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Synthesis and pharmacology of potential cocaine antagonists. 2. Structure-activity relationship studies of aromatic ring-substituted methylphenidate analogs.

As part of a program to develop medications which can block the binding of cocaine to the dopamine transporter, yet spare dopamine uptake, a series of aromatic ring-substituted methylphenidate derivatives was synthesized and tested for inhibitory potency in [3H]WIN 35,428 binding and [3H]dopamine uptake assays using rat striatal tissue. Synthesis was accomplished by alkylation of 2-bromopyridine with anions derived from various substituted phenylacetonitriles. In most cases, erythro compounds were markedly less potent than the corresponding (+/-)-threo-methylphenidate (TMP; Ritalin) derivatives. The ortho-substituted compounds were much less potent than the corresponding meta- and/or para-substituted derivatives. The most potent compound against [3H]WIN 35,428 binding, m-bromo-TMP, was 20-fold more potent than the parent compound, whereas the most potent compound against [3H]dopamine uptake, m,p-dichloro-TMP, was 32-fold more potent. Threo derivatives with m- or p-halo substituents were more potent than TMP, while electron-donating substituents caused little change or small loss of potency. All of the derivatives had Hill coefficients approaching unity, except m,p-dichloro-TMP, which had an nH of 2.0. Although the potency of the (+/-)-methylphenidate derivatives in the two assays was highly correlated (R2 = 0.986), the compounds m-chloro-,m-methyl-, and p-iodo-TMP were 4-5-fold more potent at inhibiting [3H]-WIN 35,428 binding than [3H]dopamine uptake (cocaine has a ratio of 2.3). These and other compounds may be promising candidates for further testing as potential partial agonists or antagonists of cocaine.

Animals↗

A convenient method for synthesis of enantiomerically enriched methylphenidate from N-methoxycarbonylpiperidine.

[formula: see text] This report describes a new method to prepare optically active methylphenidate starting from piperidine. The method consists of a transformation of N-methoxycarbonylpiperidine to the corresponding alpha-methoxylated carbamate I by utilizing electrochemical oxidation followed by the coupling reaction with optically active Evans imides II to produce optically active methylphenidate derivatives III with high stereoselectivities, threo-(2R,2'R)-Methylphenidate (IV; Ar = Ph; Ritalin) was easily prepared from III in three steps.

Adrenergic Agents↗

Methylphenidate does not modify the impact of response frequency or stimulus sequence on performance and event-related potentials of children with attention deficit hyperactivity disorder.

Twenty-six children with attention deficit/hyperactivity disorder (ADHD) participated in a double-blind trial consisting of 2 consecutive weeks each of placebo and methylphenidate (M = 26.92 mg/day = 0.78 mg/kg/day). As expected, stimulant therapy resulted in moderate weight loss, increased somatic complaints, and teacher and parent reports of reduced inattentiveness, aggression, and oppositionality. In both phases of the trial, patients were tested in a choice reaction time task assessing two aspects of the task that presumably affect response selection: response frequency (ratio of targets/nontargets = 25/75 vs. 50/50) and stimulus sequence (alternations vs. repetitions). Both manipulations yielded expected results on performance and event-related potentials (ERPs). Stimulant treatment increased accuracy and speed among younger children and curtailed variability of reaction time for the sample as a whole. However, methylphenidate did not affect ERPs. In combination, the results imply that the enhancement of performance by methylphenidate does not involve the demands of response selection examined in this study.

Arousal↗

Clinical and cognitive effects of methylphenidate on children with attention deficit disorder as a function of aggression/oppositionality and age.

Children diagnosed with attention deficit disorder (ADD; n = 44), ADD plus aggression/oppositionality (ADD/O; n = 34), and as not meeting ADD criteria (NC; n = 29) received methylphenidate and placebo for 21 consecutive days each. Parents and teachers rated all groups improved under medication, but teachers reported less improvement for NC than for ADD/O children. Methylphenidate and chronological age had generally similar effects in a Sternberg task: greater accuracy and speed (especially for nontargets at low memory loads), larger P3b waves of event-related potentials, more pronounced slowing of P3b latency by memory load, and a greater trend of earlier peaks for targets than for nontargets. Both methylphenidate and maturation promoted more efficient strategies involving differentiated evaluation of targets and nontargets. These results were comparable among ADD groups.

