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This medication is associated with several risks and precautions that must be taken into account before and during its use. Below are important safety considerations to discuss with your healthcare provider:

• Risk of Misuse and Dependence: Methylphenidate can be habit-forming. Misusing it by taking more than prescribed or using it differently can lead to serious side effects, including rapid heartbeat, high blood pressure, aggressive behavior, and thoughts of self-harm. This risk is higher for individuals with a history of substance or alcohol use disorders.

• Serious Heart Problems: There is a potential for severe heart issues such as sudden death, stroke, or heart attack, even at regular doses. The medication can increase blood pressure and heart rate. If you have a history of heart problems, inform your healthcare provider so they can assess the safety of this medication for you. Seek immediate medical attention if you experience unexplained fainting, chest pain during physical activity, or irregular heartbeat.

• Behavioral and Mental Health Changes: This medication may cause or worsen mental health issues, including hallucinations, unclear thinking, or mania. If you have a history of mood disorders, discuss this with your provider. Contact your healthcare provider immediately if you notice any new or worsening mental health symptoms.

• Prolonged and Painful Erection: Rarely, some individuals may experience prolonged and painful erections, potentially requiring medical intervention. If an erection lasts longer than 4 hours, stop taking the medication and seek immediate medical help.

• Blood Circulation Issues: Methylphenidate may affect circulation, leading to conditions like Raynaud’s phenomenon, which can cause numbness or pain in extremities. Notify your healthcare provider if you notice these symptoms, as they may need to adjust your medication.

• Slowed Growth in Children: Children using this medication may experience a temporary slowing in growth. Your child's healthcare provider will monitor growth and may adjust the treatment if necessary.

• Serotonin Syndrome Risk: This condition, while rare, can be life-threatening and occurs if there is too much serotonin in the brain. The risk increases when taken with medications that affect serotonin levels. Be aware of symptoms such as rapid heartbeat, high fever, and confusion, and seek medical assistance if they occur.

• Drug Interactions: Methylphenidate can interact with several medications, including blood pressure medications and MAOIs, potentially leading to severe side effects. Discuss all current medications with your healthcare provider to avoid adverse interactions.

Contraindications: This medication should not be used by individuals with:

• Severe allergies to methylphenidate.
• Current or recent (within 14 days) use of MAOIs.
• Certain inherited sugar digestion issues (for capsule formulations).
• Conditions like marked anxiety, tension, distress, glaucoma, and motor tics or family history of Tourette syndrome (specific to certain brands).

Consult with your healthcare provider to ensure this medication is safe for you, especially if you have any pre-existing conditions or are taking other medications.

When taking this medication, some common side effects you might experience include nervousness, trouble sleeping, headache, and low appetite, which can lead to weight loss. Additionally, you might feel dizziness, nausea, or experience stomach pain. These effects are generally mild, but if they persist or worsen, it is advisable to consult your healthcare provider.

Other side effects that some users report include dry mouth, vomiting, anxiety, irritability, and a racing heart. Sweating and high blood pressure are also possible, so it's important to monitor your blood pressure regularly and inform your healthcare provider if it remains elevated.

Serious side effects, although rare, require prompt medical attention. These include signs of blood flow issues in the fingers or toes, such as coldness, numbness, or skin color changes, and unusual wounds. Also, watch out for mental health changes, like agitation, mood swings, abnormal thoughts, or hallucinations. If you experience seizures, stroke symptoms, or any signs of a heart attack, such as chest pain or shortness of breath, seek immediate medical help.

Furthermore, serotonin syndrome is a serious condition that may occur, indicated by symptoms like fast heart rate, sweating, muscle stiffness, fever, or confusion. In rare cases, males might experience a painful or prolonged erection lasting over four hours, which demands urgent medical attention to prevent lasting damage.

Lastly, a severe allergic reaction is uncommon but serious. Symptoms include rash, hives, difficulty breathing, and swelling of the face, lips, tongue, or throat. If you notice any of these symptoms, get medical help right away. Always inform your healthcare provider about any other unusual side effects you encounter.

When taking Methylphenidate ER, be aware of potential interactions with certain medications. Avoid using it with MAO inhibitors such as isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, and tranylcypromine, as this combination can lead to serious, potentially life-threatening interactions. Typically, MAO inhibitors should also not be used for two weeks before starting Methylphenidate ER. Consult your doctor for guidance on when to begin or discontinue this medication.

Alcohol can affect how quickly this medication is released and increase side effects, so it should be avoided. Certain drugs that reduce stomach acid, like antacids, ranitidine, or omeprazole, may affect specific brands of this medication. It's important to check with your pharmacist if your brand is impacted.

Avoid using dexmethylphenidate with methylphenidate, as they are very similar. This medication may also interfere with certain medical tests, potentially causing inaccurate results, so inform your healthcare providers that you're using it.

Additionally, some medications, such as furazolidone, iproniazid, and nialamide, should not be used with Methylphenidate ER. Other medications like amifampridine, bupropion, and risperidone may require a doctor’s adjustment to your dosage or usage frequency if used together. Lastly, combining it with carbamazepine could raise the risk of side effects, but it might be necessary for your treatment, so a healthcare provider may adjust your regimen accordingly. Always inform your doctor and pharmacist about all medications and supplements you are taking.