidate

Methylphenidate is a prescription medication used to treat Attention-Deficit Hyperactivity Disorder (ADHD). Methylphenidate belongs to a group of drugs called central nervous system (CNS) stimulants, which works by changing the amount of natural substances in the brain to decrease impulsiveness and hyperactivity.

This medication comes in tablet, extended-release (long-acting) tablet, extended-release (long-acting) capsule, extended-release (long-acting) chewable tablet, extended-release (long-acting) dissolvable tablet, patch, solution, and suspension forms. It is usually taken 1, 2, or 3 times a day (depending on the form of medication prescribed).

The tablets and oral solution should be taken 30 to 45 minutes before a meal. The capsule, chewable tablet and suspension forms may be taken with or without food. 

The extended-release (long-acting) chewable tablet is to be taken once daily, in the morning, with or without food.

The extended-release (long-acting) dissolvable tablet is to be taken once daily, in the morning, with or without food. The dissolvable tablet dissolves on your tongue. Let it completely dissolve before swallowing.

Do not crush, chew, or divide extended-release forms. Swallow the extended-release forms whole. If you are unsure about if your tablets can be crushed or chewed, ask your doctor or pharmacist. 

Common side effects of methylphenidate are headache, decreased appetite, and stomach ache.

Methylphenidate is a prescription medication used to treat attention-deficit hyperactivity disorder (ADHD).

Certain forms may be used in children 6 years and older. 

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Methylphenidate may be found in some form under the following brand names:

• Adhansia XR

• Concerta

• Cotempla XR-ODT

• Daytrana

• Jornay PM

• Metadate CD

• Metadate ER

• Methylin

• Methylin ER

• QuilliChew ER

• Quillivant XR

• Ritalin

• Ritalin LA

Serious side effects have been reported with methylphenidate. See “Methylphenidate Precautions” section.

The most common side effects of methylphenidate include:

• poor appetite
• nausea
• vomiting
• stomach pain
• weight loss
• tics
• trouble sleeping
• mood swings
• dizziness
• indigestion
• increased blood pressure
• irritability
• anxiety
• dry mouth
• fast heartbeat
• redness, small bumps, itching where you apply methylphenidate patch

This is not a complete list of methylphenidate side effects. Ask your doctor or pharmacist for more information.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all of the medicines that you or your child take including prescription and nonprescription medicines, vitamins, and herbal supplements. Methylphenidate and some medicines may interact with each other and cause serious side effects. Sometimes the doses of other medicines will need to be adjusted while taking methylphenidate.

Your doctor will decide whether methylphenidate can be taken with other medicines.

Especially tell your doctor if you or your child takes:

• anti-depression medicines including MAOIs
• seizure medicines
• blood thinner medicines
• blood pressure medicines
• cold or allergy medicines that contain decongestants

Know the medicines that you or your child takes. Keep a list of your medicines with you to show your doctor and pharmacist.

Do not start any new medicine while taking methylphenidate without talking to your doctor first.

Methylphenidate is a federally controlled substance (CII) because it can be abused or lead to dependence. Keep methylphenidate in a safe place to prevent misuse and abuse. Selling or giving away methylphenidate may harm others and is against the law.

Tell your doctor if you or your child has ever abused or been dependent on alcohol, prescription medicines, or street drugs.

The following have been reported with use of methylphenidate and other stimulant medicines.

• Heart-related problems:
  • sudden death in patients who have heart problems or heart defects
  • stroke and heart attack in adults
  • increased blood pressure and heart rate

Tell your doctor if you or your child have any heart problems, heart defects, high blood pressure, or a family history of these problems. Your doctor should check you or your child carefully for heart problems before starting methylphenidate.

Your doctor should check your or your child's blood pressure and heart rate regularly during treatment with methylphenidate.

Call your doctor right away if you or your child has any signs of heart problems such as chest pain, shortness of breath, or fainting while taking methylphenidate.

• Mental (psychiatric) problems:
  • All Patients
    • new or worse behavior and thought problems
    • new or worse bipolar illness
    • new or worse aggressive behavior or hostility
  • Children and Teenagers
  • new psychotic symptoms (such as hearing voices, believing things that are not true, are suspicious) or new manic symptoms

Tell your doctor about any mental problems you or your child have, or about a family history of suicide, bipolar illness, or depression.

