Concerta XR Side Effects: What You Should Know

Every medication comes with potential side effects, and Concerta XR (Methylphenidate ER) is no exception. The good news is that most side effects are mild and often improve as your body adjusts. But some are serious enough to warrant a call to your doctor — or even a trip to the emergency room.

This guide covers the common and serious side effects of Concerta XR, which groups need extra caution, and practical tips for managing side effects so you can get the most out of your treatment.

What Is Concerta XR?

Concerta XR is an extended-release form of Methylphenidate, a stimulant medication used to treat ADHD in patients aged 6 and older. It uses a special delivery system called OROS (Osmotic-controlled Release Oral delivery System) to release medication steadily over 10–12 hours. To learn more about how it works, see our guide on how Concerta XR works.

Common Side Effects

These side effects are reported frequently in clinical trials and tend to be mild to moderate. They often improve within the first few weeks of treatment:

• Decreased appetite — This is the most common side effect. Many people notice they're simply not hungry, especially during the day while the medication is active.
• Headache — Usually mild and may respond to over-the-counter pain relievers.
• Dry mouth — Staying hydrated can help.
• Nausea — Taking Concerta XR with food may reduce stomach upset.
• Insomnia — Difficulty falling asleep is common with stimulants. Taking your dose early in the morning can help.
• Anxiety — Some people feel more anxious or jittery, especially at higher doses.
• Dizziness — Usually mild and temporary.
• Stomach pain — Particularly in children and adolescents.
• Weight loss — Often related to decreased appetite.
• Irritability — May occur as the medication wears off (sometimes called the "rebound effect").

If any of these side effects are severe or don't improve after a few weeks, talk to your doctor. A dose adjustment or change in timing may help.

Serious Side Effects

While less common, these side effects require immediate medical attention:

Heart-Related Effects

• Increased heart rate and blood pressure — Concerta XR can raise both. Your doctor should monitor your vitals regularly.
• Cardiovascular events — In rare cases, stimulants have been linked to sudden death in patients with pre-existing heart problems. Tell your doctor about any history of heart defects, arrhythmias, or other cardiac issues before starting Concerta XR.

Psychiatric Symptoms

• Psychosis or mania — New or worsening hallucinations, delusions, or manic behavior can occur, even in patients without a prior psychiatric history.
• Aggression — Particularly in children and adolescents.

Other Serious Effects

• Peripheral vasculopathy (Raynaud's phenomenon) — Fingers or toes that become numb, cool, pale, or blue. Report these symptoms to your doctor.
• Priapism — A prolonged, painful erection. This is a medical emergency — seek immediate care.
• Seizures — Concerta XR may lower the seizure threshold. Use with caution if you have a history of seizures.
• Serotonin syndrome — A potentially life-threatening condition that can occur if Concerta XR is combined with serotonergic medications like SSRIs or SNRIs. Symptoms include agitation, rapid heartbeat, high body temperature, and muscle rigidity.

Call 911 or go to the ER immediately if you experience chest pain, shortness of breath, fainting, hallucinations, or signs of serotonin syndrome.

Boxed Warning: Abuse and Dependence

Concerta XR carries an FDA boxed warning (the most serious type) about the potential for abuse and dependence. As a Schedule II controlled substance, Methylphenidate has a high potential for misuse. Your doctor should assess your risk before prescribing and monitor you during treatment. Take Concerta XR exactly as prescribed — never take more than your prescribed dose or share it with others.

Specific Populations

Children and Adolescents

Concerta XR is approved for children aged 6 and older. In addition to the side effects listed above, growth suppression is a concern with long-term use. Your child's doctor should monitor height and weight regularly. If growth is significantly affected, a medication break ("drug holiday") may be recommended.

Pregnant and Breastfeeding Women

Concerta XR is classified as Pregnancy Category C, meaning it should be used during pregnancy only if the potential benefit justifies the potential risk. Methylphenidate is also excreted in breast milk, so discuss the risks and benefits with your doctor if you're breastfeeding.

Older Adults

Concerta XR has not been studied in patients over 65. Elderly patients may be more sensitive to cardiovascular and psychiatric side effects. Doctors may start with a lower dose and monitor more closely.

People With Certain Conditions

Concerta XR should not be used in people with:

• Glaucoma
• Motor tics or Tourette's syndrome (or family history)
• Severe anxiety, tension, or agitation
• Severe GI narrowing (due to the OROS tablet design)
• Current or recent use of MAO inhibitors (within 14 days)

For a full overview of who should and shouldn't take it, read What Is Concerta XR?

How to Manage Common Side Effects

Here are some practical tips that may help:

• Appetite loss: Eat a good breakfast before taking your dose. Have a larger dinner after the medication wears off. Keep nutrient-dense snacks available.
• Insomnia: Take Concerta XR as early in the morning as possible. Avoid caffeine in the afternoon and evening. Practice good sleep hygiene (cool, dark room; consistent bedtime).
• Dry mouth: Drink water throughout the day. Sugar-free gum or lozenges can stimulate saliva production.
• Headache: Stay hydrated and ask your doctor if occasional over-the-counter pain relief is appropriate.
• Irritability/rebound: Talk to your doctor about adjusting your dose or timing. Some patients benefit from a small dose of short-acting Methylphenidate in the late afternoon.

Always talk to your doctor before making changes to your medication regimen. Never stop Concerta XR abruptly without medical guidance.

Final Thoughts

Most people tolerate Concerta XR well, and many side effects lessen over time. The key is open communication with your doctor. Report any new or worsening symptoms promptly, keep your follow-up appointments, and don't hesitate to ask questions about what you're experiencing.

If you're having trouble finding Concerta XR at your pharmacy, Medfinder can help you find it in stock near you. And if cost is a concern, check out our guide on saving money on Concerta XR.