Aggression↗

Dose-response effects of methylphenidate on ecologically valid measures of academic performance and classroom behavior in adolescents with ADHD.

The effects of methylphenidate on the academic performance and classroom behavior of 45 adolescents with attention deficit hyperactivity disorder were studied. During a 6-week, placebo-controlled medication assessment in the context of a summer treatment program, participants received a double-blind, crossover trial of 3 doses of methylphenidate. Dependent measures included note-taking quality, quiz and worksheet scores, written language usage and productivity, teacher ratings, on-task and disruptive behavior, and homework completion. Group data showed positive effects of methylphenidate on academic measures; however, the greatest benefit came with the lowest dose. Although additional benefit did occur for some participants with higher doses, the largest increment of change usually occurred between the placebo and 10-mg dose. Many adolescents did not experience added benefit with increased dosages, and in some cases they experienced deterioration. Guidelines for assessment of medication effects are discussed.

Adolescent↗

Aggressive, prosocial, and nonsocial behavior in hyperactive boys: dose effects of methylphenidate in naturalistic settings.

Given the importance of interpersonal interactions for hyperactive children, we evaluated the impact of methylphenidate on specific categories of social behavior in 25 boys, aged 6-12, with attention deficit-hyperactivity disorder (ADHD). These children participated in a 3-week, double-blind, crossover trial with placebo and low (0.3 mg/kg) and moderate (0.6 mg/kg) dosages of methylphenidate during a naturalistic summer research program. Fifteen comparison boys, without problems in attention and behavior, were also observed. In addition to decreasing noncompliance, methylphenidate reduced a combined category of physical and verbal aggression for the ADHD boys, with a significant linear trend across dosages. The medication decreased aggression to levels comparable with those of the comparison boys. There were no medication effects on the frequency of nonsocial or prosocial behaviors. Results are discussed in light of the need to effect durable change in both the quantity and quality of social behavior for hyperactive children.

Aggression↗

Behavioral pharmacological similarities between methylphenidate and cocaine in cocaine abusers.

Six human participants with recent histories of cocaine use were trained to discriminate 200 mg oral cocaine hydrochloride. A range of doses of oral cocaine (50-300 mg), methylphenidate (15-90 mg), triazolam (0.125-0.75 mg), and placebo were then tested to determine whether they shared discriminative-stimulus and participant-rated effects with 200 mg cocaine. Cocaine and methylphenidate dose-dependently increased cocaine-appropriate responding, produced prototypical stimulant-like participant-rated drug effects (e.g., increased participant ratings of Drug Liking), and increased heart rate and blood pressure. Triazolam produced low levels of cocaine-appropriate responding and impaired performance. Thus, consistent with previous studies, humans can reliably discriminate oral cocaine. Consistent with in vivo behavioral neuropharmacological data, the discriminative-stimulus, participant-rated, and physiological effects of oral cocaine and methylphenidate were similar.

Adult↗

Methylphenidate, amygdalectomy, and active avoidance performance in the rat.

Amygdalectomized and control rats were given 400 active avoidance training trials in a shuttle box. Control animals received 0, 4, 8, or 16 mg/kg of methylphenidate throughout acquisition. Amygdalectomized animals were given the first 200 trials without drug, followed by 200 trials with drug. The administration of methylphenidate produced an abrupt and large improvement in performance in the amygdalectomized animals. One month after acquisition under the drug, retraining without drug revealed a significant retention effect for the three amygdaloid-drug groups relative to the nondrug-amygdaloid group. These results indicate that although amygdalectomy impairs the performance of avoidance responses, it does not prevent the learning or retention of such responses. Since methylphenidate appears to act primarily on dopaminergic mechanisms, the possible influence of amygdalectomy on such mechanisms is discussed.

Amygdala↗

Methylphenidate ('Ritalin') can ameliorate abnormal risk-taking behavior in the frontal variant of frontotemporal dementia.

The frontal variant of frontotemporal dementia is a significant neurological condition worldwide. There exist few treatments available for the cognitive and behavioural sequelae of fvFTD. Previous research has shown that these patients display risky decision-making, and numerous studies have now demonstrated pathology affecting the orbitofrontal cortex. The present study uses a within-subjects, double-blind, placebo-controlled procedure to investigate the effects of a single dose of methylphenidate (40 mg) upon a range of different cognitive processes including those assessing prefrontal cortex integrity. Methylphenidate was effective in 'normalizing' the decision-making behavior of patients, such that they became less risk taking on medication, although there were no significant effects on other aspects of cognitive function, including working memory, attentional set shifting, and reversal learning. Moreover, there was an absence of the normal subjective and autonomic responses to methylphenidate seen in elderly subjects. The results are discussed in terms of the 'somatic marker' hypothesis of impaired decision-making following orbitofrontal dysfunction.

