Methylphenidate

Pre-existing structural heart disease, cardiomyopathy, or significant valvular disease increases risk of adverse cardiovascular events. Requires cardiology clearance.

Blood pressure should be controlled before methylphenidate initiation. Monitoring required in all patients.

Patients with known arrhythmias or prolonged QT interval require cardiology evaluation before stimulant initiation.

Active seizure disorder requires careful risk-benefit assessment. Can be used in well-controlled epilepsy under neurological supervision.

Personal or family history of psychosis represents elevated risk. Requires careful monitoring and specialist supervision.

May be used cautiously under mood stabilizer coverage but carries risk of mood destabilization.

Risk-benefit assessment required. Most guidelines recommend discontinuation during pregnancy unless clinical need is compelling.

Uncontrolled hyperthyroidism should be treated before methylphenidate initiation.

Patients with narrow anterior chamber angles require ophthalmological clearance before stimulant use.

Any methylphenidate ingestion in a patient taking an MAOI requires immediate emergency evaluation. A minimum 14-day washout from MAOI discontinuation is required before methylphenidate initiation.