Methylphenidate: Increased Abuse or Appropriate Use ? (original) (raw)
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Dikkat Eksikliği Hiperaktivite Bozukluğu tedavisi için yazılan metilfenidat reçetelerinin değerlendirilmesi Amaç: Metilfenidat, dikkat eksikliği-hiperaktivite bozukluğu (DEHB)'nun tedavisinde kullanılan ve kontrole tabi olan bir ilaçtır. Bu araştırmada metilfenidatın reçetelenmesine ait detayların araştırılması amaçlandı. Gereç ve Yöntem: İstanbul Sağlık Müdürlüğü arşivindeki 2009 yılı Ocak-Aralık dönemine ait seçilen örneklem üzerinden DEHB tanılı toplam 5681 metilfenidat içeren kırmızı reçete (MİKR) retrospektif olarak incelenerek ilaç kullanımının detayları değerlendirildi. İstatistiksel karşılaştırmalarda Ki kare testi kullanıldı ve p<0.05 olduğunda, istatistiksel olarak anlamlılıktan söz edildi. Bulgular: DEHB tanılı, MİKR'lerin büyük kısmında (%85.4) yaş bilgisinin bulunmadığı; bu bilgiye sahip olan reçetelerin ise %78.5'inin 18 yaş altı çocuklara ait olduğu saptandı. MİKR'lerin %73.7'si erkek hastalara aitti. MİKR'lerin %63'ünü çocuk ve ergen psikiyatri uzmanları ile çocuk sağlığı ve hastalıkları uzmanlarının yazmış olduğu görüldü. Çocukları tedavi eden hekimlerin yazdığı reçetelerin daha çok üniversite hastanelerinde (%64.5), erişkinleri tedavi eden hekimlerin yazdığı reçetelerin ise daha çok özel hastanelerde (%36.6) yazıldığı saptandı. Çocukları tedavi eden hekimler metilfenidat'ın doz bilgisini diğer hekimlerden daha fazla yazmışlardı (p<0.01). MİKR'leri çocuk yaş grubunu tedavi eden hekimler en çok kış, diğer hekimler ise en çok yaz mevsiminde yazmıştı (p<0.01). Sonuç: Metilfenidat, daha çok çocuk hastalara reçete edilmekle birlikte bu tedaviyi alan erişkin hasta oranının hiç de az olmadığı dikkati çekmektedir. Erişkinler için yazılan reçetelerde daha belirgin olmak üzere, MİKR'leri yazan hekimlerin bazı reçeteleme alışkanlıkları ile ilgili eksiklikleri önemsenmeli ve düzeltilmeye çalışılmalıdır. Anahtar sözcükler: Metilfenidat, dikkat eksikliği hiperaktivite bozukluğu, ilaç tedavisi, ilaç reçeteleri Kli nik Psikofarmakoloji Bülteni 2013;23(1):42-8 ABS TRACT:
Methylphenidate use in children with attention deficit hyperactivity disorder
Revista de Saúde Pública, 2015
A Brazilian Health Technology Assessment Bulletin (BRATS) article regarding scientific evidence of the efficacy and safety of methylphenidate for treating attention deficit hyperactivity disorder (ADHD) has caused much controversy about its methods. Considering the relevance of BRATS for public health in Brazil, we critically reviewed this article by remaking the BRATS search and discussing its methods and results. Two questions were answered: did BRATS include all references available in the literature? Do the conclusions reflect the reviewed articles? The results indicate that BRATS did not include all the references from the literature on this subject and also that the proposed conclusions are different from the results of the articles chosen by the BRATS authors themselves. The articles selected by the BRATS authors showed that using methylphenidate is safe and effective. However, the BRATS final conclusion does not reflect the aforementioned and should not be used to support de...
Variables That Affect the Clinical Use and Abuse of Methylphenidate in the Treatment of ADHD
American Journal of Psychiatry, 2003
Objective : Methylphenidate, the most common treatment for attention deficit hyperactivity disorder (ADHD), increases extracellufar dopamine in the brain, which is associated with its reinforcing as well as its therapeutic effects. The authors evaluated variables that distinguish these two properties. Method : The brain imaging and clinical literatures were analyzed to identify variables that contribute to the abuse liability as well as to the clinical efficacy of methylphenidate. Results : Four variables were identified. 1) Dose-there is a threshold for methylphenidate-induced dopamine increases to be perceived as reinforcing and to produce therapeutic effects. 2) Pharmacokinetics-the reinforcing effects of methylphenidate are associated with rapid changes in serum concentrations and presumably fast dopamine increases (as achieved with intravenous injection or insufflation), whereas the therapeutic effects are associated with slowly ascending serum concentrations and presumablyi smoothly rising dopamine levels (a€ :. achieved with oral administration). 3) lri. http.-Iajp-psych iotryonline. org
Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD)
The Cochrane database of systematic reviews, 2015
Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed and treated psychiatric disorders in childhood. Typically, children with ADHD find it difficult to pay attention, they are hyperactive and impulsive.Methylphenidate is the drug most often prescribed to treat children and adolescents with ADHD but, despite its widespread use, this is the first comprehensive systematic review of its benefits and harms. To assess the beneficial and harmful effects of methylphenidate for children and adolescents with ADHD. In February 2015 we searched six databases (CENTRAL, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, Conference Proceedings Citations Index), and two trials registers. We checked for additional trials in the reference lists of relevant reviews and included trials. We contacted the pharmaceutical companies that manufacture methylphenidate to request published and unpublished data. We included all randomised controlled trials (RCTs) comparing methylphenidate v...
