Methylphenidate, a well-known central nervous system stimulant, is widely used for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD). While its prescription is routine in many Western countries, India presents a unique case with stricter regulations, lower awareness, and evolving prescription patterns.

How Is Methylphenidate Prescribed in India?

ADHD remains underdiagnosed and undertreated in India due to multiple factors, including stigma, limited specialized professionals, and cautious prescribing practices. Studies have shown that:

• Around 28% of children with ADHD in India receive methylphenidate monotherapy.
• 12% of ADHD cases are treated with a combination of stimulants and other medications like atomoxetine or risperidone.
• Nonstimulant options, including atomoxetine and alpha-2 agonists, are frequently used when stimulants are not tolerated.

Unlike in Western countries, where long-acting formulations (Concerta, Ritalin LA) are preferred, short-acting formulations dominate prescriptions in India due to cost considerations and availability.

Medication Adherence: Do Patients Stick to the Plan?

Adherence to ADHD medication is a crucial factor in successful treatment, but several challenges impact it in India:

✔ Good Compliance (62%) – Many patients stick to their medication regimens when symptom improvement is evident.
✖ Barriers to Adherence – Side effects like insomnia, appetite suppression, and headaches can reduce long-term compliance.
✖ Parental Concerns – Fear of dependency and social stigma surrounding ADHD often lead to premature discontinuation of treatment.

Regulatory Framework: A Strictly Controlled Drug

Methylphenidate falls under Schedule X of the Drugs and Cosmetics Rules, 1945, meaning:

• It cannot be sold without a specialized prescription from a registered medical professional.
• Pharmacists must maintain detailed records of its sale.
• Imports and production are tightly controlled to prevent misuse.

This regulatory control aims to prevent stimulant abuse, especially in adolescent and young adult populations.

India vs. the World: Global Prescription Trends

A global comparison reveals stark differences:

• USA & Europe: High prescription rates with a preference for long-acting formulations.
• India & Other Asian Countries: Lower prescription rates, greater use of nonstimulants, and concerns about potential misuse.
• Socioeconomic Barriers: Access to ADHD medication remains difficult in low-income populations, limiting treatment options.

Balancing Benefits and Risks

While methylphenidate is an effective and safe medication for ADHD, it is often viewed with caution in India. With increasing awareness and better training of healthcare providers, its appropriate use may improve outcomes for many children and adults struggling with ADHD.

🔍 Future Directions:
✅ Improved public and professional awareness about ADHD and stimulant medications.
✅ Development of cost-effective long-acting formulations to improve adherence.
✅ Regular monitoring and support programs for children on stimulants.

What are your thoughts on ADHD medication use in India? Have you encountered challenges with prescribing or using methylphenidate?