Transient Right Ventricular Failure from Intravenous Injection of Methylphenidate Tablets

Methylphenidate (MPH) is a sympathomimetic stimulant used to manage adult narcolepsy and attention deficit hyperactivity disorder (ADHD), which is frequently abused. We present the case of a 37-year-old female who developed acute right ventricle (RV) failure after the self-injection of IV MPH. While difficult to prove causation, the temporal relationship between self-injection and symptom onset suggests a role for MPH in this patient's acute RV failure. Other causes for acute RV failure were ruled out: she had no prior history of PH, ECG was not consistent with ischemia, computed tomography angiography (CTA) was negative for pulmonary embolism (PE), and Right heart catheterization (RHC) was not consistent with left ventricular failure. While there are case reports of persistent PH with chronic IV MPH use, this case describes the only reported incident of transient acute RV failure after IV MPH use.