Review question We reviewed the evidence of the effects of methylphenidate on the behaviour of children and adolescents with ADHD. Background ADHD is one of the most commonly diagnosed and treated childhood psychiatric disorders. Children diagnosed with ADHD find it hard to concentrate. They are often hyperactive (fidgety, unable to sit still for long periods) and impulsive (doing things without stopping to think). ADHD can make it difficult for children to do well at school, because they find it hard to follow instructions and to concentrate. Their behavioural problems can interfere with their ability to get on well with family and friends, and they often get into more trouble than other children. Methylphenidate is the drug most often prescribed to treat children and adolescents with ADHD. Study characteristics We found 185 randomised controlled trials (RCTs; studies in which participants are randomly assigned to one of two or more treatment groups), involving 12,245 children or a...
Value in Health, 2011
Mental and behavioural disorders are common in childhood and adolescence, but less than one-fifth of these children receive the necessary treatments. Psychotropic medications are recommended for the treatment of a variety childhood and adolescent mental disorders, and the use of such medications has recently increased in many countries. The aim of the study was to investigate the use of prescription psychotropic medication among children with developmental disorders and predictors for said use. A cross-sectional paediatric study based on a questionnaire that was answered by the children's parents and corroborated by clinical records was used. Type and frequency of psychotropic use, reasons for use, and the determining factors were the main measure. In total, 64% of children were receiving psychotropic medication; 40% of the drugs were prescribed in an off-label way, and 73% were meant to treat attention deficit hyperactivity disorder. The stimulant methylphenidate was the most commonly prescribed drug among both the diagnosed and undiagnosed children (89.6% and 60%, respectively), followed by the non-stimulant atomoxetine. Age (OR 3.7, 95% CI 1.1 to 12.3), diagnosis (OR 8.1, 95% CI 2.1 to 30.7) and the father being the head of the household (OR 5.8, 95% CI 1.2 to 29.0) were determinants of psychotropic medication use. The most common psychotropic medication prescribed to children in developmental disorder care centres is the stimulant methylphenidate. These drugs are frequently prescribed in an off-label way to children despite a lack of evidence regarding medication efficacy and safety.
High dose methylphenidate treatment in adult attention deficit hyperactivity disorder: a case report
Journal of Medical Case Reports, 2012
Introduction: Stimulant medication improves hyperactivity, inattention, and impulsivity in both pediatric and adult populations with Attention Deficit Hyperactivity Disorder (ADHD). However, data regarding the optimal dosage in adults is still limited. Case presentation: We report the case of a 38-year-old Caucasian patient who was diagnosed with Attention Deficit Hyperactivity Disorder when he was nine years old. He then received up to 10 mg methylphenidate (Ritalin W ) and 20 mg sustained-release methylphenidate (Ritalin SR W ) daily. When he was 13, his medication was changed to desipramine (Norpramin W ), and both Ritalin W and Ritalin SR W were discontinued; and at age 18, when he developed obsessive-compulsive symptoms, his medication was changed to clomipramine (Anafranil W ) 75 mg daily. Still suffering from inattention and hyperactivity, the patient began college when he was 19, but did not receive stimulant medication until three years later, when Ritalin W 60 mg daily was re-established. During the 14 months that followed, he began to use Ritalin W excessively, both orally and rectally, in dosages from 4800-6000 mg daily. Four years ago, he was referred to our outpatient service, where his Attention Deficit Hyperactivity Disorder was re-evaluated. At that point, the patient's daily Ritalin W dosage was reduced to 200 mg daily orally, but he still experienced pronounced symptoms of, Attention Deficit Hyperactivity Disorder so this dosage was raised again. The patient's plasma levels consistently remained between 60-187 nmol/l-within the recommended range-and signs of his obsessive-compulsive symptoms diminished with fluoxetine 40 mg daily. Finally, on a dosage of 378 mg extended-release methylphenidate (Concerta W ), his symptoms of Attention Deficit Hyperactivity Disorder have improved dramatically and no further use of methylphenidate has been recorded during the 24 months preceding this report. Conclusions: Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) in this adult patient, who also manifested a co-occurring obsessive compulsive disorder, dramatically improved only after application of a higher-than-normal dose of methylphenidate. We therefore suggest that clinicians consider these findings in relation to their adherence to current therapeutic guidelines.
Clinical Pharmacology & Therapeutics
The evidence regarding the benefits and harms of methylphenidate in children and adolescents with ADHD remains inconclusive. Between 2012 and 2018, we conducted two Cochrane systematic reviews on methylphenidate for ADHD. All procedures, such as searches, data extraction and quality assessment followed Cochrane guidelines. The first review included 185 randomised clinical trials. We observed possible beneficial effects of methylphenidate versus placebo or no-intervention, but methodological flaws, such as lack of blinding, outcome reporting bias and heterogeneity, prevented the effective evaluation of the magnitude of intervention effects. The meta-analysis of serious adverse events was considerably underpowered to identify a difference in these events, preventing the drawing of firm conclusions. Methylphenidate increased the risk of non-serious adverse events, with the most common events being appetite suppression and difficulty sleeping. This review has been heavily exposed in many critical articles and editorials. We have rebutted the criticism and have shown that the evidence base for the use of methylphenidate for children and adolescents is indeed flawed. The second review included 260 non-randomised studies, with over 2.2 million participants. Methylphenidate significantly increased the risk of serious adverse events compared to no-intervention. More than 50% of the participants treated with methylphenidate experienced one or more adverse events considered to be non-serious. Our comprehensive reviews of methylphenidate in children and adolescents with ADHD indicate that much of the ADHD research to date is seriously undermined by avoidable methodological flaws that could lead to an overestimation of benefits and an underestimation of harms of methylphenidate.