Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Methylphenidate”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 145 records · Page 8Linked to original sources
PubMed2003

Poison centers' experience with methylphenidate abuse in pre-teens and adolescents.

OBJECTIVE: To evaluate trends and toxicity of methylphenidate abuse in pre-teens and adolescents reported to poison centers. METHOD: The 1993-1999 American Association of Poison Control Centers Toxic Exposure Surveillance System was queried for methylphenidate abuse cases in children aged 10 through 19 years that were followed to known outcome. Main outcome measures included number of cases annually, toxicity, management site, and coded medical outcome. RESULTS: Of 759 cases, 42.7% involved 10-through 14-year-olds. For the 530 (70.0%) cases involving methylphenidate only, the frequency increased sevenfold from 1993 to 1999. Of 570 patients (75.1%) managed in a health care facility, 398 were discharged from the emergency department and 172 were admitted. Symptoms occurred more commonly in exposures involving coingestants (84.3%) than in methylphenidate-only exposures (71.1%). The most common symptoms in adolescents with methylphenidate only were tachycardia (31.7%), agitation/irritability (25.7%), and hypertension (11.5%). Outcomes were no effect in 189 cases (24.9%) and mild, moderate, and severe in 318 (41.9%), 245 (32.3%), and 7 (0.9%) patients, respectively. CONCLUSIONS: Poison center data demonstrate increasing frequency of methylphenidate abuse. While the majority of adolescents experienced clinical effects and were managed in a health care facility, outcomes were good, especially in cases involving methylphenidate only.

Adolescent↗
PubMed2004

Children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment: impact on parental practices.

OBJECTIVE: To test the hypothesis that multimodal psychosocial intervention, which includes parent training, combined with methylphenidate significantly enhances the behavior of parents of children with attention-deficit/hyperactivity disorder (ADHD), compared with methylphenidate alone and compared with methylphenidate and nonspecific psychosocial treatment (attention control). METHOD: One hundred three children with ADHD (ages 7-9), free of conduct and learning disorders, who responded to short-term methylphenidate therapy were randomized for 2 years to receive either (1) methylphenidate treatment alone; (2) methylphenidate plus psychosocial treatment that included parent training and counseling, social skills training, academic assistance, and psychotherapy; or (3) methylphenidate plus attention control treatment. Parents rated their knowledge of parenting principles and negative and positive parenting behavior. Children rated their parents' behavior. RESULTS: Psychosocial treatment led to significantly better knowledge of parenting principles but did not enhance parenting practices, as rated by parents and children. Significant improvement in mothers' negative parenting occurred across all treatments and was maintained. CONCLUSIONS: In nonconduct-disordered, stimulant-treated children with ADHD, parent training does not improve self-rated parental behavior. The benefits of brief stimulant treatment for negative parental behavior are sustained with extended treatment.

Attention Deficit Disorder with Hyperactivity↗
PubMed2004

Design and rationale of controlled study of long-term methylphenidate and multimodal psychosocial treatment in children with ADHD.

OBJECTIVE: To describe the rationale, methodology, and sample characteristics of a dual-site treatment study (New York and Montreal) of children with attention-deficit/hyperactivity disorder (ADHD) conducted between 1990 and 1995. The hypotheses were that (1) methylphenidate combined with comprehensive multimodal psychosocial treatment was superior to methylphenidate alone in improving multiple functions and (2) the efficacy of the psychosocial intervention resulted from its specific components and not from nonspecific treatment effects. METHOD: One hundred three children with ADHD (ages 7-9), free of conduct and learning disorders, who responded to methylphenidate, were randomized for 2 years to (1) methylphenidate treatment alone; (2) methylphenidate combined with multimodal psychosocial treatment that included parent training and counseling, academic assistance, psychotherapy, and social skills training; or (3) methylphenidate plus attention control treatment that excluded specific aspects of the psychosocial intervention. Children were switched to single-blind placebo after 12 months; methylphenidate was reinstituted when clinically indicated. Assessments included ratings by parents, teachers, children, and psychiatrists; school observations in academic and gym classes; and academic performance tests. Almost 80% of families completed the 2-year study. Companion papers present treatment effects. CONCLUSIONS: A comprehensive 2-year psychosocial treatment was delivered successfully to children with ADHD and their families.

