Related Experiment Video
Updated: May 28, 2026
Color Spot Test As a Presumptive Tool for the Rapid Detection of Synthetic Cathinones
Published on: February 5, 2018
Severe toxicity due to injected but not oral or nasal abuse of methylphenidate tablets
Marcel Bruggisser1, Michael Bodmer, Matthias E Liechti
1Division of Clinical Pharmacology & Toxicology, Department of Biomedicine and Department of Internal Medicine, University Hospital and University of Basel, Switzerland.
Background:
Non-medical use of methylphenidate is increasing. Little is known about potential acute medical complications associated with recreational use of methylphenidate.
Study Aim:
To identify medical problems associated with methylphenidate abuse.
Methods:
Retrospective case series of methylphenidate abuse cases presenting to an inner city emergency department.
Results:
We identified 14 cases of methylphenidate abuse between 2003 and 2010. Ten of these patients abused methylphenidate alone while four co-ingested other drugs, mainly alcohol. The route of ingestion was oral in nine patients, nasal in one and intravascular in four. Severe toxicity was exclusively observed in users who injected the drug. Two cases involved accidental intra-arterial injection and resulted in tissue necrosis leading to the amputation of a forearm and of fingertips, respectively. Clinical findings in the non-serious cases included mild to moderate symptoms and signs of sympathetic nervous stimulation such as agitation, tachycardia, hypertension, anxiety, hallucination, headache, tremor and dizziness. Nine of the fourteen patients were taking methylphenidate as a prescribed drug. Eight patients were former or current multiple substance abusers.
Conclusion:
Methylphenidate misuse is not a significant burden for emergency departments in Switzerland. Oral and nasal administration of methylphenidate did not result in severe toxicity. However, injection of crushed methylphenidate pills lead to serious local toxicity. Most patients with methylphenidate abuse had a prescription for the drug indicating deviation from medical use. A history of multiple substance use may be a risk factor for non-medical use of methylphenidate.
Insights
Recreational methylphenidate use can cause severe medical issues, particularly when injected, leading to complications like tissue necrosis and amputation. Many users have prescriptions, indicating diversion from medical use.
Area of Science:
- Emergency Medicine
- Clinical Toxicology
- Pharmacology
Background:
- Non-medical use of methylphenidate is a growing public health concern.
- Limited data exists on the acute medical complications of recreational methylphenidate use.
Purpose of the Study:
- To investigate and identify the spectrum of medical problems associated with methylphenidate abuse.
Main Methods:
- A retrospective case series design was employed.
- Data was collected from methylphenidate abuse cases presenting to an urban emergency department between 2003 and 2010.
Main Results:
- Fourteen cases of methylphenidate abuse were identified.
- Severe toxicity, including tissue necrosis and amputation, occurred exclusively in patients who injected the drug.
- Most patients (9/14) were prescribed methylphenidate, and 8/14 had a history of multiple substance abuse.
Conclusions:
- While oral and nasal methylphenidate abuse did not lead to severe toxicity, intravenous administration poses significant risks.
- Methylphenidate misuse, often involving prescription diversion, is linked to a history of polysubstance abuse.
- The study highlights the potential for serious local toxicity from injecting crushed methylphenidate pills.
More Related Videos
09:16A General Method for Evaluating Deep Brain Stimulation Effects on Intravenous Methamphetamine Self-Administration
Published on: January 22, 2016
10:17High-throughput and Comprehensive Drug Surveillance Using Multisegment Injection-Capillary Electrophoresis-Mass Spectrometry
Published on: April 23, 2019
Related Concept Videos
01:24Drug Toxicity: Dose-Dependent Reactions
01:28Adrenergic Agonists: Mixed-Action Agents
Ephedrine and pseudoephedrine lack a catecholamine group, making them less susceptible to degradation by metabolic enzymes. They have increased oral bioavailability and lipophilicity, resulting in a longer duration of action. Their response is reduced by...
01:00Drug Toxicity: Overview
01:30Toxidromes: Clinical Features
01:23Drugs Acting on Autonomic Ganglia: Stimulants
Ganglionic stimulants activate NM nicotinic receptors in autonomic ganglia, falling into two categories: nicotine mimetics [e.g., lobeline, dimethylpiperazine, tetramethylammonium] and muscarinic receptor agonists [e.g., muscarine, methacholine]. The first category's action is rapid and blocked by nicotinic receptor antagonists, while the second category's action is delayed and blocked by atropine-like agents. Nicotine, an alkaloid, affects the heart rate by stimulating sympathetic or...
01:24Antiasthma Drugs: Methylxanthines
Theophylline is thought to inhibit phosphodiesterase enzymes, increasing intracellular levels of cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). This rise in cAMP and cGMP concentrations stimulates cardiac function,...