Vomiting methylphenidate

Increased activities of aspartate transaminase, alanine transaminase, and alkaline phosphatase were reported in a 67-year-old woman with a stroke who had taken methylphenidate 10 mg tds. Nausea, vomiting, and dizzy spells occurred. The drug was withdrawn and liver enzymes returned to normal, but when she was rechallenged with a small dose (2.5 mg), the pathological changes recurred (32). 

A modified-release, once-daily formulation has been evaluated in 282 children with ADHD in a double-blind, placebo-controUed trial for 28 days (37). For core ADHD symptoms, both once-daily modified-release and thrice-daily immediate-release methylphenidate were superior to placebo and not different from each other. A similar percentage of patients reported at least one adverse event with both formulations. The most commonly reported adverse events were headache and upper respiratory infections, followed by abdominal pain, cough, pharyngitis, vomiting, and otitis media. Of these, only headache and abdominal pain were considered to be related to the study medication. One patient withdrew because of depression with modified-release methylphenidate and one because of tics with placebo. Headache occurred in 14%, 5.8%, and 10% of patients taking modified-release methylphenidate, immediate-release methylphenidate, or placebo respectively, and abdominal pain in 6.7%, 5.8%, and 1.0%. Other adverse events included appetite suppression (modified-release methylphenidate) and insomnia (aU three). The results of this study suggest that once-daily modified-release methylphenidate provides efficacy superior to placebo and is not significantly different from thrice-daily immediate-release methylphenidate. 

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. 

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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