Attention Deficit Disorder with Hyperactivity↗
PubMed2005

Methylphenidate unintentional ingestion in preschool children.

BACKGROUND: With the rising number of prescriptions for methylphenidate has come an increase in preschool younger siblings being exposed to the risk of ingesting methylphenidate. Furthermore, the symptoms of methylphenidate ingestion in preschool children have not been previously defined. METHODS: Over a 3-year period we enrolled and followed by telephone children aged <6 years with methylphenidate ingestion, whether it was their own medication or someone else's, at time of first call to the poison control center. RESULTS: A total of 49 children aged 30+/-11 months were included. Patients ingested a median of 1 tablet (range 0.25-10) for a total median dose of 0.9 mg/kg (range 0.26-12). Twenty-one patients were referred to a health care facility, and the poison control center recommended activated charcoal for 12 of them. Patients referred to a health care facility ingested more methylphenidate: median 1.8 versus 0.7 mg/kg (P<0.001). Patients for whom activated charcoal was recommended ingested more methylphenidate: median 3.5 versus 0.8 mg/kg (P<0.001). Twenty-four patients developed symptoms: agitation or irritability in 17, somnolence in 5, vomiting in 2, and abdominal pain in 2. Two patients had tachycardia. Patients who ingested an extended-release preparation had similar rates of symptoms as those who ingested a regular preparation, 7/9 versus 17/40 (P=0.07), while having ingested similar amounts, median 1.6 versus 0.8 mg/kg (P=0.08). Patients who ingested 1 tablet or less had a similar rate of symptoms as those who ingested more than 1 tablet: 12/29 versus 10/17 (P=0.25). There was no difference in the dose ingested for those who became symptomatic compared with those who remained asymptomatic: median 1.2 (range 0.26-12) versus 0.8 mg/kg (range 0.26-3.8) (P=0.08). CONCLUSION: Preschool children ingesting less than 1 mg/kg of regular methylphenidate can be safely managed at home in spite of the fact that some will develop minor symptoms.

Child, Preschool↗
PubMed2006

Naturalistic long-term use of methylphenidate in bipolar disorder.

Antidepressant use seems to be problematic in bipolar disorder. The dopaminergic agent, bupropion, seems to be equally effective to serotoninergic agents but with greater safety. Methylphenidate is a stimulant medication that is sometimes used as an antidepressant in bipolar adults and is frequently used in children with comorbid bipolar and attention-deficit disorder. There are no data available for the safety of long-term methylphenidate in adults. A retrospective chart review of bipolar patients who received methylphenidate while attending a bipolar clinic was conducted. Data regarding side effects and symptoms were collected. Sixteen charts were reviewed. The mean duration of methylphenidate treatment was 14 months (+/-SD, +/-17.5 months; range, 1-60 months). Five had comorbid attention-deficit disorder, the remainder received the methylphenidate for depression. The mean dose was 16.3 mg/d (+/-SD, +/-8.7 mg/d; range, 5-40 mg/d). Several mild to moderate side effects were reported. Two patients (12.5%) discontinued methylphenidate because of adverse side effects. When available (44% of the sample), general assessment of function increased from (+/-SD) 48.3 +/- 9.9 to 69.3 +/- 10.6 (P = 0.006). Methylphenidate seems to be safe in the naturalistic setting. Controlled studies are needed to confirm its efficacy and safety in bipolar depression.

Adolescent↗
PubMed2006

A randomized, double-blind, placebo-controlled trial of augmentation with an extended release formulation of methylphenidate in outpatients with treatment-resistant depression.

