Seeking advice: medical interaction: methylphenidate and metoprololsuccinate

ADHD - medical, neurological, therapeutic
1

I am not a doctor, or have any medical degree whatsoever, but having an innate ASD-syndrome (that has been operated) I know a bit about the heart - I need advice on what can be done about my problem.

I was recently diagnosed with ADHD. Five years ago I was operated for an innate ASD-syndrome. A period hereafter I was treated with metoprololsuccinte (HEXAL) with very good results. Approx. 6 months later I was free of any medicine.

I am now, in the upscaling of using methylphenidate for my ADHD. I am, mentally responding very well to the medicial, and can feel a difference even on a relatively low dosis of 36mg/day and I really would like to scale to 108mg that my psychiatrist is suggesting he thinks is good for me.

Unfortunately, I am getting tachycardiac symptoms as well as atrial fibrillation symptoms.

I can supress it completely with 50-100mg metoprolol/day (from my old storage of metoprololsuccinate (HEXAL)). I have no sideffects from metoprololsuccinate and methylphenidate (other than mouthdraught and eyedraught) that I can tell. Personally I am not concerned by taking metoprololsuccinate in combination with methylphenidate, but prefer to avoid it, as I am concerned that dosis of 108mg methylphenidate will require more than 200mg metoprololsuccinate - and I am not a doctor, so I dont have a proffessional oppinion :slight_smile: - its just me and my internetsearch

I am very concerned that I will not be able to use ADHD-medicines and must stop treatment, because of this situation. I realise that there are other medical alternatives but dont know if they have the same problem/ingredients.

So my questions are:

  1. Would it be ok to take metoprololsuccinate in combination with methylphenidate? is it a viable way?

  2. are there any other medicines for ADHD that dont have the heart-trigger effect?

Any other ideas will be helpful, though I am pretty sure therapy is not the answer for me. I am really excited about the effects methylphenidate has on me.

Hope for help.

With love,

Lars

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Hi Lars,

welcome to the forum.

I’m neither a medical doctor nor a psychologist too, just interested in the science of ADHD.

Although this isn’t your question, congenital ASD-syndrome seems to have a 3 to 4-time higer burden for ADHD. I wasn’t aware of this before.

https://www.researchgate.net/publication/356826392_Hyperactivity_and_Inattention_in_Young_Patients_Born_With_an_Atrial_Septal_or_Ventricular_Septal_Defect

ADHS stimulants are generally critical with heart diseases. For the concrete case I will have to dig a bit deeper. Searching pubmed for methylpheidate and asd I so´pntaneously found just one case study yet, which won’t mean much more than giving a shade of an idea:

Most important about methylphenidate and hypertension: did you stop any consume of caffeine while dosing methylphenidate? Consequently, absolutely?
Caffeine is another stimulant and causes cross-reactions with ADHD stimulants in around 50% of those affected. Therefore, it is very important to completely and consistently omit caffeine when dosing stimulants for ADHD.

Once you’re sure how MPH affects you, you can try adding caffeine again. The difference is that you will then know that any cross-reactions are caused by the added caffeine and not by the ADHD stimulants.

For cross-reactions you may have a look here: https://www.drugs.com/interactions-check.php?drug_list=1606-0,1615-14142

MPH rises blood pressure (although to a lesser extent than atomoxetine). If you need to lower your blood pressure, you might try guanfacine. This may be off label for adults (butr I am not sure if this is true in denmark, too). But first be absolutely sure to not consume any caffeine on dsy with methylphenidate.

By the way:

How comes? Is he clairvoyant?

And how did he figure out 108 mg? That is more than one and a half times the usual recommended upper limit for the daily dose of MPH, which is 60 mg. I could understand 80, but 108??? How did he come up with that?
Especially with heart problems, I would be very cautious about exceeding the recommended maximum dose. Even for people without pre-existing heart conditions, an increase above 60 mg per day should only be done under close medical supervision.

On top of that, the appropriate stimulant dose is in no way predictable. It is completely independent of age or weight. There are adults for whom 2.5 mg is sufficient as a single dose (even if they are few), while others actually need more than the maximum daily dose of 60 mg. Therefore, stimulants for ADHD should always be dosed very slowly and patiently and, above all, adjusted to individual responses. There is definitely no target dose. very slowly and patiently and, above all, adjusted to individual responses. There is definitely no target dose.

This might be helpful in general about dosing of ADHD medication:

Best

Ulrich

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