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Inhibition by methylphenidate of transport across the yeast cell membrane.

The influence of methylphenidate on glycolysis in yeast cells was studied to describe more fully the nature of the reactions in which this drug participates. CO(2) production and O(2) uptake of yeast cells was inhibited 75% by a 10 mm concentration of the compound. This effect, with glucose as a substrate, occurred at pH 7.0, but not at pH 4.5. Kinetic data indicated that the reaction was noncompetitive and complex; the methylphenidate effect on CO(2) production could not readily be reversed. Glycolysis by cell-free extracts was not inhibited at the 10-mm concentration, but was affected at 100 mm. Utilization of O(2) with maltose and ethyl alcohol as substrates also was reduced. Entry into the cells of a number of different carbohydrates and of glycine was inhibited to different degrees. The loss from suspended cells of materials absorbing at 280 nm was reduced, and the efflux of sorbose, arabinose, and lactose was decreased. Thus, transport into and out of the cells was inhibited and leakage, or permeability, was reduced. It is hypothesized that methylphenidate reacts with a cell membrane constituent, or constituents, and inhibits glycolysis by blocking sugar passage.

Arabinose↗

The methylphenidate test for differentiating desipramine-responsive from nortriptyline-responsive depression.

Monitoring tricyclic antidepressant concentrations in the plasma of 43 patients with major depressive disorders indicated that some responded to imipramine or desipramine but not to amitriptyline or nortriptyline, or vice versa, even though plasma levels were within therapeutic ranges. Mood elevation by methylphenidate predicted marked improvement from treatment with imipramine or desipramine but not with amitriptyline or nortriptyline. When methylphenidate failed to improve mood, patients responded to amitriptyline or nortriptyline but not to desipramine. These results suggest differential drug responses with different tricyclic antidepressants, the clinical utility of the methylphenidate test, and the heterogeneity of depressions. The authors question the mechanism of action of nortriptyline via blockade of norepinephrine reuptake.

Adolescent↗

Dexamethasone suppression test and mood response to methylphenidate in primary depression.

Thirty-four patients who met Research Diagnostic Criteria for the diagnosis of major depressive disorder, primary subtype, were given the dexamethasone suppression test (DST) and a methylphenidate challenge. The two tests divided the patients along the following lines: One group did not suppress cortisol and failed to respond to methylphenidate, while the other group did suppress cortisol and had a positive mood response to methylphenidate. In an open clinical trial, the former group responded preferentially to amitriptyline and the latter group responded preferentially to imipramine.

Adult↗

A comparison of aripiprazole, methylphenidate, and placebo for amphetamine dependence.

OBJECTIVE: Problems related to illegal amphetamine use have become a major public health issue in many developed countries. To date, evidence on the effectiveness of psychosocial treatments has remained modest, and no pharmacotherapy has proven effective for amphetamine dependence. METHOD: Individuals meeting DSM-IV criteria for intravenous amphetamine dependence (N=53) were randomly assigned to receive aripiprazole (15 mg/day), slow-release methylphenidate (54 mg/day), or placebo for 20 weeks. The study was terminated prematurely due to unexpected results of interim analysis. An intention-to-treat analysis was used. The primary outcome measure was the proportion of amphetamine-positive urine samples. RESULTS: Patients allocated to aripiprazole had significantly more amphetamine-positive urine samples than patients in the placebo group (odds ratio=3.77, 95% CI=1.55-9.18), whereas patients who received methylphenidate had significantly fewer amphetamine-positive urine samples than patients who had received placebo (odds ratio=0.46, 95% CI=0.26-0.81). CONCLUSIONS: Methylphenidate is an effective treatment for reducing intravenous drug use in patients with severe amphetamine dependence.

Adult↗

Effects of methylphenidate on functional magnetic resonance relaxometry of the cerebellar vermis in boys with ADHD.