Aged↗

Cluster headache management with methylphenidate (Ritalin).

The authors report rapid cluster headache relief in a 43-year-old man with a 5-year history of refractory cluster headache. The patient described complete headache relief within 10 minutes of taking 10 mg of methylphenidate (Ritalin) when used to abort the onset of his headaches. Subsequently, a scheduled Ritalin dose taken each morning was sufficient to prevent his nightly headaches. In addition, 1 week of prophylactic methylphenidate therapy halted the series of cluster headaches. This is the first reported case of relief of cluster headaches with methylphenidate.

Adult↗

Toward individualized evidence-based medicine: five "N of 1" trials of methylphenidate in geriatric patients.

OBJECTIVES: To investigate the efficacy of methylphenidate in depressed or apathetic geriatric patients. DESIGN: Five "N of 1" trials (individual cross-over, double-blinded, randomized trials). SETTING: Department of Geriatrics, University Medical Center, Nijmegen, and two nursing homes in Nijmegen, the Netherlands. PARTICIPANTS: Patients suffered from depression due to a general medical condition (n = 2); depression resistant to antidepressive drugs (n = 1), chronic apathy due to mild and moderate severe dementia (n = 2). INTERVENTION: Methylphenidate (5 mg bid) and placebo (both for two subsequent days) in 5 weeks of randomized treatment blocks. MEASUREMENTS: Montgomery Asberg Depression Rating Scale (MADRS), Apathy Evaluation Scale (AES)-clinician, the AES-informant, Barthel index and a semiquantitative checklist of adverse effects. RESULTS: Among the three depressed patients, two showed significant improvement on the MADRS (P = .089 and P = .001; alpha = 0.10), one patient's apathy showed significant improvement on AES-clinician and -informant (P = .077 and P = .086). One apathetic patient's trial was stopped because AES could not be completed. None of the patients showed significant changes in the Barthel index. No side effects developed. CONCLUSION: "N of 1" trials are useful in evaluating efficacy of methylphenidate in depressed or apathetic geriatric patients. Single-patient trials can be a useful tool in pharmacotherapeutic decision-making in frail older subjects.

Aged↗

Effects of TENS and methylphenidate in tuberculous meningo-encephalitis.

PRIMARY OBJECTIVE: Beneficial effects of transcutaneous electrical nerve stimulation (TENS) on cognition and behaviour were observed in a child with probable Herpes Simplex Encephalitis. Based on these positive findings, it was examined in the present case study whether a child who had been diagnosed to suffer from tuberculous meningitis would benefit from TENS. Furthermore, as aggression and overactive behaviour were also prominent clinical symptoms, the effects of methylphenidate were investigated. METHODS AND PROCEDURES: Neuropsychological tests were used to assess attention/concentration and visuospatial and visuoconstructive memory. Behaviour, including the level of activity during 24 hours, was assessed by one observation scale and actigraphy. EXPERIMENTAL INTERVENTIONS: TENS and methylphenidate. MAIN OUTCOMES AND RESULTS: TENS particularly improved overall affective behaviour. Methylphenidate appeared to have the opposite effect on cognition and hardly any effect on patient's behaviour. CONCLUSIONS: TENS might improve the patient's behavioural functioning. Pros and cons for treatment effects are discussed.

Central Nervous System Stimulants↗

Methylphenidate and dextroamphetamine abuse in substance-abusing adolescents.

The prevalence of methylphenidate and dextroamphetamine misuse and abuse was examined in 450 adolescents referred for substance abuse treatment. Twenty three percent reported nonmedical use of these substances and six percent were diagnosed as methylphenidate or dextroamphetamine abusers. Abuse was more common in individuals who were out of school and had an eating disorder. Methylphenidate and dextroamphetamine abuse appears to be much less common than abuse of most other substances. It does occur, however, and parents and schools need to exert greater control over the dispensing of these medications. Physicians are advised to prescribe non-stimulant medications (eg, bupropion) when treating attention deficit hyperactivity disorder in substance-abusing individuals.

