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Thread: Ritalin and an Upset Stomach

  1. #1

    Default Ritalin and an Upset Stomach

    I was diagnosed with gastritis a few months back. From what I have been reading it appears that Ritalin has the tendency to exacerbate GERD related issues. Just wondering if anyone has any experience with this. Also wondering if there are any good ways of mitigating this potential side effect.
    Helpful riverstyx Rated helpful

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    Ritalin and an Upset Stomach
  3. #2
    That is actually a well known side effect. The label says you can take with food to minimize the stomach problems but it will take longer for the med to absorb. I've also read where people swear by taking probiotics (the kind you can find in capsules) with their dose.
    Helpful riverstyx, rickduresh Rated helpful
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  4. #3
    Agree with vor: even a small meal will help. And, while haven't taken for this purpose, I have found just taking a good probiotic daily has helped my digestion, regardless of medication. If you have GERD related problems, you may already be taking nexium. Which seems to help lots of stomach related issues. Don't know whether it's contraindicated for ritalin,. (There's some informative sub threads--those guys probably know the scientific answer, and they're interesting reading regardless.) My unscientific answer to nearly everything involving stomach problems was posted by someone else, (but related to completely different medication.) Pepto bismol, including the chewable kind, nearly always seems to make my stomach feel better when it acts up. And sometimes will take some beforehand. Again, that's just anecdoctal--don't know anything about interaction between it and ritalin. Good luck.
    Last edited by cyb2004; 09-09-2011 at 01:53 PM. Reason: typo
    Helpful riverstyx Rated helpful
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  5. #4
    Try something like a fruit and yogurt smoothie. It will quell an upset stomach but wont interfere with the medicines absorption the way a full meal will.
    Helpful riverstyx, rickduresh, naynay Rated helpful

  6. Did you have gastritis before going on Ritalin? Also, what's your dosage, height, and weight? Has your dosage been changed recently? (By recently I mean over the last year or so - not a few weeks or months.) Before you started taking Ritalin, did you have the same symptoms? If so, were your symptoms at the same level of severity as they are today? (More severe, same, less severe.) Obviously, they've become worse over time or else this thread wouldn't exist. But sometimes things can "sneak up" on you and it wouldn't be unusual for Ritalin to gradually worsen gastritis. So, to the best of your ability, try and think back to how you felt before going on Ritalin.

    That being said, every person's physiology is different. However, I'm assuming that there aren't any additional paramaters (like other health conditions/interactions between meds) than the ones I listed above and that Ritalin is the proper medication in your case. Most people on the correct med and dosage experience the average/expected outcome. If this is not the case, either the dosage needs to be adjusted or the prescribing physician should try the patient on a different medication.

    Multi-dimensional Gaussian function is the mathematical term used in medicine (among other fields) to predict expected outcomes or complications (dubbed side effects when referring to meds) given the patient's age, height, weight, health, along with your medical and social background (parameters). Basically, it's a fancy word for The Bell Curve. Anyhow, this is how a prescribing physician determines the medication and dosage to prescribe. Sorry for bantering on - I'm the type of person who likes to know the reason behind questions (as do most people I know) and figured I'd explain the reasoning behind my inquires. Also, I didn't want to seem as though I was interrogating you.
    Helpful UncleBen, naynay, rickduresh Rated helpful

  7. #6
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    Other people beat me to the punch. If a pill upsets your stomach, then taking it with a glass of water on a half-full or full stomach can go a long way to minimize nausea triggered by it.

    However, I am somewhat puzzled by your suggestion that ritalin tends to exacerbate GERD related issues. I do not agree with that assessment. In fact, there is no literature to support it. If you could share your sources---articles from pharmacology or gastrointestinal specialty type journals, New England Journal of Medicine, emedicine or medscape, a respected journal or even a book provided it is backed up with empirical evidence---I would be happy to review them and offer my interpretation. I'd even change my opinion should the evidence warrant it. But . . . an NSAID like motrin would certainly exacerbate GERD---there are studies to prove it. BUT . . . I think you are conflating stomach problems with GERD, when there is a marked difference. It is not uncommon for ritalin to cause nausea, stomach ache and decreased appetite, but these symptoms are not emblematic of Gastroesophageal reflux disease (GERD). As someone who has a lot of experience taking stimulants (including dextroamphetamine, dexedrine, adderall, amphetamine salts, methamphetamine/desoxyn, the pro-drug vyvanse) and including ritalin in almost every possible form (plain ritalin LA, ritalin in time-released form as concerta, focalin). My experience has been that the stomach upset and nausea only sets in AFTER the drug has had time to take effect, usually no sooner than 10 or 15 minutes and more commonly about 45 minutes to an hour after ingestion. So long as you have food in your stomach, there should be no problem with taking the pill initially. Even on an empty stomach, it's unlikely to upset your stomach. However, once the drug has undergone first-pass metabolism (it's rapidly absorbed by fluids in the gastrointestinal area, and then extensively absorbed by the small intestine and eventually the colon) you may begin to experience stomach upset. If you really do have GERD, however, this shouldn't be a problem unless you try to eat right away after taking the ritalin.

