Methylphenidate (Concerta®) plays an important role in the treatment of attention-deficit/hyperactivity disorder (ADHD).
It is known to cause side effects such as difficulty focusing the eyes³.

Glaucoma is also an eye side effect of Concerta®.

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A large study published in 2024
has revealed that ADHD medications may increase the risk of glaucoma¹.

In addition to Concerta®, Strattera® and Adderall® are also described.

Methylphenidate

• Brand names: Concerta®, Ritalin®
• Open-angle glaucoma risk: 23% increase (aIRR 1.23)
• Use: central nervous system stimulant / first-line ADHD medication

Atomoxetine

• Brand name: Strattera®
• Angle-closure glaucoma risk: 2.55 times the incidence rate (aIRR 2.55)
• Use: non-stimulant

Amphetamine

• Brand name: Adderall® (not approved in Japan)
• Angle-closure glaucoma risk: increased 2.27-fold (aIRR 2.27)
• Use: central nervous system stimulant

Methylphenidate works by inhibiting the reuptake of dopamine and norepinephrine. These neurotransmitters are also involved in regulating eye pressure, and interference with them may increase the risk of glaucoma¹.

What to keep in mind when using ADHD medications is
that the effect of increasing glaucoma risk may appear regardless of the dose.

Concerta® for ADHD: Side Effects That May Raise Glaucoma Risk

Details of the Study: Concerta® May Raise Glaucoma Risk

In a large cohort study published in 2024 (240,257patients with ADHD), the following increases in risk were found:

• Methylphenidate users: open-angle glaucomarisk increased by 23%
  (adjusted incidence rate ratio [aIRR] 1.23; 95% confidence interval 1.05–1.59)
• Atomoxetine users: angle-closure glaucomarisk increased 2.55-fold
  (aIRR 2.55; 95% confidence interval 1.20–5.43)
• Amphetamine users: angle-closure glaucomarisk increased 2.27-fold
  (aIRR 2.27; 95% confidence interval 1.42–3.63)

Breakdown of drug use among the patients studied (mean age 45 years, 55% women):

• Amphetamine: 44.54%
• Methylphenidate: 33.82%
• Atomoxetine: 6.59%
• Multiple drugs used together: 15.04%

What to Watch For While Using ADHD Medications: Clinical Observation and Response

Elevated eye pressure and the onset of glaucoma with methylphenidate (Concerta®) have been described in case reports.

In a reported case, a 10-year-old boy who had used methylphenidate at 60 mg/day for 2 years developed reduced vision in both eyes, and his eye pressure rose to 30 mmHg even with eye drop treatment.

This patient had posterior subcapsular cataract and advanced glaucoma, was resistant to eye drop treatment, and required glaucoma surgery (Lu et al., 2006)².

This strongly suggests the need for regular eye examinations while using ADHD medications. 

Recommended Preventive Approach

Given how widely ADHD medications are used, the researchers point out that the association between these drugs and glaucoma risk has public health significance. Regular monitoring is important, and the following measures are recommended:

Concerta® for ADHD: Side Effects That May Raise Glaucoma Risk

It has become clear that glaucoma risk rises in users of ADHD medications, to differing degrees depending on the type of drug.

While maintaining the effectiveness of treatment, regular follow-up in eye care is important.

References

1. Darwich, R., Etminan, M., He, B., Eadie, B.D., 2024. Medications for attention deficit hyperactivity disorder associated with increased risk of developing glaucoma. Eye 38, 2638–2643. https://pubmed.ncbi.nlm.nih.gov/38710937/

2. Lu, C.-K., Kuang, T.-M., Chou, J.C.-K., 2006. Methylphenidate (Ritalin)-associated cataract and glaucoma. J Chin Med Assoc 69, 589–590. https://pubmed.ncbi.nlm.nih.gov/17182354/

3. Soyer, J., Jean-Louis, J., Ospina, L.H., Bélanger, S.A., Bussières, J.F., Kleiber, N., 2019. Visual disorders with psychostimulants: A paediatric case report. Paediatr Child Health 24, 153–155. https://pubmed.ncbi.nlm.nih.gov/31110455/