To review the short- and long-term safety and efficacy of stimulants for the treatment of children with attention-deficit/hyperactivity disorder (ADHD).
A Medline search was conducted for both randomized controlled trials and reviews to determine the efficacy and safety of stimulant drugs for treating children with ADHD. Information was obtained on adverse events associated with their use, including their impact on height and weight gain during childhood. Animal data were reviewed for information on tolerance, sensitization, and the impact of high-dose stimulant effects on neurons and on the development of hepatic tumors. Human data on dopamine transporter occupancy by stimulants were also included.
Stimulant treatment studies show robust short-term efficacy and a good safety profile. Longer-term studies are few in number but have produced no conclusive evidence that careful therapeutic use of these medications is harmful.
Current evidence indicates that stimulants show efficacy and safety in studies lasting up to 24 months.
"ation of ratings, nor does it typically include a trial on the full range of clinical doses. Also, this method may not predict the most effective long-term maintenance dose (Greenhill et al., 1999). The NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/ Hyperactivity Disorder (MTA) used a double-blind, placebo-controlled, dose-response titration protocol (Greenhill et al., 1996; MTA Cooperative Group, 1999a) to identify the optimal MPH dose for each child with attention-deficit/hyperactivity disorder (ADHD). "
[Show abstract][Hide abstract] ABSTRACT: Objective
Results of the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA) were analyzed to determine whether a double-blind, placebo-controlled methylphenidate (MPH) titration trial identified the best MPH dose for each child with attention-deficit/hyperactivity disorder (ADHD).
"preparations in treating ADHD (Greenhill et al. 1999). There is, however, concern about using psychostimulants to treat ADHD in individuals with an SUD (Wilens et al. 2006; Kollins 2008; Levin et al. 2009). "
[Show abstract][Hide abstract] ABSTRACT: Psychostimulants are effective treatments for attention-deficit/hyperactivity disorder (ADHD) but may be associated with euphoric effects, misuse/diversion, and adverse effects. These risks are perceived by some clinicians to be greater in substance-abusing adolescents relative to non-substance-abusing adults. The present study evaluates the subjective effects, misuse/diversion, and adverse effects associated with the use of osmotic-release oral system methylphenidate (OROS-MPH), relative to placebo, for treating ADHD in adolescents with a substance use disorder (SUD) as a function of substance use severity and compared these risks with those associated with the treatment of ADHD in adults without a non-nicotine SUD.
Datasets from two randomized placebo-controlled trials of OROS-MPH for treating ADHD, one conducted with 303 adolescents (13-18) with at least one non-nicotine SUD and one with 255 adult smokers (18-55), were analyzed. Outcome measures included the Massachusetts General Hospital Liking Scale, self-reported medication compliance, pill counts, and adverse events (AEs).
Euphoric effects and misuse/diversion of OROS-MPH were not significantly affected by substance use severity. The euphoric effects of OROS-MPH did not significantly differ between the adolescent and adult samples. Adults rated OROS-MPH as more effective in treating ADHD, whereas adolescents reported feeling more depressed when taking OROS-MPH. The adolescents lost more pills relative to the adults regardless of treatment condition, which suggests the importance of careful medication monitoring. Higher baseline use of alcohol and cannabis was associated with an increased risk of experiencing a treatment-related AE in OROS-MPH, but baseline use did not increase the risk of serious AEs or of any particular category of AE and the adolescents did not experience more treatment-related AEs relative to the adults.
With good monitoring, and in the context of substance abuse treatment, OROS-MPH can be safely used in adolescents with an SUD despite non-abstinence.
Journal of child and adolescent psychopharmacology 10/2011; 21(5):455-63. DOI:10.1089/cap.2011.0014 · 2.93 Impact Factor
"Although the mechanism of action is not completely understood, MPH is known to be associated with an increase in dopamine and norepinephrine levels in the extraneuronal space, probably owing to reuptake inhibition. This is thought to improve neurotransmission and to mediate the beneficial effects of MPH on ADHD symptoms . MPH is primarily metabolised by de-esterification to ritalinic acid, which is pharmacologically inactive; therefore, MPH has a low absolute bioavailability, and a short half life (2-3 h) and duration of action [11-13]. "
[Show abstract][Hide abstract] ABSTRACT: Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed neurobehavioural disorder in childhood, affecting over 5% of children worldwide. As well as the core symptoms of inattention, hyperactivity and impulsivity, patients often exhibit learning difficulties and impairment in social functioning. The frequency of referral is higher for boys than for girls (about 2:1), and girls are generally older at the time of referral.
Pharmacological therapy is considered the first-line treatment for patients with severe ADHD and severe impairment. Stimulant medications are licensed in the UK for the management of ADHD in school-age children and young people, and are effective in controlling ADHD symptoms.
While immediate-release preparations of methylphenidate (MPH) have proven effective in the treatment of ADHD, there are a number of problems associated with their use, most notably compliance, stigma and medication diversion. Modified release preparations are now available that overcome the need for multiple daily dosing, and which offer different MPH release profiles, thereby enabling the physician to match the medication to the patient's particular requirements.
This review describes the diagnosis, referral and treatment pathways for patients with ADHD in the UK and the practical considerations when initiating pharmacological treatment. The clinical experience of treating ADHD with a modified-release MPH preparation (Equasym XL®) is illustrated with case studies.
Annals of General Psychiatry 09/2011; 10(1):25. DOI:10.1186/1744-859X-10-25 · 1.40 Impact Factor
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