Methylphenidate adverse effects

Handen 3-week, double- 3 females Methylphenidate Methylphenidate, 8 of 13 Adverse effects included cry-... 

A number of studies indicate that some but not all antidepressants are effective in ADHD. Spencer and colleagues (66) found 29 studies (involving 1,016 patients) that supported the efficacy of TCAs in the treatment of ADHD. Desipramine is the TCA with the most efficacy data. Desipramine, based on a meta-analysis of five randomized trials involving 170 ADHD patients had efficacy (i.e., effect size) comparable with that of methylphenidate ( 90, 91). However, desipramine produced a higher rate of adverse effects compared with psychostimulants. Moreover, several sudden, unexpected deaths have been reported in children on desipramine ( 92,... 

The adverse effects associated with methylphenidate are generally mild and short-lived, with the most common effects being insomnia, decreased appetite, stomach ache, headache, and jitteriness. Although methylphenidate has been abused, the problem of abuse is generally seen in adults who use multiple substances or in adolescents experimenting with medications (28). Sweden withdrew methylphenidate from its market in 1968 because some adults dissolved tablets and injected the solution, leading to serious cases of talc granulomatosis (38). However, most cases of methylphenidate abuse apparently have led to less serious consequences (28). 

As with methylphenidate, the adverse effects associated with pemoline are generally mild. The most common effects are insomnia, decreased appetite, stomachache, headache, and jitteriness (28). Periodic monitoring of liver enzymes is necessary because of the potential for hepatic toxic effects. 

The stimulant drugs, including all methylphenidate and amphetamine products, produce a wide array of adverse effects on the brain and mind as well as the overall body. Strattera, marketed by Eli Lilly as a nonstimulant, shares most of these adverse effects. Table 11.1 summarizes the adverse drug reaction data from eight controlled clinic trials. Table 11.2... 

Methylphenidate releases stored dopamine but most of its action is to irrhibit uptake of central neurotransmitters. Its effects and adverse effects are very similar to amphetamines. Methylphenidate has a low systemic availability and slow onset of... 

Two cases of dyskinesia and bruxism in children have been attributed to an interaction of methylphenidate with valproic acid. These adverse effects were severe, occurred a few hours after the ingestion of methylphenidate 5 mg, and lasted for 4 and 7 hours (56). 

The most common side effect of clonidine is dose-dependent sedation that usually subsides after 2 to 3 weeks of therapy. Of concern are reports of bradycardia, rebound hypertension, heart block, and sudden death. Four children have died on the combination of methylphenidate and clonidine however, complicating factors make it impossible to link the drug combination directly with the cause of death. Of 10,060 children exposed to clonidine and assessed by a poison control center over a 7-year period, moderate (19%) to major (2%) toxic effects (bradycardia, hypotension, and respiratory depression) including one death were reported. Overdoses, concurrent clonidine and stimulant administration, as well as missed doses of clonidine aU add to the risk of adverse cardiovascular events. Similar adverse-effect concerns apply to treatment with guanfacine, although its U2a selectivity may result in less sedation and hypotension than clonidine. ... 

Quintana et al. reported a double-blind, placebo-controlled study of 10 autistic children. The study employed a randomized crossover design in which subjects received placebo (2 weeks) or methylphenidate (10 mg twice daily for the first week, 20 mg twice daily for the second week) in random order. A modest but statistically significant improvement over placebo was noted in ABC measures of hyperactivity, irritability, and stereotypic behavior, with no significant increase in adverse effects (Quintana et al., 1995). 

Isolated reports describe delirium in one patient and a seizure in another when methylphenidate was taken with sertraline. Schizophrenia and symptoms of amfetamine toxicity have also been reported in two patients taking amfetamine and fluoxetine. There is an isolated report of the serotonin syndrome associated with concurrent citalopram and dexamfetamine and another associated with sertraline and etilefrine. There is also a report of adverse effects associated with fluoxetine and phenylpropanolamine. 

An isolated report describes a tonic-clomc seizure in a 13-year-old boy after he had been taking sertraline 25 to 50 mg daily and methylphenidate 80 mg daily for about 2 weeks. He had been receiving methylphenidate without significant adverse effects for about 10 months before the seizure and following discontinuation of the sertraline experienced no further seizures. ... 

In contrast, beneficial augmentation of effects has been reported with methylphenidate and SSRIs (fluoxetine, paroxetine, sertraline) without significant adverse effects. ... 

Methylphenidate can increase the levels and rate of response to tricyclic antidepressants. This has led to both increased beneficial and adverse effects. No significant pharmacokinetic interaction has been reported between desipramine and dexamfetamine or methylphenidate. An isolated report describes a blood dyscrasia in a child given methylphenidate and imipramine. 

In vitro experiments with human liver slices indicate that methylphenidate inhibits the metabolism of imipramine, resulting in raised blood levels. The accelerated response to tricyclic antidepressants may also be partly due to increased serum levels in the presence of methylphenidate, although the adverse effects observed were not entirely consistent with elevated levels of tricyclics. There are also reports suggesting that... 

Information is limited. Some therapeutic improvement including accelerated response is seen in some patients. This may be partially because of the very marked rise in the blood levels of the antidepressant due to methylphenidate, but may also be due to an additional effect on mood attributable to methylphenidate. Concurrent use may cause adverse effects sufficiently severe to necessitate withdrawal of methylphenidate, but it is not certain whether this can solely be attributed to increases in serum levels of tricyclic antidepressants. Information about other tricyclic antidepressants is lacking. However, it has been suggested that concurrent use in children and adolescents may be undesirable, due to case reports of adverse behavioural effects. If concurrent use is deemed necessary it would seem prudent to monitor concurrent use for adverse tricyclic effects (e.g. dry mouth, blurred vision, urinary retention) and adjust the dose as necessary. 

Systematic reviews In 26 placebo-con-trolled trials in 811 adults with ADHD, methylphenidate was well tolerated in the short-term and produced no serious adverse effects [59 ]. However, there is little information on the long-term safety of methylphenidate in adults, although the number of serious adverse effects reported has so far been low. Methylphenidate is associated with modest increases in blood pressure and heart rate. Surveys of the use of stimulants in US universities have shown that misuse of prescribed medications, for recreation or to enhance the ability to study, is fairly common, although the magnitude of harm that arises from such practices is unclear. 

Psychiatric Psychosis is an important but unpredictable adverse effect of stimulant medications and can mimic the symptoms of ADHD. Four cases of stimulant-induced psychosis (three with methylphenidate and one with Concerta XL) resolved spontaneously on withdrawal of medication and... 

Amphetamines (excluding methylphenidate hydrochloride and anorexics) Stimulate adverse CNS effects. High... 

Handen, B.L., Feldman, H., Gosling, A., Breaux, A.M., and McAu-liffe, S. (1991) Adverse side effects of methylphenidate among mentally retarded children with ADHD. / Am Acad Child Adolesc Psychiatry 30 241—245. 

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