    Now, if that fails, you have another option---you can request a prescription antiemetic from the doc. Reglan is a popular drug to prevent nausea, and so is phenergan, but both might offset the stimulant effect of the ritalin even as it attenuates the possible nausea. Reglan (metoclopramide) is impossible to find on the net, but phenergan(promethazine) is much more common and can be ordered on for cheap, so long as you are willing to wait 3 or 4 weeks.

    I also wanted to point out that you equate GERD with gastritis. The two are different problems entirely. GERD, or gastroesophogeal reflux disease, is a serious problem of erosion of the esophagus brought about by stomach acid backing up. It often triggers chest pain which can mimic a heart attack, and warrants serious treatment typically with either prilosec, a proton pump inhibitor, or nexium. Gastritis, on the other hand, manifests as stomach pain, bloating, indigestion, nausea and less commonly vomiting. Gastritis is much more common. In my time working in an acute care clinic for soldiers, two PA's attested to just how common it was---they said it was the most common reason for nausea. Usually it means you ate something bad, but it can also be caused by alcohol consumption and a few other things. Like GERD, there could be erosion, but unlike GERD, it's erosion not of the esophagus but erosion of the stomach lining. Abuse of NSAID's like ibuprofen, naproxen, diclofenac, mobic, toradol and aspirin on a long-term basis can definitely cause gastritis and a certain level of erosion since these drugs inhibit not only the inflammatory agents which cause pain but also the stomach's prostaglandins which help to protect it from the hydrochloric acid which would otherwise erode the lining. GERD and gastritis are NOT the same thing. Gastritis usually resolves on its own, but in severe cases, the same treatment used to treat GERD (like prilosec) can also be used to treat a serious case of gastritis.

    Still, I'm troubled by this problem that you anticipate. Ritalin LA 10mg pills are very, very small. Even for those who have extremely weak and sensitive stomachs (a problem which I theorize is more psychological than physical, since people who express an aversion to taking medicine typically claim that all pills upset their stomach, even a tylenol, despite empirical evidence to the contrary which proves that a single tylenol pill will NOT induce real physical symptoms such as nausea) a single pill shouldn't be an issue, with or without food. Especially with food, so long as it's easily digestible food like apple sauce, or one that follows the BRAT diet---banana, rice, apple sauce and toast. By the way, when I was in the field as an Army medic people who had mild to moderate cases of gastritis aka gastroenteritis, we recommended a BRAT diet, which is bananas, rice, apple sauce, and toast. It usually worked well, and quite often we didn't even need to administer an anti-emetic like phenergan.

    Bottom line: if you need your ritalin, don't hesitate to take it. Just have a bit of apple sauce or a piece of toast with it. You'll be fine. If you're not fine, it's probably not the tiny-ass pill you swallowed. Instead it's probably something more serious unrelated to the ritalin, and you should seek medical attention soon.
    Helpful naynay, rickduresh Rated helpful

  8. #7
    @vor @cyb2004 @olyoxen @flapjack @QVC1212
    Thanks for all of your replies.
    I should have specifically mentioned that I have not taken Ritalin before, and was just curious as to how it may interact with my GERD/Gastritis. Through trial and error I have been able to determine what foods and drinks to avoid (not surprisingly, spicy/fatty foods, coffee, alcohol);
    I decided to go on a strict BRAT diet about a month ago and this has been helping to keep the GERD under control and hopefully reducing the inflammation in my stomach.
    My 'research' regarding the original question amounted to typing the phrase "Ritalin GERD" into Google. Of course, I found some 'evidence' of people having 'issues', but Google can be your worst enemy when it comes to this kind of research, and that's when I realized I should just post this as a question on the forum and get peoples real experience and input.

  9. Make sure you eat and stay hydrated. If your diet's poor, take a multivitamin. Stimulants are very beneficial to us ADHD types, but at the same time, they can tax your body if you aren't treating it correctly.

    Stay hydrated, stay healthy, and enjoy the benefits of your RX.
    Helpful rickduresh Rated helpful

  10. #9
    Yeah, making a point to eat and stay hydrated is very important. If you become too dehydrated or malnourished the meds will not work as well and you begin to feel sickly and "detached".

    If you find it too difficult to eat/drink then it is very helpful to start on meal replacement shakes, like boost or ensure, which gives you balanced nutrition like calories, fat, carbs, sugar and protein, as well as vitamins and minerals. Also start on a multi-vitamin as the above poster mentioned. Taking vitamin C before bed time can help keep your immune system going strong. Just don't take the vit C or a multi-vitamin with vit C right before/during or after taking your meds as the acidity will decrease effectiveness, even more so with amphetamines.

    But yeah yogurt/probiotics will help with an upset stomach, as will taking with a meal. Taking on food will increase the amount of time for the med to take effect, but it will make it take effect slower over a period of time and last longer.

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