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What
Doctors Know About Ritalin |
Pharmacology
“Methylphenidate (Ritalin) is a mild central nervous system stimulant.
The mode of action in humans is not completely understood, but Methylphenidate
presumably activates the brain stem arousal system and cortex to produce
its stimulant effect.
There is neither specific evidence which clearly establishes the mechanism
whereby Methylphenidate produces its mental and behavioral effects in children,
nor conclusive evidence regarding how these effects relate to the condition
of the central nervous system.
Peak plasma concentrations of 10.8 and 7.8 ng/mL were observed, on average,
2 hours after administration of 0.30 mg/kg in children and adults, respectively.
Special Diagnostic
Considerations
Specific etiology of this syndrome is unknown, and there is no single diagnostic
test. Adequate diagnosis requires the use not only of medical but of special
psychological, educational, and social resources.
WARNINGS!
Children: Methylphenidate
SHOULD NOT BE USED IN CHILDREN UNDER SIX YEARS, since safety and
efficacy in this age group have not been established.
Sufficient data on safety and efficacy of long-term use of Methylphenidate
in children are not yet available. Although a causal relationship has not
been established, suppression of growth (i.e., non-weight gain, and/or non-height
gain) has been reported with the long-term use of stimulants in children.
Therefore, patients requiring long-term therapy should be carefully monitored.
Seizures: There is some clinical evidence that Methylphenidate may lower
the convulsive threshold in patients with prior history of seizures, with
prior EEG abnormalities in absence of seizures, and, very rarely, in absence
of history of seizures and no prior EEG evidence of seizures. Safe concomitant
use of anticonvulsants and Methylphenidate has not been established. In
the presence of seizures, the drug should be discontinued.
Use cautiously in patients with hypertension. Blood pressure should be monitored
at appropriate intervals in all patients taking Methylphenidate, especially
those with hypertension.
Symptoms of visual disturbances have been encountered in rare cases. Difficulties
with accommodation and blurring of vision have been reported.
Long-term effects of Methylphenidate in children have not been well established.
To Prevent this medicine from affecting sleep: try not to take a dose later
than 6 pm.
Adverse Reactions
Nervousness and insomnia are the most common adverse reactions but are usually
controlled by reducing dosage and omitting the drug in the afternoon or
evening. Other reactions include hypersensitivity (including skin rash,
urticaria, fever, arthralgia, exfoliative dermatitis, erythema multiforme
with histopathological findings of necrotizing vasculitis, and thrombocytopenic
purpura); anorexia; nausea; dizziness; palpitations; headache; dyskinesia;
drowsiness; blood pressure and pulse changes, both up and down; tachycardia;
angina; cardiac arrhythmia; abdominal pain; weight loss during prolonged
therapy. There have been rare reports of Tourette's syndrome. Toxic psychosis
has been reported. Although a definite causal relationship has not been
established, the following have been reported in patients taking this drug:
isolated cases of cerebral arteritis and/or occlusion; leukopenia and/or
anemia; transient depressed mood; a few instances of scalp hair loss.
In children, loss of appetite, abdominal pain, weight loss during prolonged
therapy, insomnia, and tachycardia may occur more frequently; however, any
of the other adverse reactions listed above may also occur.
Drug Abuse and Dependence:
Methylphenidate should be given cautiously to emotionally unstable patients,
such as those with a history of drug dependence or alcoholism, because such
patients may increase dosage on their own initiative.
Chronically abusive use can lead to marked tolerance and psychic dependence
with varying degrees of abnormal behavior. Frank psychotic episodes can
occur, especially with parenteral abuse. Careful supervision is required
during drug withdrawal, since severe depression as well as the effects of
chronic over-activity can be unmasked. Long-term follow-up may be required
because of the patient's basic personality disturbances.
Overdose : Signs
and Symptoms
Signs and symptoms of acute overdosage, resulting principally from overstimulation
of the central nervous system and from excessive sympathomimetic effects,
may include the following: vomiting, agitation, tremors, hyperreflexia,
muscle twitching, convulsions (may be followed by coma), euphoria, confusion,
hallucinations, delirium, sweating, flushing, headache, hyperpyrexia, tachycardia,
palpitations, cardiac arrhythmias, hypertension, mydriasis, and dryness
of mucous membranes.
Treatment
If you or someone you know may have used more than the recommended dose
of this medicine, contact your local poison control center or emergency
room immediately.
Treatment consists of appropriate supportive measures. The patient must
be protected against self-injury and against external stimuli that would
aggravate overstimulation already present. If signs and symptoms are not
too severe and the patient is conscious, gastric contents may be evacuated
by induction of emesis or gastric lavage. In the presence of severe intoxication,
use a carefully titrated dosage of a short- acting barbiturate before performing
gastric lavage.
Intensive care must be provided to maintain adequate circulation and respiratory
exchange; external cooling procedures may be required for hyperpyrexia….
Children (6 years and over only!)
Methylphenidate should be initiated in small doses, with gradual weekly
increments. Daily dosage above 60 mg is not recommended.
If improvement is not observed after appropriate dosage adjustment over
a one-month period, the drug should be discontinued.”
From the website: http://www.healthyplace.com
Articles and Information
Behavioral Communication of Children
Rising Ritalin Use by Phyllis Gray
A Perspective on ADHD, ADD, and ODD
What Doctors Know, The Pharmacology of Ritalin
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