Which condition is a contraindication to methylphenidate therapy?

• A. No kids under 6
• B. Cardiac disease
• C. Caffeine may increase effects
• D. Decreased effects of antihypertensives

Answer: (B)

The main idea here is that methylphenidate, as a CNS stimulant, boosts sympathetic activity in the body. This means it increases heart rate and blood pressure and can provoke or worsen heart-related problems. Because of this, it is contraindicated in people with known cardiac disease, including structural heart abnormalities, cardiomyopathy, serious arrhythmias, or other significant heart conditions. In patients with these conditions, using a stimulant drug can raise the risk of adverse events like hypertension, tachyarrhythmias, or ischemia.

The other options aren’t absolute contraindications. Not giving methylphenidate to kids under six is a labeling guideline reflecting age and approval status, not an inherent safety contraindication. Caffeine interaction is a potential effect modifier to monitor, not a blanket prohibition. Decreased effects of antihypertensives would be a clinical consideration or concern in management, but it doesn’t by itself classify methylphenidate as contraindicated.