ADHD: METHYLPHENIDATE

Question 1

Methylphenidate - MOA

Answer 1

Potent CNS stimulant.
Increased dopamine and noradrenaline levels in the brain.

Question 2

CI

Answer 2

• CVD
• Psychosis
• Hyperthyroidism
• Severe hypertension
• Severe depression/ Suicidal tendencies

Question 3

Cautions

Answer 3

• Epilepsy
• Alcohol & drug dependence
• Anxiety/ Depression
• FMHx of Tourette’s

Question 4

Side effects

Answer 4

• Anxiety, Depression
• Drowsiness (sedation, patients should be warned about driving)
• Growth retardation in children
• Seizures (stop if increased seizure frequency)
• Pyschiatric symptoms: aggitation, aggression
• Weight loss (decreased appetite)
• Tics

w tags dp

Question 5

Monitoring

Answer 5

• Pulse and blood pressure
• Psychiatric symptoms
• Weight/ height appetite at initiation, each dose change, and every 6 months (MAINLY IN CHILDREN)

Question 6

Which formulation of Methylphenidate must be brand specific? and Why?

Answer 6

• MR
• Diff preps may not have same clinical effect

Question 7

MR preps preferred due to

Answer 7

• Pharmacokinetic profile
• Convenience – take less a day
• Improved adherence
  Should be prescribed as brand only

Question 8

Take in morning with breakfast for these two brands of methylphenidate

Answer 8

Medikinet, Equasym

Question 9

If a patient has dysphagia, the following three brands of methylphenidate do not have appropriate dose form due to restricted GI lumen

Answer 9

concerta xl, demlosart PR tabs, xaggitin xl

Question 10

Why should alcohol be avoided with methylphenidate

Answer 10

it might increase conc of methylphenidate

Question 11

TCAs interaction with methylphenidate

Answer 11

methylphenidate may increase conc of TCAs e.g. amitriptyline, imipramine, doxepin, dosulepin etc
use with caution and adjust dose

Question 12

interaction - MAOB inhibitor and methylphenidate

Answer 12

selegiline, rasagiline
these are predicted to increase risk of hypertensive crisis when given with methylphenidate - avoid

Question 13

avoid this high risk abx because methylphenidate may increase risk of elevates BP when given with it

Answer 13

linezolid