Attention Deficit Disorders (previously known as Minimal Brain Dysfunction in Children). Other terms being used to describe the behavioral syndrome below include: Hyperkinetic Child Syndrome, Minimal Brain Damage, Minimal Cerebral Dysfunction, Minor Cerebral Dysfunction. Methylphenidate is indicated as an integral part of a total treatment program which typically includes other remedial measures (psychological, educational, social) for a stabilizing effect in children with a behavioral syndrome characterized by the following group of developmentally inappropriate symptoms: moderate-to-severe distractibility, short attention span, hyperactivity, emotional lability, and impulsivity. The diagnosis of this syndrome should not be made with finality when these symptoms are only of comparatively recent origin. Nonlocalizing (soft) neurological signs, learning disability, and abnormal EEG may or may not be present, and a diagnosis of central nervous system dysfunction may or may not be warranted.

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. Characteristics commonly reported include: chronic history of short attention span, distractibility, emotional lability, impulsivity, and moderate-to-severe hyperactivity; minor neurological signs and abnormal EEG. Learning may or may not be impaired. The diagnosis must be based upon a complete history and evaluation of the child and not solely on the presence of 1 or more of these characteristics. Drug treatment is not indicated for all children with this syndrome. Stimulants are not intended for use in the child who exhibits symptoms secondary to environmental factors and/or primary psychiatric disorders, including psychosis. Appropriate educational placement is essential and psychosocial intervention is generally necessary. When remedial measures alone are insufficient, the decision to prescribe stimulant medication will depend upon the physician’s assessment of the chronicity and severity of the child’s symptoms.

CNS stimulant drugs

Methylphenidate is a mild CNS stimulant which blocks the reuptake of norepinephrine and dopamine into presynaptic neurons. It also stimulates the cerebral cortex and subcortical structures causing increased sympathomimetic activity.

Adults-

Tablets: Administer in divided doses 2 or 3 times daily, preferably 30 to 45 minutes before meals. Average dosage is 20 to 30 mg daily. Some patients may require 40 to 60 mg daily. In others, 10 to 15 mg daily will be adequate. Patients who are unable to sleep if medication is taken late in the day should take the last dose before 6 p.m.

Sustained release tablets: This tablets have a duration of action of approximately 8 hours. Therefore, Methylphenidate sustained release tablets may be used in place of Methylphenidate tablets when the 8-hour dosage of Methylphenidate sustained release tablets corresponds to the titrated 8 hour dosage of Methylphenidate. Methylphenidate sustained release tablets must be swallowed whole and never crushed or chewed.

Children (6 Years and Over)-

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 1-month period, the drug should be discontinued.

Tablets: Start with 5 mg twice daily (before breakfast and lunch) with gradual increments of 5 to 10 mg weekly.

Sustained release tablets: Methylphenidate sustained release tablet have a duration of action of approximately 8 hours. Therefore, Methylphenidate sustained release tablet may be used in place of Methylphenidate tablets when the 8 hour dosage of Methylphenidate sustained release tablet corresponds to the titrated 8 hour dosage of Methylphenidate. Methylphenidate sustained release tablet must be swallowed whole and never crushed or chewed.

If paradoxical aggravation of symptoms or other adverse effects occur, reduce dosage, or, if necessary, discontinue the drug. Methylphenidate should be periodically discontinued to assess the child’s condition. Improvement may be sustained when the drug is either temporarily or permanently discontinued. Drug treatment should not and need not be indefinite and usually may be discontinued after puberty.

Should be taken on an empty stomach. Take 30-45 min before meals. May be taken with or without food.  Swallow whole, do not divide/chew/crush.

History of marked anxiety, tension, agitation; glaucoma; hyperthyroidism; anorexia; phaeochromocytoma; tics or family history or diagnosis of Tourette’s syndrome. Pre-existing CV disorders (e.g. severe HTN, heart failure, angina, MI, arrhythmia); aneurysm; vascular abnormalities. Concomitant or within 14 days of MAOI use.

Abdominal pain, aggression, alopecia, anorexia, arrhythmias, arthralgia, asthenia, changes in BP, cough, depression, diarrhoea, dizziness, dry mouth, dyspepsia, fever, growth restriction, headache, insomnia, irritability, movement disorders, nasopharyngitis, nausea, nervousness, palpitation, pruritus, rash, wt loss, tachycardia, tics, vomiting, confusion, abnormal dreams, constipations, dyspnoea, epistaxis, muscle cramps, suicidal ideation, urinary frequency. Rarely, angina, sweating, visual disturbances, cerebral arteritis, blood disorders, angle-closure glaucoma, seizures, tolerance, MI. Transdermal: Insomnia, decreased appetite; nausea; tic, emotional instability; vomiting, anorexia; nasal congestion, nasopharyngitis; wt loss.

Pregnancy Category C. Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Patient with history of seizure disorder, alcohol or drug abuse. HTN and other CV disorders that might be exacerbated by increases in BP or heart rate; pre-existing psychosis or bipolar disorder. Childn. Pregnancy and lactation.

Symptoms: Vomiting, tremor, agitation, muscle twitching, hyperpyrexia, hallucinations, euphoria, confusions, delirium, sweating, flushing, headache, HTN, dryness of mucous membranes, tachycardia, mydriasis, palpitations.

Management: Symptomatic and supportive treatment.

Store between 20-25° C. Protect from light and moisture.