Call your doctor right away if you or your child have any new or worsening mental symptoms or problems while taking methylphenidate, especially seeing or hearing things that are not real, believing things that are not real, or are suspicious.

• Circulation problems in fingers and toes [Peripheral vasculopathy, including Raynaud’s phenomenon]:
  • Fingers or toes may feel numb, cool, painful
  • Fingers or toes may change color from pale, to blue, to red

Tell your doctor if you have or your child has numbness, pain, skin color change, or sensitivity to temperature in the fingers or toes. Call your doctor right away if you have or your child has any signs of unexplained wounds appearing on fingers or toes while taking this medication.

• Long, painful erections. These have occurred at higher doses. Seek immediate medical attention if prolonged erections occur. 
• Slowing of growth (height and weight) in children. 

Methylphenidate may cause other serious side effects, including:

• seizures, mainly in patients with a history of seizures
• slowing of growth (weight and height)
• eyesight changes or blurred vision
• allergic skin rash (patch form). Stop using methylphenidate patch and see your doctor right away if you have swelling or blisters at or around the application site. You may have a skin allergy to the patch. People who have skin allergies to methylphenidate patch may develop an allergy to all medicines that contain methylphenidate, even those methylphenidate medicines that are taken by mouth.

Do not take methylphenidate if you or your child:

• are very anxious, tense, or agitated
• have an eye problem called glaucoma
• have tics or Tourette’s syndrome, or a family history of Tourette's syndrome. Tics are hard to control repeated movements or sounds.
• are taking or have taken within the past 14 days an anti-depression medicine called a monoamine oxidase inhibitor or MAOI.
• are allergic to anything in methylphenidate dosage forms

Methylphenidate should not be used in children less than 6 years old because it has not been studied in this age group.

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of methylphenidate, there are no specific foods that you must exclude from your diet when receiving methylphenidate.

Before starting methylphenidate, tell your or your child's doctor about all health conditions (or a family history of) including:

• are allergic to methylphenidate
• heart problems, heart defects, high blood pressure
• mental problems including psychosis, mania, bipolar illness, or depression
• tics or Tourette's syndrome
• seizures or have had an abnormal brain wave test (EEG)
• circulation problems in fingers and toes
• glaucoma
• phenylketonuria (PKU). Methylphenidate ER (extended-release) chewable tablets contain phenylalanine as part of the artificial sweetener, aspartame. The artificial sweetener may be harmful to people with PKU or who are allergic to phenylalanine.
• skin problems such as eczema or psoriasis, or have skin reactions to soaps, lotions, make-up, or adhesives/glues (patch form)

Tell your doctor if you or your child is pregnant, planning to become pregnant, or breastfeeding.

Tell your doctor about all of the medicines that you or your child take including prescription and nonprescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant. It is not known if methylphenidate will harm your unborn baby.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Methylphenidate falls into category C. There are no adequate animal or human studies or studies in animals have shown a harmful and undesired effect on the unborn baby, yet there are no adequate and well-controlled studies in pregnant women.

This medication may be given to a pregnant woman if her healthcare provider believes that its benefits to the pregnant woman outweigh any possible risks to her unborn baby.

A pregnancy exposure registry monitors the outcomes of pregnant women taking certain forms of methylphenidate. Register for the National Pregnancy for Psychostimulants at 1-866-961-2388.

Tell your doctor if you are breastfeeding or plan to breastfeed. It is not known if methylphenidate is excreted in human breast milk or if it will harm your nursing baby.

Take methylphenidate exactly as prescribed by your doctor. Follow the directions on your prescription label carefully