We examined the efficacy and tolerability of augmentation with an extended release formulation of methylphenidate (OROS MPH, Concerta) in patients with major depression who were nonresponders or partial responders to antidepressants. Sixty subjects with treatment-resistant depression (TRD) participated in a 4-week, randomized, double-blind, placebo-controlled study of augmentation with methylphenidate (18-54 mg/d). The preexisting antidepressant dose was unchanged. The primary efficacy measure was change in the 21-item Hamilton Depression Rating Scale from randomization to end of treatment. Data were analyzed with intent-to-treat with last observation carried forward approach. There were no statistically significant differences between the methylphenidate (n = 30) and placebo (n = 30) groups in reduction in 21-item Hamilton Depression Rating Scale scores (drug, -6.9; placebo, -4.7) from baseline to end of treatment (F1,47 = 1.24, P = 0.22), although responders were numerically higher in the extended-release methylphenidate group (40.0%) than in the placebo group (23.3%). On the secondary efficacy measures of changes in Clinical Global Impression-Improvement and Severity scores and Beck Depression Inventory-Second Edition, the drug failed to separate from placebo, although the proportion of responders in the drug group were numerically higher than placebo. There were no significant differences in weight, heart rate, and blood pressure changes between the 2 groups. The common adverse events were loss of appetite, nausea, headache, and anxiety. The mean dose of drug was 34.2 mg/d. The study did not demonstrate a statistically significant benefit for augmentation with methylphenidate in TRD. Combination of methylphenidate with antidepressants was well tolerated. Adequately powered, randomized, controlled trials are necessary to fully evaluate the efficacy of extended-release methylphenidate in TRD.

Adolescent↗
PubMed2005

Methylphenidate: prescribing patterns in a South African primary care patient population.

BACKGROUND AND OBJECTIVE: Sales figures have indicated that there has been a steady increase in the use of methylphenidate in South Africa. The primary aim of the study was to investigate the prescribing of methylphenidate (indicated for Attention Deficit Hyperactivity Disorder in children, and narcolepsy) in a South African primary care patient population. METHODS: A retrospective, exposure cohort drug utilization study was conducted in the South African private health care sector. Data were obtained from a medical aid administrator and were analysed for all patients who received one or more prescriptions for methylphenidate (N06B A04) during 2002. RESULTS AND DISCUSSION: A total of 106 patients received one or more prescriptions for methylphenidate during the year. Ninety of the 106 patients (84.9%) were under 25 years of age (average age 10.51 years, SD=3.92 years). These 90 patients were all single and the majority of them (75.6%) were males. The Lorenz curve was used to illustrate skewness in the prescribing of methylphenidate to the patient population. Patients under the age of 25 years received on average 3.46 prescriptions for methylphenidate during the year. The most common chronic diagnosis category was 'Hyperkinetic Syndrome of Childhood'. Most of the prescriptions were obtained from pharmacies, followed by dispensing doctors and rehabilitation services. CONCLUSION: The results were in agreement with a previous South African study conducted in 1996. Further studies are recommended, especially into the quality of life of patients before and after receiving methylphenidate.

Adolescent↗
PubMed1985

[3H]Threo-(+/-)-methylphenidate binding to 3,4-dihydroxyphenylethylamine uptake sites in corpus striatum: correlation with the stimulant properties of ritalinic acid esters.

Saturable and stereoselective binding sites for [3H]threo-(+/-)-methylphenidate were characterized in rat brain membranes. The highest density of [3H]threo-(+/-)-methylphenidate binding sites was found in the synaptosomal fraction of corpus striatum. Scatchard analysis revealed a single class of noninteracting binding sites with an apparent dissociation constant (KD) of 235 nM and a maximum number of binding sites (Bmax) of 13.4 pmol/mg protein. Saturable, high-affinity binding of [3H]threo-(+/-)-methylphenidate to striatal synaptosomal membranes was dependent on the presence of sodium ions. A good correlation (r = 0.88; p less than 0.001) was observed between the potencies of various psychotropic drugs in displacing [3H]threo-(+/-)-methylphenidate from these sites and their potencies as inhibitors of [3H]3,4-dihydroxyphenylethylamine ( [3H]dopamine) uptake into striatal synaptosomes. A good correlation (r = 0.85; p less than 0.001) was also observed between the potencies of a series of ritalinic acid esters in inhibiting [3H]threo-(+/-)-methylphenidate binding to striatal synaptosomal membranes and their potencies as motor stimulants in mice. These observations suggest that the binding sites for [3H]threo-(+/-)-methylphenidate described here are associated with a dopamine uptake or transport complex, and that these sites may mediate the motor stimulant properties of ritalinic acid esters such as methylphenidate.

