Agitation methylphenidate

Patients with marked anxiety, tension, and agitation, because the drug may aggravate these symptoms hypersensitivity to methylphenidate or other components of the product patients with glaucoma, motor tics, or a family history or diagnosis of Tourette s syndrome during treatment with monoamine oxidase inhibitors (MAOIs), and also within a minimum of 14 days following discontinuation of an MAOl (hypertensive crises may result). 

Marked anxiety, tension, and agitation (the drug may aggravate these symptoms) hypersensitivity to methylphenidate or other components of the product glaucoma motor tics or a family history or diagnosis of Tourette syndrome. 

A 22-year-old man who had had ADHD since the age of 8 years took methylphenidate, and had an adequate response for 14 years (52). However, his symptoms worsened and he switched from methylphenidate to mixed amfetamine salts 20 mg bd. A month later he continued to have difficulty in focusing on tasks, and the dosage was eventually increased to 45 mg tds over several weeks, with symptomatic improvement. However, 5 days later, he awoke feeling nauseated and agitated and had choreiform movements of his face, trunk, and limbs. He had also taken escitalopram 10 mg/day for anxiety and depression for 2 months before any changes in his ADHD medications. He was treated with intravenous diphenhydramine, lora-zepam, and diazepam without improvement in the chorea. Amfetamine was withdrawn and 3 days later his chorea abated. He restarted methylphenidate and the movement disorders did not recur. 

Emergence or worsening of activation and agitation may represent the induction of a bipolar state, especially a mixed dysphoric bipolar II condition sometimes associated with suicidal Ideation, and require the addition of a mood stabilizer and/or discontinuation of d,l-methylphenidate... 

Of 289 patients exposed to excessive doses of methylphenidate, 31% had symptoms, including most commonly tachycardia, agitation, and lethargy (41). No patient developed severe symptoms, although there was a less favorable outcome with intentional versus unintentional exposure. Peak exposure occurred in 6- to 9-year-old children, in whom therapeutic error was the most common reason for exposure. 

Stimulants have been used as antidepressants for many years, especially dextroamphetamine (Dexedrine) and methylphenidate (Ritalin). They have the side effects of anxiety, insomnia, agitation, and appetite suppression. They can be quite effective antidepressants but are now usually reserved for medically ill patients such as those who have had a stroke and those unresponsive to other antidepressants. 

Methylphenidate should not be used with monoamine oxidase inhibitors such as tranylcypromine. Symptoms of overdose may include euphoria, confusion, delirium, coma, toxic psychosis, agitation, headache, vomiting, dry mouth, mydriasis, self-injury, fever, diaphoresis, tremors, hyper-reflexia, muscle twitching, seizures, flushing, hypertension, tachycardia, palpitations, and arrhythmias. 

Methylphenidate increases dopamine levels in the CNS, which then may be converted to norepinephrine in adrenergic terminals. This may result in mood elevation. The use of this drug, however, is limited to treatment-refractory cases or when standard medical therapies are nol tolerated, as CNS stimulants may aggravate coexisting anxiety or agitation in depressed patients. 

Amphetamines methylphenidate cocaine Agitation, hypertension, tachycardia, delusions, hallucinations, hyperthermia, seizures, death Apathy, irritability, increased sleep time, disorientation, depression... 

In a 6-week-randomised, double-blind study, 44 patients diagnosed with ADHD were randomly assigned to receive bupropion 100-150 mg/day or methylphenidate (20-30 mg/day) treatment. No serious events were observed in the study in any of the patients. The most commonly reported adverse events were abdominal pain (30%), anxiety (25%), decreased appetite (55%), agitation (20%), insomnia (50%), dizziness (5%), dry mouth (15%), nervousness (25%), tachycardia (5%), headache (50%) and vomiting (15%) [18 ]. In a randomised, double-blind. 

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