• Daytrana (methylphenidate patch)
  • Use Daytrana exactly as your doctor tells you to.
  • Your doctor may change your dose if needed.
  • Apply Daytrana to your hip 2 hours before an effect is needed.
  • Do not wear Daytrana longer than 9 hours a day.
  • Apply Daytrana to a different hip each day.
  • Do not cut Daytrana patches.
  • Parents or caregivers should apply and remove Daytrana for their child if the child is not responsible enough to do so
  • Your doctor may stop Daytrana treatment to check your ADHD symptoms.
  • Your doctor may do certain blood tests and check your heart and blood pressure while you use Daytrana.
  • If you forget to apply a patch in the morning, you may apply the patch later in the day. You should remove your patch at the usual time of day to lower the chance of side effects later in the day.
  • If you have loss of appetite or trouble sleeping in the evening, ask your doctor if you can take the patch off earlier in the day.
  • Contact with water while bathing, swimming, or showering can make the patch not stick well or make it fall off. If your patch falls off, do not touch the sticky side of the patch with your fingers. You may apply a new patch to a different area on the same hip. If you have to replace a patch that has fallen off, the total wear time for the first and second patch should not be more than a total of 9 hours in 1 day. Do not reapply the same patch that fell off.
  • If you wear Daytrana longer than 9 hours, or if you wear more than 1 patch at a time, you have used too much Daytrana. Remove all Daytrana patches and wash the application sites right away. Call your local poison control center or go to the nearest hospital emergency room right away if you have vomiting, agitation, shaking, confusion or mental changes, see things that are not there (hallucinations), sweating, redness in your face, headache, or heartbeat changes.
• Ritalin (regular release tablets)
  • Take Ritalin exactly as prescribed. Your doctor may adjust the dose until it is right for you or your child.
  • Ritalin is usually taken 2 to 3 times a day.
  • Take Ritalin 30 to 45 minutes before a meal.
  • From time to time, your doctor may stop Ritalin treatment for a while to check ADHD symptoms.
  • Your doctor may do regular checks of the blood, heart, and blood pressure while taking Ritalin. Children should have their height and weight checked often while taking Ritalin. Ritalin treatment may be stopped if a problem is found during these check-ups.
  • If you or your child takes too much Ritalin or overdoses, call your doctor or poison control center right away, or get emergency treatment.
• Ritalin SR (extended release tablets)
  • Take Ritalin-SR exactly as prescribed. Your doctor may adjust the dose until it is right for you or your child.
  • Take Ritalin-SR 30 to 45 minutes before a meal. The effect of a dose of Ritalin-SR usually lasts about 8 hours.
  • Do not chew or crush Ritalin-SR tablets. Swallow Ritalin-SR tablets whole with water or other liquids. Tell your doctor if you or your child cannot swallow Ritalin-SR whole. A different medicine may need to be prescribed.
  • From time to time, your doctor may stop Ritalin-SR treatment for a while to check ADHD symptoms.
  • Your doctor may do regular checks of the blood, heart, and blood pressure while taking RITALIN-SR. Children should have their height and weight checked often while taking Ritalin-SR. Ritalin-SR treatment may be stopped if a problem is found during these check-ups.
  • If you or your child takes too much Ritalin-SR or overdoses, call your doctor or poison control center right away, or get emergency treatment.
• Ritalin LA (extended release capsule)
  • Take Ritalin LA exactly as prescribed. Your doctor may adjust the dose until it is right for you or your child. 
  • Take Ritalin LA once a day in the morning. Ritalin LA is an extended-release capsule. It releases medicine into your body throughout the day. 