Animals↗
PubMed2005

cAMP and extracellular signal-regulated kinase signaling in response to d-amphetamine and methylphenidate in the prefrontal cortex in vivo: role of beta 1-adrenoceptors.

d-Amphetamine and methylphenidate are widely used in the treatment of attention-deficit/hyperactivity disorder. Both drugs increase extracellular norepinephrine and dopamine in the prefrontal cortex, where they are believed to exert their therapeutic effects. However, the molecular mechanisms underlying their action are poorly understood. To investigate the intracellular signaling pathways activated by d-amphetamine and methylphenidate in the prefrontal cortex in vivo in mice, we measured the cAMP-dependent Ser845 phosphorylation of alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor GluR1 subunit and the active form of extracellular signal-regulated kinase (ERK). Administration of d-amphetamine (5-10 mg/kg) or methylphenidate (10-20 mg/kg) increased phosphorylation of GluR1. Basal and d-amphetamine-induced GluR1 phosphorylation was reduced by propranolol, a general beta-adrenoceptor antagonist, and betaxolol, a beta1-antagonist, but not by (+/-)-1-[2,3-(dihydro-7-methyl-1H-inden-4-yl)oxy]-3-[(1-methylethyl)amino]-2-butanol (ICI-118,515), a beta2-antagonist. The effect of methylphenidate was also blocked by propranolol and betaxolol. The d-amphetamine effect was slightly potentiated by prazosin, an alpha1-adrenoceptor antagonist, and mimicked by yohimbine, an alpha2 antagonist. Blockade of dopamine or N-methyl-d-aspartate (NMDA) receptors or serotonin depletion had no effect on d-amphetamine-induced GluR1 phosphorylation. d-amphetamine but not methylphenidate increased ERK phosphorylation. This effect required multiple signaling pathways because it was blocked by beta1- and alpha1-adrenoceptor antagonists, by dizocilpine maleate (MK801), an NMDA antagonist, and by serotonin depletion. In contrast, blockade of dopamine receptors had no effect on d-amphetamine-induced ERK phosphorylation. Propranolol and betaxolol increased the hyperlocomotion produced by d-amphetamine and methylphenidate. Thus, both d-amphetamine and methylphenidate potently activate the cAMP pathway in the prefrontal cortex through beta1-adrenergic receptors. This activation could have behavioral consequences and contribute to the treatment of attention-deficit/hyperactivity disorder.

Animals↗
PubMed1999

Association of methylphenidate-induced craving with changes in right striato-orbitofrontal metabolism in cocaine abusers: implications in addiction.

OBJECTIVE: The authors have shown that decreases in dopamine D2 receptors in cocaine abusers were associated with decreased metabolism in the cingulate and prefrontal and orbitofrontal cortices. To assess whether increasing dopamine would reverse these metabolic decrements, they measured the effects of methylphenidate, a drug that increases dopamine, on brain glucose metabolism in 20 cocaine abusers. METHOD: The subjects underwent two [18F]fluorodeoxyglucose positron emission tomography scans, one after two sequential placebo injections and one after two intravenous doses of methylphenidate. D2 receptors were measured with [11C]raclopride to evaluate their relation to methylphenidate-induced metabolic changes. RESULTS: Methylphenidate induced variable changes in brain metabolism: subjects with the higher D2 measures tended to increase metabolism, whereas those with the lower D2 measures tended to decrease metabolism. Methylphenidate's effects were significant for increases in metabolism in the superior cingulate, right thalamus, and cerebellum. Methylphenidate-induced changes in the right orbitofrontal cortex and right striatum were associated with craving, and those in the prefrontal cortex were associated with mood. CONCLUSIONS: Although methylphenidate increased metabolism in the superior cingulate, it only increased metabolism in orbitofrontal or prefrontal cortices in the subjects in whom it enhanced craving and mood, respectively. This indicates that dopamine enhancement is not sufficient per se to increase metabolism in these frontal regions. Activation of the right orbitofrontal cortex and right striatum (brain regions found to be abnormal in compulsive disorders) in the subjects reporting craving may be one of the mechanisms underlying compulsive drug administration in addicted persons. The predominant correlation of craving with right but not left brain regions suggests laterality of reinforcing and/or conditioned responses.

Adult↗
PubMed1996

Depression in the medically ill elderly: a focus on methylphenidate.