Adolescent↗

Methylphenidate selectively improves story retelling in children with attention deficit hyperactivity disorder.

OBJECTIVES: The goal of this study was to determine stimulant effects on story grammar, comprehension, and errors in the narratives of children with attention deficit hyperactivity disorder (ADHD) with and without comorbid language impairment. Previous research has demonstrated impairments in the narrative abilities of children with ADHD, but the effect of the primary treatment modality (methylphenidate) is unknown. METHODS: Fifty children with ADHD (7 to 12 years of age) were stratified for language impairment that might influence performance. In an acute, randomized, placebo-controlled crossover trial with two single doses (10 and 20 mg) of methylphenidate, the children listened to an audiotaped story while viewing a wordless picture book of the study, then retold the story and answered comprehension questions. The narratives were transcribed and coded for story grammar, length, and errors. RESULTS: Methylphenidate only increased children's reporting of the story characters' internal responses and attempts. It had no effect on story length or responses to comprehension questions. Responses to the factual questions were significantly more accurate than the inferential questions, irrespective of medication dose. Comorbid language impairment had no effect on performance or stimulant response. CONCLUSION: Story grammar analysis was sensitive to drug effects, which were subtle but specific and clinically meaningful. Results provide evidence for the theoretical linkage between internal responses and attempts.

Attention Deficit Disorder with Hyperactivity↗

A thin layer chromatographic method for high volume screening of urine for methylphenidate abuse.

A thin layer chromatographic (TLC) method for the high volume screening of urine for methylphenidate (Ritalin) abuse is presented. The method utilizes charcoal extraction of ritalinic acid from urine and a simple test-tube methylation step for the conversion of the ritalinic acid to methylphenidate. The methylphenidate is then subjected to a routine TLC drug procedure for subsequent qualitative identification.

Chromatography, Thin Layer↗

Does methylphenidate constrict cognitive functioning?

It has been suggested that stimulants enhance attention in children with (attention deficit disorder with hyperactivity) (ADDH) by producing a generalized constriction or "over-focusing." Such a phenomenon might be expected to adversely affect performance on tasks, such as those in the Wallach-Kogan (W-K) battery, which explicitly call for cognitive flexibility or "divergent thinking." Nineteen ADDH children, 6 to 10 years of age, were tested on two modified subtests of the W-K battery at baseline, following placebo, and following three different dosages (.3, .6 and 1.0 mg/kg) of methylphenidate. Contrary to the hypothesis, methylphenidate did not decrease but rather sustained output on the tests, which contrasted with a decline in productivity seen across nondrug days. Some ADDH subjects displayed particularly large increases in output following methylphenidate and may represent an atypical subgroup of children who became overaroused on medication.

Arousal↗

Effects and noneffects of methylphenidate in children with mental retardation and ADHD.

Stimulant medication efficacy was evaluated in 14 children with attention-deficit hyperactivity disorder and IQs of 48 to 74 in a double-blind crossover study of two methylphenidate doses and placebo. Dependent measures included behavioral ratings, work output, measures of learning, attention and impulsivity, and direct observation of peer social interactions. Nine children (64%) were methylphenidate-responders, based upon the Conners Hyperactivity Index. Significant gains in on-task behavior and attentional skills were noted with methylphenidate in comparison to placebo. No improvement on measures of learning or social interactions were observed. Results extend and replicate previous research conducted by the authors.

Attention Deficit Disorder with Hyperactivity↗

Methylphenidate in hyperactive boys with comorbid tic disorder: II. Short-term behavioral effects in school settings.

In this study, 11 prepubertal hyperactive boys with tic disorder received placebo and three doses of methylphenidate (0.1, 0.3, and 0.5 mg/kg) for 2 weeks each, under double-blind conditions. Each boy was observed for approximately 20 hours in the school setting (classroom seatwork activities, lunchroom, and playground). Results showed that methylphenidate effectively suppressed hyperactive/disruptive behaviors in the classroom and physical aggression in the lunchroom and on the playground. Methylphenidate also reduced the occurrence of vocal tics in the classroom and the lunchroom. None of the motor tic measures revealed drug effects, but the lowest mean rate of motor tics occurred on the 0.3 mg/kg dose. On an operationally defined minimal effective dose, only one boy experienced motor tic exacerbation.

Attention Deficit Disorder with Hyperactivity↗