OBJECTIVE: The authors used functional magnetic resonance imaging (fMRI) to test the effects of methylphenidate on steady-state blood volume in the midline vermis of the cerebellum in boys with attention deficit hyperactivity disorder (ADHD). This region was selected as it has been observed to be significantly smaller in children with ADHD. Also, in preclinical studies, the vermis has been shown to modulate forebrain dopamine systems, to influence locomotor activity, and to contain a significant density of dopamine transporters. METHOD: T(2) relaxometry was used to indirectly assess blood volume in the cerebellum (hemispheres and midline vermis) of 10 boys with ADHD who were administered placebo or one of three different doses of methylphenidate continuously for 1 week. T(2) relaxation time values are inversely proportional to local cerebral blood volume. After each week of treatment, and within 1-3 hours of the boys' afternoon dose, testing for drug efficacy was performed by using objective measures of activity. RESULTS: Moderate and high doses of methylphenidate increased T(2) relaxation time in a rate-dependent manner-increasing T(2) relaxation time in the most active children with ADHD and reducing T(2) relaxation time in subjects with ADHD who were not objectively hyperactive. CONCLUSIONS: This preliminary study supports a role for the vermis in ADHD and suggests that further research is needed to clarify the relationship between vermal size, vermal blood flow, stimulant response, and the developmental pathophysiology of ADHD.

Attention↗

Methylphenidate treatment of negative symptoms in patients with dementia.

This pilot study evaluated response of negative symptoms (NS) to methylphenidate in patients with dementia and relationships between NS, depression, and cognitive deficits in these patients. Consecutively admitted patients with NS and dementia--12 with dementia of Alzheimer's type and 15 with vascular dementia--were rated on severity of NS (SANS and PANSS-N scales), depressive symptoms (Ham-D), and cognitive impairment (MMSE) before and after treatment with methylphenidate. NS decreased significantly, and cognitive scores increased. A decrease in depression scores was nonsignificant after all variance attributable to NS was removed. NS, depression, and cognitive scores were not significantly intercorrelated. Results were similar for Alzheimer's and vascular dementia patients. Negative symptoms in dementia patients appear responsive to methylphenidate treatment. This effect may underlie putative changes in symptoms of depression observed by other researchers.

Aged↗

A controlled trial of methylphenidate in black adolescents. Attentional, behavioral, and physiological effects.

The short-term effects of methylphenidate were examined on behavioral, laboratory, academic, and physiological measures in 11 black male adolescents diagnosed as having attention deficit disorder (ADD). In a double-blind, crossover design with randomized order, the subjects received placebo and each of three methylphenidate doses (0.15 mg/kg, 0.30 mg/kg, and 0.50 mg/kg) for a period of 2 weeks per medication dosage. Significant drug effects were found for the majority of measures. In general, the higher doses resulted in the most beneficial response in behavioral, academic, and laboratory measures of attention and impulsivity. However, a significant linear increase occurred in diastolic blood pressure. The results suggest that methylphenidate is an effective adjunct to the treatment of ADD in adolescents.

Adolescent↗

Effects of methylphenidate on the auditory processing abilities of children with attention deficit-hyperactivity disorder.

Stimulant medications are widely used as part of the treatment for children with attention deficit-hyperactivity disorder (ADHD). The current study investigated the effects of methylphenidate on auditory vigilance, auditory processing abilities, and receptive language abilities of children with ADHD. Twenty subjects (17 males and 3 females) ranged in age from 7 to 13 years. Each subject had been diagnosed as having ADHD and had been prescribed methylphenidate for the control of hyperactivity. The test battery included the Auditory Continuous Performance Test (ACPT), SCAN (a screening test for auditory processing disorders in children), and the Token Test for Children. Results indicated that there was significant improvement in the children's performance on all measures when on methylphenidate. Implications of these findings are discussed.

Adolescent↗

Steady-state pharmacokinetics and tolerability of modafinil given alone or in combination with methylphenidate in healthy volunteers.