OBJECTIVE: To describe depression in the medically ill elderly and discuss methylphenidate as a treatment option. DATA SOURCES: A MEDLINE search from 1986 to 1995 was done to identify the literature published on depression in the medically ill as well as the literature on the use of methylphenidate for depression in the medically ill elderly. The references of articles found were evaluated for other relevant articles. STUDY SELECTION: Retrospective and prospective studies that evaluated the use of methylphenidate in depressed, medically ill elderly were reviewed. DATA EXTRACTION: Information on depression in the medically ill elderly was abstracted from original and review articles on the subject. The information pertaining to methylphenidate came from clinical studies. CONCLUSIONS: Depression in the medically ill elderly occurs frequently and is underdetected in part because of the difficulty in diagnosing depression in this population. Methylphenidate has been found to be a safe and effective treatment of depression in the medically ill elderly. A potential advantage of methylphenidate over other antidepressants is its relatively quick onset of action, usually within 2-5 days. Older patients whose depressive symptoms are interfering with their functional capabilities or participation in prescribed therapies to improve or restore function after a medical illness should be considered for a trial of methylphenidate.

Aged↗
PubMed2006

Patient-controlled methylphenidate for cancer fatigue: a double-blind, randomized, placebo-controlled trial.

PURPOSE: To evaluate the effectiveness of patient-controlled methylphenidate as compared with placebo in cancer patients with fatigue, as measured by the Functional Assessment for Chronic Illness Therapy-Fatigue (FACIT-F). PATIENTS AND METHODS: Patients with a fatigue score of at least 4 on a scale of 0 to 10 (0 = no fatigue, 10 = worst possible fatigue) and hemoglobin level of at least 10 g/dL were included. Patients were randomly assigned to receive 5 mg methylphenidate or placebo every 2 hours as needed (maximum of four capsules a day), for 7 days. Patients completed a daily diary including study drug record and fatigue intensity. A research nurse telephoned patients daily to assess toxicity and fatigue level. All patients were offered open-label methylphenidate for 4 weeks. FACIT-F and the Edmonton Symptom Assessment System (ESAS) were assessed at baseline, and days 8, 15, and 36. The FACIT-F fatigue subscore on day 8 was considered the primary end point. RESULTS: Of 112 patients randomly assigned, 52 patients in the methylphenidate and 53 in the placebo group were assessable for analysis. Fatigue intensity improved significantly on day 8 in both the methylphenidate and placebo groups. However, there was no significant difference in fatigue improvement by FACIT-F (P = .31) or ESAS (P = .14) between groups. In open-label phase, fatigue intensity maintained low as compared with baseline. No significant toxicities were observed. CONCLUSION: Both methylphenidate and placebo resulted in significant symptom improvement. Methylphenidate was not significantly superior to placebo after 1 week of treatment. Longer study duration is justified. The role of daily telephone calls from a research nurse should be explored as a palliative care intervention.

Adult↗
PubMed2002

Extended-release methylphenidate (Ritalin LA).

An extended-release formulation of methylphenidate (Ritalin LA), a CNS stimulant that inhibits dopamine and noradrenaline (norepinephrine) reuptake into presynaptic neurons, has been developed for use in patients with attention deficit/hyperactivity disorder (ADHD). In children with ADHD and healthy male adults, extended-release methylphenidate 20mg was rapidly absorbed and demonstrated two distinct peak plasma concentrations approximately 4 hours apart. The absorption pharmacokinetics of extended-release methylphenidate 20mg, which closely mimics those of immediate-release methylphenidate 10mg given in two doses 4 hours apart, permits once-daily administration. In a 2-week randomised, double-blind, placebo-controlled trial in 134 evaluable children aged 6 to 12 years with ADHD, symptoms improved to a significantly greater extent with extended-release methylphenidate 10 to 40mg once daily than with placebo. Extended-release methylphenidate improved both inattention and hyperactivity symptoms and was effective in children with combined- (inattentive and hyperactive/impulsive) type or predominantly inattentive-type ADHD. In clinical trials, the safety and tolerability profiles of extended-release methylphenidate were consistent with that of the immediate-release formulation.

Administration, Oral↗
PubMed2001

How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis.

