The therapeutic dose varies from individual to individual, but a typical dose would be 10 mg tid. One may start with 5 mg bid to see if the medication is well-tolerated, and then increase the dose until side effects appear or until target symptoms are relieved. The most common side effects are insomnia, edginess, diminished appetite, weight loss and dysphoria. Nausea, abdominal pain and headache are usually mild and transitory. Blood pressure and heart rate may be elevated, but in adults these elevations are usually minimal and clinically insignificant.
Side effects are dose-related and can be avoided by lowering the dose.
Beta-blockers such as propranalol or nadolol have been used to treat jitteriness that some patients experience on methylphenidate. The therapeutic effect lasts about 4 hours so methylphenidate is often prescribed in divided doses. Methylphenidate should not be taken too late in the day because of possible insomnia. There is a sustained-release form, the therapeutic effect of which lasts 8 hours. It can be helpful for patients who forget to take their noon dose.