The potential for a pharmacokinetic (PK) drug-drug interaction between modafinil and methylphenidate, each at steady state, was investigated in an open-label, randomized, single-period study in 32 healthy male and female volunteers. All subjects received modafinil once daily orally for 28 days (200 mg on Days 1-7 and 400 mg on Days 8-28). On Days 22 to 28, half of the subjects also received 20 mg of methylphenidate orally 8 hours after their modafinil dose. PK profiles of modafinil were obtained on Days 21 and 28 and compared between the two groups. There were no statistically significant differences between the treatment groups in the mean changes in PK parameters for modafinil. Parameters for its metabolites were also similar between the groups, and all treatments were well tolerated. The results indicate that administration of low-dose methylphenidate 8 hours after treatment with modafinil does not appear to alter the steady-state pharmacokinetics of modafinil in healthy volunteers.

Adult↗

Mechanism of action of methylphenidate: insights from PET imaging studies.

Methylphenidate (MPH) is the most commonly prescribed drug for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD). We have used Positron Emission Tomography (PET) to investigate the mechanism of action of MPH in the human brain. We have shown (a) that oral MPH reaches peak concentration in the brain 60-90 minutes after its administration, (b) that therapeutic doses of MPH block more than 50% of the dopamine transporters (DAT), and (c) that of the two enantiomers that compose MPH, it is d-threo-methylphenidate (d-MPH) and not l-threo-methylphenidate (l-MPH) that binds to the DAT. We have also shown that therapeutic doses of MPH significantly enhance extracellular dopamine (DA) in the basal ganglia, which is an effect that appears to be modulated by the rate of DA release and that is affected by age (older subjects show less effect). Thus, we postulate (a) that MPH's therapeutic effects are in part due to amplification of DA signals, (b) that variability in responses is in part due to differences in DA tone between subjects, and (c) that MPH's effects are context dependent. Because DA enhances task specific neuronal signaling and decreases noise, we also postulate that MPH-induced increases in DA could improve attention and decrease distractibility; and that since DA modulates motivation, the increases in DA would also enhance the saliency of the task facilitating the 'interest it elicits' and thus improving performance.

Adolescent↗

Responses to methylphenidate and varied doses of caffeine in children with attention deficit disorder.

Six children with the diagnosis of Attention Deficit Disorder were treated as day hospital patients, using different stimulant medication. They were studied in a double-blind crossover experiment in which they received caffeine in low dose or in a high dose. Methylphenidate was added to both dosages, as well as administered alone. Results indicated that caffeine in low dosage when added to methylphenidate was superior to all other treatment conditions. Caffeine in low dosage could not be differentiated from 10 mg of methylphenidate. High dosage caffeine was not different from placebo or no-drug conditions. This study offers evidence to support a curvilinear pattern of dose-response for caffeine, in attenuating the behavioural manifestations of this syndrome.

Attention Deficit Disorder with Hyperactivity↗

Narcosuggestion in chronic conversion symptoms using combined intravenous amobarbital and methylphenidate.

Five patients with chronic conversion symptoms were treated with narcoanalysis and narcosuggestion using combined methylphenidate and amobarbital. The combination of methylphenidate and amobarbital proved useful because methylphenidate antagonized sedation and allowed optimal patient cooperation. In four cases recovery of neurological function was obtained in the first or second interview and subsequently improved with practice and positive feedback. In each instance recovery of neurological function during a narcoanalytic interview confirmed the diagnosis of a conversion reaction. The narcoanalytic interview also confirmed or uncovered important psychopathology and psychodynamics which permitted more accurate treatment of the underlying psychiatric disorders.

Adult↗

Are too many children being treated with methylphenidate?

A survey was conducted of the use of methylphenidate in British Columbia during a six month period to determine if a disproportionate number of children are being treated with methylphenidate for hyperactivity. The data obtained do not indicate a problem regarding the diagnosis of attention deficit hyperactivity disorder in children. However, the data pertaining to adults indicate that the reasons stated for prescribing methylphenidate are controversial in a significant number of cases.

Adolescent↗

The go-no go test in attention deficit disorder is sensitive to methylphenidate.