BACKGROUND: Numerous small clinical trials have been carried out to study the behaviourally defined efficacy and safety of short-acting methylphenidate compared with placebo for attention-deficit disorder (ADD) in individuals aged 18 years and less. However, no meta-analyses that carefully examined these questions have been done. We reviewed the behavioural evidence from all the randomized controlled trials that compared methylphenidate and placebo, and completed a meta-analysis. METHODS: We searched several electronic sources for articles published between 1981 and 1999: MEDLINE, EMBASE, PsychINFO, ERIC, CINAHL, HEALTHSTAR, Biological Abstracts, Current Contents and Dissertation Abstracts. The Cochrane Library Trials Registry and Current Controlled Trials were also consulted. A study was considered eligible for inclusion if it entailed the following: a placebo-controlled randomized trial that involved short-acting methylphenidate and participants aged 18 years or less at the start of the trial who had received any primary diagnosis of ADD that was made in a systematic and reproducible way. RESULTS: We included 62 randomized trials that involved a total of 2897 participants with a primary diagnosis of ADD (e.g., with or without hyperactivity). The median age of trial participants was 8.7 years, and the median "percent male" composition of trials was 88.1%. Most studies used a crossover design. Using the scores from 2 separate indices, this collection of trials exhibited low quality. Interventions lasted, on average, 3 weeks, with no trial lasting longer than 28 weeks. Each primary outcome (hyperactivity index) demonstrated a significant effect of methylphenidate (effect size reported by teacher 0.78, 95% confidence interval [CI] 0.64-0.91; effect size reported by parent 0.54, 95% CI 0.40-0.67). However, these apparent beneficial effects are tempered by a strong indication of publication bias and the lack of robustness of the findings, especially those involving core ADD features. Methylphenidate also has an adverse event profile that requires consideration. For example, clinicians only need to treat 4 children to identify an episode of decreased appetite. INTERPRETATION: Short-acting methylphenidate has a statistically significant clinical effect in the short-term treatment of individuals with a diagnosis of ADD aged 18 years and less. However, the extension of this placebo-controlled effect beyond 4 weeks of treatment has not been demonstrated. Exact knowledge of the extent and definition of the short-term behavioural usefulness of methylphenidate is questioned.

Adolescent↗
PubMed2001

Prescription of methylphenidate to children and youth, 1990-1996.

BACKGROUND: There are concerns about the frequency and appropriateness of psychostimulant drug prescription to children. In order to identify unusual or unexpected patterns of use or prescribing, we reviewed prescription of methylphenidate (Ritalin) to children and adolescents aged 19 years or less in British Columbia between 1990 and 1996. METHODS: We obtained information about patients, physicians and prescriptions from British Columbia's Triplicate Prescription Program database for controlled drugs. Prescription data were available for the period Jan. 1, 1990, to Dec. 31, 1996. Linkage with the BC Linked Health Dataset provided additional demographic and health information. RESULTS: In 1990, 1715 children received at least 1 prescription for methylphenidate (1.9 per 1000 children). By 1996, the number had increased to 10,881 children (11.0 per 1000). Because some children were prescribed methylphenidate in more than 1 year, we also calculated the frequency with which the drug was prescribed to children who had never received it before. This rate increased from 1.0 per 1000 children in 1990 to 4.7 per 1000 in 1995; the rate fell in 1996 to 3.5 per 1000. The number of children receiving methylphenidate varied across health regions of the province, from 12.0 to 35.4 per 1000. Use also varied by socioeconomic status quintile: in the 2 lowest (least privileged) quintiles, 21.6 per 1000 children received methylphenidate, compared with 18.4 per 1000 in the 3 highest quintiles (relative risk 1.2, 95% confidence interval 1.1-1.2). Pediatricians and psychiatrists wrote 23% and 21% of all prescriptions respectively. General practitioners accounted for 56% of all prescriptions and 41% of initial methylphenidate prescriptions. A claim for prior specialist consultation was found in 30% of such cases. Many of the children who received more than 10 prescriptions had seen 4 or more physicians. The average daily dosage prescribed differed little among general practitioners, pediatricians and psychiatrists, unlike the mean interval between successive prescriptions: 89.9 (standard deviation [SD] 68.2), 99.8 (SD 64.1) and 75.9 (SD 70.2) days respectively. Persistence with therapy was more likely when a psychiatrist provided the initial prescription, or with involvement of more than one specialty. INTERPRETATION: Many trends and practices in the prescription of methylphenidate to children in British Columbia are consistent with other settings and accepted standards. Some aspects warrant closer investigation, including regional and socio-economic discrepancies in the distribution of patients, the relative involvement of primary and specialist care providers, continuity of care issues and time intervals between prescriptions.

Adolescent↗
PubMedDate not supplied

[The effect of discontinuation of methylphenidate at adolescence onset on adult attention deficit hyperactivity disorder].