  • Swallow Ritalin LA capsules whole with water or other liquids. If you cannot swallow the capsule, open it and sprinkle the medicine over a spoonful of applesauce. Swallow the applesauce and medicine mixture without chewing. Follow with a drink of water or other liquid. Never chew or crush the capsule or the medicine inside the capsule. 
  • Ritalin LA should not be taken with alcohol. This may result in a more rapid release of the dose of Ritalin LA
  • From time to time, your doctor may stop Ritalin LA treatment for a while to check ADHD symptoms. 
  • Your doctor may do regular checks of the blood, heart, and blood pressure while taking Ritalin LA. Children should have their height and weight checked often while taking Ritalin LA. Ritalin LA treatment may be stopped if a problem is found during these check-ups. 
  • If you or your child takes too much Ritalin LA or overdoses, call your doctor or poison control center right away, or get emergency treatment.
• Metadate CD (methylphenidate extended release capsule) 
  • Take Metadate CD exactly as prescribed. Your doctor may adjust the dose until it is right for you or your child.
  • Take Metadate CD once each day in the morning before breakfast. Metadate CD is an extended release capsule. It releases medicine into your body throughout the day.
  • Metadate CD can be taken with or without food.
  • Swallow Metadate CD capsules whole with water or other liquids. If you cannot swallow the capsule, open it and sprinkle the medicine over a spoonful of applesauce. Swallow the applesauce and medicine mixture without chewing. Follow with a drink of water or other liquid. Never chew or crush the capsule or the medicine inside the capsule.
  • Metadate CD should not be taken with alcohol. This may result in a more rapid release of the dose of Metadate CD.
  • From time to time, your doctor may stop Metadate CD treatment for a while to check ADHD symptoms.
  • Your doctor may do regular checks of the blood, heart, and blood pressure while taking Metadate CD. Children should have their height and weight checked often while taking Metadate CD. Metadate CD treatment may be stopped if a problem is found during these check-ups.
  • If you or your child takes too much Metadate CD or overdoses, call your doctor or poison control center right away, or get emergency treatment.
• Metadate ER (methylphenidate extended release tablet)
  • Take Metadate ER exactly as prescribed. Your doctor may adjust the dose until it is right for you or your child.
  • Take Metadate ER once a day. Metadate ER is an extended release tablet. It releases medicine into your body throughout the day.
  • Do not chew or crush Metadate ER tablets. Swallow Metadate ER tablets whole with water or other liquids. Tell your doctor if you or your child cannot swallow Metadate ER whole. A different medicine may need to be prescribed.
  • From time to time, your doctor may stop Metadate ER treatment for a while to check ADHD symptoms.
  • Your doctor may do regular checks of the blood, heart, and blood pressure while taking Metadate ER. Children should have their height and weight checked often while taking Metadate ER. Metadate ER treatment may be stopped if a problem is found during these check-ups.
  • If you or your child takes too much Metadate ER or overdoses, call your doctor or poison control center right away, or get emergency treatment.
• Methylin (methylphenidate oral solution)
  • Take Methylin Oral Solution exactly as prescribed. Your doctor may adjust the dose until it is right for you or your child.
  • Methylin Oral Solution is usually taken 2 to 3 times a day.
  • Take Methylin Oral Solution 30 to 45 minutes before meals.
  • From time to time, your doctor may stop Methylin Oral Solution treatment for awhile to check ADHD symptoms.
  • Your doctor may do regular checks of the blood, heart, and blood pressure while taking Methylin Oral Solution. Children should have their height and weight checked often while taking Methylin Oral Solution. Methylin Oral Solution treatment may be stopped if a problem is found during these check-ups.
  • If you or your child takes too much Methylin Oral Solution or overdoses, call your doctor or poison control center right away, or get emergency treatment.