The go-no go test requires a subject to emit a simple motor response to one cue while inhibiting the response in the presence of another cue. This test has been effective in demonstrating impulsivity (elevated commission error rate) in children with attention deficit disorder (ADD). In this study, we examined the effects on go-no go test performance of two doses of methylphenidate (0.15 mg/kg and 0.3 mg/kg) administered in double-blind placebo-controlled fashion to children with ADD. Our results indicate that even modest doses of methylphenidate improve the go-no go performance of these children by decreasing their tendency to make impulsive commission errors. Thus the test is sensitive to the effects of methylphenidate and can be used to monitor a response to therapy.

Adolescent↗

Paroxysmal kinesigenic dystonia after methylphenidate administration.

We report a patient who developed paroxysmal kinesigenic dystonia shortly after initiation of therapy with methylphenidate for presumed attention deficit-hyperactivity disorder. Attacks persisted long after methylphenidate was discontinued and responded completely to treatment with carbamazepine. Though it is possible that methylphenidate caused this syndrome in our patient, it is more likely that the stimulant triggered the onset of a genetically determined disorder.

Adolescent↗

Methylphenidate for fatigue in advanced cancer: a prospective open-label pilot study.

Psychostimulants such as methylphenidate are used for fatigue in cancer patients. We report a prospective, open-label, pilot study of the successful use of methylphenidate to treat fatigue in nine of 11 consecutive patients with advanced cancer. Seven had received radiation or chemotherapy, a median of three weeks (range from one to 30 weeks) prior to methylphenidate. A rapid onset of benefit was noted, even in the presence of mild anemia. Sedation and pain also improved in some. Only one patient had side effects severe enough to stop the medication.

Aged↗

Zinc sulfate as an adjunct to methylphenidate for the treatment of attention deficit hyperactivity disorder in children: a double blind and randomized trial [ISRCTN64132371].

BACKGROUND: Attention-deficit hyperactivity disorder is an early-onset, clinically heterogenous disorder of inattention, hyperactivity, and impulsiveness. The diagnosis and treatment of attention-deficit hyperactivity disorder continues to raise controversy, and, there is also an increase in treatment options. In this 6-week double blind, placebo controlled-trial, we assessed the effects of zinc plus methylphenidate in the treatment of children with attention deficit hyperactivity disorder. To the best of our knowledge, this study is the first double blind and placebo controlled clinical trial assessing the adjunctive role of zinc in ADHD. METHODS: Our subjects were 44 outpatient children (26 boys and 18 girls) between the ages of 5-11 (mean +/- SD was 7.88 +/- 1.67) who clearly met the DSM IV diagnostic criteria for attention-deficit hyperactivity disorder and they were randomized to methylphenidate 1 mg/kg/day + zinc sulfate 55 mg/day (with approximately 15 mg zinc element) (group 1) and methylphenidate 1 mg/kg/day + placebo (sucrose 55 mg) (group 2) for a 6 week double blind clinical trial. The principal measure of the outcome was the Teacher and Parent ADHD Rating Scale. Patients were assessed by a child psychiatrist at baseline, 14, 28 and 42 days after the medication started. RESULTS: The present study shows the Parent and Teacher Rating Scale scores improved with zinc sulfate over this 6-week, double blind and placebo controlled trial. The behavior of the two treatments was not homogeneous across the time. The difference between the two protocols was significant as indicated by the effect on the group, the between-subjects factor (F = 4.15, d.f. = 1, P = 0.04; F = 4.50, d.f. = 1, P = 0.04 respectively). The difference between the two groups in the frequency of side effects was not significant. CONCLUSIONS: This double-blind, placebo-controlled study demonstrated that zinc as a supplementary medication might be beneficial in the treatment of children with attention-deficit hyperactivity disorder. However, further investigations and different doses of zinc are required to replicate these findings in children with ADHD.

Ambulatory Care↗

Methylphenidate increases serum growth hormone concentrations.

Serum growth hormone (GH) and cortisol concentrations were measured in 12 healthy, young men following oral administration of methylphenidate (20 mgm ) or a placebo. Methylphenidate elicited unequivocal GH elevations in 9 of 12 subjects while only 2 subjects showed GH elevation following placebo. Cortisol concentrations were not affected by methylphenidate.

Adult↗