Who should not use Concerta? A guide to contraindications

October 8, 2025 •

3 min read

According to the official Concerta Medication Guide, patients with a history of serious heart defects, severe hypertension, or those taking monoamine oxidase inhibitors (MAOIs) should not use this medication. Understanding who should not use Concerta? is crucial for preventing severe health risks associated with this central nervous system stimulant, including the potential for abuse and addiction.

Quick Summary

This guide outlines the critical health conditions, mental health risks, and dangerous drug interactions that make the prescription stimulant Concerta unsafe for certain individuals, necessitating a thorough medical evaluation.

Key Points

Heart Problems: Patients with serious heart defects, severe hypertension, or other significant cardiac disease should not use Concerta due to the risk of sudden death or other cardiovascular events.
MAO Inhibitors: Concerta is strictly contraindicated in patients taking or who have recently taken (within 14 days) a monoamine oxidase inhibitor (MAOI), as this can cause a life-threatening hypertensive crisis.
Psychiatric Conditions: Individuals with severe anxiety, agitation, psychosis, or bipolar disorder should avoid Concerta, as it can worsen these symptoms or induce manic episodes.
Gastrointestinal Narrowing: Because Concerta's tablet shell does not dissolve, it is unsafe for patients with pre-existing severe narrowing of the intestines or similar GI motility disorders.
Substance Abuse History: Concerta is a Schedule II controlled substance with a high potential for abuse, and it is not recommended for those with a history of drug or alcohol dependence.
Tourette's Syndrome: Use of Concerta should be avoided by individuals with tics or a family history of Tourette's syndrome, as it can exacerbate symptoms.
Seizure Disorders: Concerta can lower the seizure threshold and should be used with caution in patients with a history of seizures.
Hypersensitivity: Patients with a known allergy or hypersensitivity to methylphenidate or any other ingredient in Concerta should not use the medication.

Concerta (methylphenidate) is a Schedule II controlled substance prescribed for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children aged 6 and older, adolescents, and adults. While effective for many, its powerful stimulant effects mean it is not suitable or safe for everyone. The decision to prescribe Concerta requires a comprehensive medical history review by a qualified healthcare professional. This article details the major contraindications and precautions for this medication.

Serious Cardiac and Circulatory Conditions

Individuals with pre-existing heart problems face an increased risk of serious cardiovascular events, including sudden death, heart attack, and stroke, when using stimulants like Concerta.

Contraindicated heart conditions

Concerta should not be used by patients with structural cardiac abnormalities (such as congenital heart defects or cardiomyopathy), serious heart disease (especially coronary artery disease or arrhythmias), or severe hypertension.

Circulatory problems

Concerta can also cause or worsen peripheral vasculopathy like Raynaud's phenomenon, which affects blood flow to the extremities. Dose adjustment or discontinuation may be needed if this occurs.

Pre-existing Psychiatric Disorders

Due to its impact on brain chemistry, Concerta can affect individuals with existing mental health issues.

Conditions that may be worsened

Concerta is contraindicated in those with severe anxiety, tension, or agitation. Stimulant use can also trigger psychotic or manic symptoms in individuals with or without a history of psychosis or bipolar disorder. Additionally, it can cause or worsen tics and Tourette's syndrome. A personal or family history of these conditions should be discussed with a doctor.

Dangerous Drug Interactions

Combining Concerta with certain medications can lead to dangerous side effects. It is crucial to inform a healthcare provider of all medications being taken.

Monoamine oxidase inhibitors (MAOIs)

Concerta should not be taken with or within 14 days of stopping an MAOI due to the risk of a hypertensive crisis.

Serotonergic Drugs

Using Concerta with other drugs that increase serotonin can lead to serotonin syndrome.

Other Health Considerations and Warnings

Concerta is also contraindicated in patients with severe gastrointestinal narrowing due to the nature of the tablet. It should be used with caution in those with a history of seizure disorders, as it can lower the seizure threshold. Individuals with a history of substance abuse are at higher risk for misuse. Concerta is contraindicated in patients with hyperthyroidism and glaucoma.

Precautions in Specific Populations

Concerta is not approved for children under 6. Use during pregnancy should be carefully considered, and breastfeeding is generally not recommended.

Concerta Contraindications vs. Warnings Table


Condition / Risk	Contraindication (Should NOT Use)	Warning / Precaution (Use with Caution)
Heart Problems	Severe structural heart defects, cardiomyopathy, serious arrhythmias, severe hypertension.	Mild hypertension, a family history of heart disease or sudden cardiac death.
Psychiatric Issues	Severe anxiety, tension, agitation, history of psychosis or bipolar illness.	Personal or family history of depression, suicidal thoughts, or other mental health conditions.
Drug Interactions	Within 14 days of taking a Monoamine Oxidase Inhibitor (MAOI).	Concomitant use with other serotonergic drugs or vasopressors.
Gastrointestinal	Severe narrowing of the intestines (e.g., small bowel disease, cystic fibrosis).	No GI contraindication if no severe narrowing is present.
Tics / Tourette's	Existing Tourette's syndrome or tics.	A family history of tics or Tourette's syndrome.
Substance Abuse	Active substance use disorder.	History of drug or alcohol dependence; requires careful monitoring.

Conclusion

While effective for ADHD, Concerta carries serious risks for certain individuals. It is contraindicated in patients with severe heart problems, severe psychiatric disorders, or those taking MAOIs. Caution is advised for those with a history of substance abuse, seizure disorders, glaucoma, or certain GI issues. A thorough medical evaluation is essential before starting Concerta. Patients should discuss concerns with their healthcare provider and review the official Medication Guide for detailed safety information.

Concerta Medication Guide - US FDA

Frequently Asked Questions

Concerta can increase blood pressure and heart rate. If you have severe hypertension or other serious heart problems, you should not take Concerta. For those with milder high blood pressure, your doctor will monitor your blood pressure closely to ensure it remains safe.

Combining Concerta with certain antidepressants, specifically monoamine oxidase inhibitors (MAOIs), is very dangerous and can cause a hypertensive crisis. It is also risky with other serotonergic drugs and should be done only under a doctor's supervision.

Yes, Concerta is contraindicated for patients with severe anxiety, tension, or agitation because the stimulant effect can worsen these conditions. You should discuss any history of anxiety with your doctor before starting Concerta.

Concerta tablets must be swallowed whole and should not be crushed, chewed, or divided. If a patient cannot swallow the tablet whole, a different form of medication, or a different treatment, will be needed.

No, Concerta is not approved for use in children under 6 years of age. Its safety and effectiveness have not been established in this younger age group.

Patients with tics or Tourette's syndrome, or a family history of these conditions, should not take Concerta as it can cause or worsen tics and Tourette's symptoms.

Concerta's non-deformable tablet shell, which passes through the digestive tract mostly intact, makes it unsafe for individuals with pre-existing severe narrowing of the intestines due to the risk of intestinal blockage.