• Methylin and Methylin ER (methylphenidate regular and extended release tablet)
  • Take Methylin and Methylin ER exactly as prescribed. Your doctor may adjust the dose until it is right for you or your child.
  • Methylin is usually taken 2 to 3 times a day.
  • Take Methylin and Methylin ER 30 to 45 minutes before a meal. The effect of a dose of Methylin ER usually lasts about 8 hours.
  • Do not chew or crush Methylin ER tablets. Swallow Methylin ER tablets whole with water or other liquids. Tell your doctor if you or your child cannot swallow Methylin ER whole. A different medicine may need to be prescribed.
  • From time to time, your doctor may stop Methylin and Methylin ER treatment for a while to check ADHD symptoms.
  • Your doctor may do regular checks of the blood, heart, and blood pressure while taking Methylin and Methylin ER. Children should have their height and weight checked often while taking Methylin and Methylin ER. Methylin and Methylin ER treatment may be stopped if a problem is found during these check-ups.
  • If you or your child takes too much Methylin and Methylin ER or overdoses, call your doctor or poison control center right away, or get emergency treatment.
• Quillivant (methylphenidate powder for oral suspension)
  • Take Quillivant XR exactly as prescribed. Your doctor may adjust the dose until it is right for you or your child.
  • Take Quillivant XR once each day in the morning. Quillivant XR is an extended-release suspension. It releases medicine into your body throughout the day.
  • Quillivant XR should be used with the oral dosing dispenser provided with the product. If the oral dosing dispenser is missing or not provided, please contact your pharmacist for a replacement.
  • Quillivant XR can be taken with or without food. Taking Quillivant XR with food may shorten the time it takes for the medicine to start working.
  • From time to time, your doctor may stop Quillivant XR treatment for a while to check ADHD symptoms.
  • Your doctor may do regular checks of the blood, heart, and blood pressure while taking Quillivant XR.
  • Children should have their height and weight checked often while taking Quillivant XR. Quillivant XR treatment may be stopped if a problem is found during these check-ups.
  • In case of poisoning call your poison control center at 1-800-222-1222 right away, or go to the nearest hospital emergency room.
• Concerta (methylphenidate extended release tablet)
  • Take Concerta exactly as prescribed. Your doctor may adjust the dose until it is right for you or your child.
  • Do not chew, crush, or divide the tablets. Swallow Concerta tablets whole with water or other liquids. Tell your doctor if you or your child cannot swallow Concerta whole. A different medicine may need to be prescribed.
  • Concerta can be taken with or without food.
  • Take Concerta once each day in the morning. Concerta is an extended-release tablet. It releases medication into your/your child's body throughout the day.
  • The Concerta tablet does not dissolve completely in the body after all the medicine has been released. You or your child may sometimes notice the empty tablet in a bowel movement. This is normal.
  • From time to time, your doctor may stop Concerta treatment for a while to check ADHD symptoms.
  • Your doctor may do regular checks of the blood, heart, and blood pressure while taking Concerta. Children should have their height and weight checked often while taking Concerta. Concerta treatment may be stopped if a problem is found during these check-ups.
  • If you or your child takes too much Concerta or overdoses, call your doctor or poison control center right away, or get emergency treatment.
• QuilliChew ER (methylphenidate extended release chewable tablet) 
  • Your doctor may adjust the dose until it is right for you or your child.
  • Take QuilliChew ER 1 time each day in the morning.
  • QuilliChew ER is an extended-release chewable tablet that releases medicine into your body throughout the day.
  • The 20 mg and 30 mg QuilliChew ER chewable tablets are scored (bisected) and can be cut in half if needed, for you to get the right dose. QuilliChew ER 40mg is not scored (bisected) and cannot be divided.
  • QuilliChew ER can be taken with or without food.
  • Talk to your healthcare provider if a dose is missed.
  • From time to time, your doctor may stop QuilliChew ER treatment for a while to check ADHD symptoms.
  • Your doctor may do regular checks of the blood, heart, and blood pressure while taking QuilliChew ER.
  • Children should have their height and weight checked often while taking QuilliChew ER.
  • QuilliChew ER treatment may be stopped if a problem is found during these check-ups. 
• Cotempla XR-ODT (methylphenidate extended release dissolvable tablet)
  • Take Cotempla XR-ODT exactly as prescribed.
  • Cotempla XR-ODT comes as a tablet that dissolves on your tongue.
  • Cotempla XR-ODT is taken 1 time a day, in the morning, with or without food.
  • Do not chew, divide, or break Cotempla XR-ODT tablets.
  • Let the tablet completely dissolve before swallowing. 
  • Avoid drinking alcohol while taking Cotempla XR-ODT.

