I do see methylphenidate or Ritalin use for adults from time to time, and this medication case study certainly identifies some issues that Ritalin could be complicating.
Let’s dig into this medication list and I will give you my top three things to consider. When we get a med list like this, it can often be a challenge as to what to prioritize first. Patient specifcs are certainly going to guide you as to what is most important as well, but I feel that reviewing a medication list serves as a great educational tool.
This is likely an adult patient going by their medication list, which leads me to my first concern in using the Ritalin. They apparently have some significant cardiac/hypertension issues based on the med list as well as potentially (clonazepam) anxiety and possibly insomnia issue (mirtazapine use at bedtime). Both of these can be exacerbated by the Ritalin. Looks as if this is a possible case of upper and downer type medications combating each other. This needs to be investigated further.
Vital signs monitoring is going to be very important looking at the number of meds that can lower blood pressure in addition to the above mentioned Ritalin which can increase it. Blood sugars and pulses will need to be followed closely as well given the glyburide use and metoprolol/digoxin combination.
In addition to vitals monitoring, there are plenty of labs to check, TSH, INR, CBC, BMP to name a few due to Synthroid, Coumadin, Lasix etc.
Check out my 30 medication mistakes! – A 6 page PDF on problems I see in my everyday practice as a pharmacist – a free resource to subscribers