INTRODUCTION: The positive effect of methylphenidate on children and adults with ADHD is well known. However, the effect of discontinuation of methylphenidate at adolescence onset on adult s ADHD is unknown. Objective. To determine the effect of discontinuation of methylphenidate at adolescence onset on adult s attention deficit, hyperactivity, impulsivity and functional disabilities. PATIENTS AND METHODS: Adults and their parents, spouses and/or friends were requested to fill out the same criteria diagnosis form filled out by their parents and teachers before (7 years of age), during (7.5 years of age) and at the end of treatment (12 years of age). They took methylphenidate (0.1 0.5 mg/kg/day) from age 7 to 12 years because ADHD. Inattention, hyperactivity, impulsivity and functional disability were statistically analyzed by the paired sample method before, during at the end of treatment and at age 27 years. RESULTS: Methylphenidate used for 5 years (7.5 12 years of age) improved significantly (p< 0.001) the average score for inattention, hyperactivity, impulsivity and functional impairment compared to pre (7 year of age) and post (27 years of age) treatment. The discontinuation of methylphenidate for 15 years (12 27 year of age) deteriorate significantly the average score for inattention and functional impairment when pre adolescent and adult values were compared (p< 0.001). CONCLUSIONS: The results strongly suggest that methylphenidate must be used throughout the adulthood to avoid the degree of inattention and functional disability found in this study.

Adolescent↗
PubMed2004

Sustained-release methylphenidate: new preparations. New pharmaceutical forms: a slight advantage for a small number of children.

(1) When non-drug measures don't work in severe attention-deficit/hyperactivity disorder, methylphenidate, an amphetamine, attenuates symptoms in about 75% of children, at least in the short term. (2) Two forms of sustained-release methylphenidate--tablets (Concerta LP) and microgranule-filled capsules (Ritaline LP)--are marketed in France. (3) In two cross-over trials (one week per treatment) and in a parallel-group trial lasting one month, sustained-release methylphenidate tablets (18 mg to 54 mg/day in a single dose) were no more or less effective than short-acting methylphenidate (5 mg to 15 mg three times a day), but the sustained-release formulation was significantly more effective than placebo. The rating scale used in these trials was not sensitive enough to show whether the two forms had the same duration of action. A one-year non comparative trial in 435 children suggested that initial efficacy persisted in at least half the children treated with sustained-release tablets. (4) The only clinical trial of sustained-release methylphenidate capsules--a randomised double-blind placebo controlled trial lasting two weeks--showed that sustained-release capsules were more effective than placebo. (5) All these short-term trials confirmed the known amphetamine-like adverse effects of methylphenidate. The sustained-release tablets are large and rigid. They have the potential to cause gastrointestinal obstruction. (6) The sustained-release tablets can be difficult to swallow, and must not be cut, crushed, or chewed. The capsules can be opened so the microgranules inside them can be mixed with food. (7) In practice, it is best to start with short-acting methylphenidate, which is better evaluated than sustained-release formulations. If it's effective, and if treatment needs to be simplified, the child can be switched to a sustained-release form later; capsules are less risky than tablets, and are also more convenient.

Attention Deficit Disorder with Hyperactivity↗
PubMed1994

Reinforcing and subjective effects of methylphenidate in humans.

This study assessed the reinforcing and subjective effects of methylphenidate in a group of 35 adults (15 females and 20 males) with no history of drug dependence. A discrete-trial choice procedure was used to assess the reinforcing effects of a single oral dose of methylphenidate selected to produce a moderate subjective response in each subject (range 20-40mg). A number of variables (gender, current and past drug use, personality, and baseline mood and arousal) were examined in an attempt to identify sources of variability in drug response. Methylphenidate was chosen on 28% of occasions. In the group as a whole, methylphenidate had no effect on ratings of drug liking, but did increase ratings indicative of "positive" mood, CNS stimulation and anxiety. Within-subject variability in methylphenidate choice was related to variability in subjective response to the drug across choice trials. Methylphenidate choice was also associated with between-subject differences in prior opioid use and several personality dimensions. When compared with the results of a prior study of the same design with d-amphetamine, these results suggest that methylphenidate produces a somewhat different profile of subjective effects, and may be a less efficacious reinforcer than d-amphetamine.

Journal Article↗