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully. The dose your doctor recommends may be based on the following:

• the condition being treated
• other medical conditions you have
• other medications you are taking
• how you respond to this medication
• your weight
• your height
• your age
• your gender

Daytrana (methylphenidate patch)

• The recommended starting dose for patients new to or converting from another formulation of methylphenidate is 10 mg.
• Daytrana should be applied to the hip area (using alternating sites) 2 hours before an effect is needed and should be removed 9 hours after application. Daytrana may be removed earlier than 9 hours if a shorter duration of effect is desired or late day side effects appear.

Ritalin and Methylin (regular release tablets)

• Adults:
  • Average dosage is 20 to 30 mg daily. Some patients may require 40 to 60 mg daily.
  • In others adults, 10 to 15 mg daily will be adequate.
  • Patients who are unable to sleep if medication is taken late in the day should take the last dose before 6 p.m.
• Children (6 years and older):
  • Start with 5 mg twice daily (before breakfast and lunch) with gradual increments of 5 to 10 mg weekly.
  • This medication should be initiated in small doses, with gradual weekly increments. Daily dosage above 60 mg is not recommended.

Ritalin SR (extended-release tablets): The recommended adult dose is usually taken once every 8 hours.

Ritalin LA (extended-release capsule):  The recommended starting dose of Ritalin LA is 20 mg once daily. Dosage may be adjusted in weekly 10 mg increments to a maximum of 60 mg/day taken once daily in the morning. Daily dosage above 60 mg is not recommended.

Metadate CD (methylphenidate extended-release capsule) 

• The recommended starting dose is 20 mg once daily. Dosage may be adjusted in weekly 10-20 mg increments to a maximum of 60 mg/day taken once daily in the morning, depending upon tolerability and degree of efficacy observed. Daily dosage above 60 mg is not recommended.
• If improvement is not seen after the dose is adjusted over a one-month period, the drug should be discontinued.

Metadate ER (methylphenidate extended-release tablet): The average dosage is 20 to 30 mg daily. Some may require 40 to 60 mg daily. In others, 10 to 15 mg daily will be adequate. Those who are unable to sleep if medication is taken late in the day should take the last dose before 6 pm.

Methylin (methylphenidate oral solution):

• Adults: The average dosage is 20 to 30 mg daily. Some patients may require 40 to 60 mg daily. In others, 10 to 15 mg daily will be adequate. Patients who are unable to sleep if medication is taken late in the day should take the last dose before 6 p.m.
• Children (6 years and older): Start with 5 mg twice daily (before breakfast and lunch) with gradual increments of 5 to 10 mg weekly. A daily dose above 60 mg is not recommended. If improvement is not seen after the dose is adjusted over a one-month period, the drug should be discontinued.

Methylin ER (methylphenidate extended-release tablet): The recommended adult dose is usually taken once every 8 hours.

Quillivant (methylphenidate powder for oral suspension): For patients 6 years and above, recommended starting dose is 20 mg given orally once daily in the morning. Dosage may be increased weekly in increments of 10 mg to 20 mg per day. Daily dosage above 60 mg is not recommended. 

Concerta (methylphenidate extended-release tablet): 

• For children and adolescents new to methylphenidate, the recommended starting dosage is 18 mg once daily. Dosage may be increased by 18 mg/day at weekly intervals and should not exceed 54 mg/day in children and 72 mg/day in adolescents.
• For adult patients new to methylphenidate, the recommended starting dose is 18 or 36 mg/day. Dosage may be increased by 18 mg/day at weekly intervals and should not exceed 72 mg/day for adults.

QuilliChew ER (methylphenidate extended-release chewable tablet) 

• For patients 6 years and above, the recommended starting dose is 20 mg given orally once daily in the morning.
• The dose may be gradually increased each week in increments of 10 mg, 15 mg or 20 mg per day.
• Daily dosage above 60 mg is not recommended.

Cotempla XR-ODT (methylphenidate extended-release dissolvable tablet)

• The recommended starting dose of Cotempla XR-ODT for the treatment of ADHD is 17.3 mg in the morning. 
• Your doctor may increase your dose weekly based on symptoms.
• The max dose of Cotempla XR-ODT is 51.8 mg. 

If you take too much this medication, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If this medication is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

Store methylphenidate in a safe place at 68°F to 77°F (20°C to 25°C).

Keep methylphenidate and all medicines out of the reach of children.

Do not push the dissolvable tablets through the blister pack. Peel the foil packaging and then remove the tablet to place immediately on the tongue.

Store dissolvable tablets at room temperature. Keep blister packs in the reusable travel case after removed from the carton. 

Methylphenidate is a federally controlled substance (CII) because it can be abused or lead to dependence. Keep methylphenidate in a safe place to prevent misuse and abuse. Selling or giving away methylphenidate may harm others, and is against the law.

Tell your doctor if you or your child have (or have a family history of) ever abused or been dependent on alcohol, prescription medicines or street drugs.

Drug Dependence

Methylphenidate should be given cautiously to patients with a history of drug dependence or alcoholism. Chronic abusive use can lead to marked tolerance and psychological dependence with varying degrees of abnormal behavior. Frank psychotic episodes can occur, especially with parenteral abuse. Careful supervision is required during withdrawal from abusive use, since severe depression may occur. Withdrawal following chronic therapeutic use may unmask symptoms of the underlying disorder that may require follow-up.