Dr Sharon Rees @reesprescribe
Day 1: The mild CNS stimulant #methylphenidate was synthesised in the1940s & marketed as Ritalin by the 1950s, after recognition it improved concentration. Trialled for many conditions e.g chronic fatigue & chronic pain; it is now associated with its main licensed use for ADHD symptom management
Dr Sharon Rees @reesprescribe
Day 2: #methylphenidate is the 1st line drug treatment for ADHD 6-18yrs. Oral dose range 10-60 mg/day depending on age & response. If immediate release, divide doses 1-3/day. Long-acting preparations contain a mixture of immediate & modified release drug & may not be equivalent to each other (care if switching). Adults with ADHD may need indefinitely, although long-term use is not fully evaluated. Use is unlicensed in adults, except some brands if being continued post-initiation in childhood. #methylphenidate is a schedule 2 CD in UK & US. Careful titration & withdrawal needed
Dr Sharon Rees @reesprescribe
Day 3: Kinetics: good GI absorption (no effect from food), with effects in 4+ hrs (3-9 hrs if m.r). Metabolism via de-esterification to ritalinic acid (inactive). 80% excreted as ritalinic acid; no known effect of renal impairment. T½ 2-7 hrs. If #methylphenidate is used with alcohol the metabolite ethylphenidate is produced. This may contribute to toxicity & psychiatric symptoms eg agitation, psychosis & tachycardia, HTN, hyperthermia (not exhaustive)
Dr Sharon Rees @reesprescribe
Day 4: #methylphenidate increases dopamine availability as it is believed to inhibit the dopamine transporter (less reuptake). Oral #methylphenidate produces a mild effect, linked to stimulating brain regions controlling attention & behaviour. This leads to improved concentration & reduced impulsivity. At high doses and/or taken i.v or intra-nasally, #methylphenidate causes dopaminergic stimulation & euphoria. This carries the risk of addiction, as well as psychoses & adverse drug effects
Dr Sharon Rees @reesprescribe
Day 5: Contraindicated in cardiovascular disorders, hyperthyroidism, some psychiatric conditions. Common ADEs include insomnia, aggression, altered mood, GI disorders, headache, reduced appetite. Uncommon/rare: constipation, psychotic disorder, blood disorders (NOT exhaustive). Pre-use screening & ongoing monitoring for physical, cardiovascular & mental health status is needed; checks also needed if dose change
Dr Sharon Rees @reesprescribe
Day 6: DDIs: Alcohol, TCAs, warfarin & some anti-convulsants can increase concentration of #methylphenidate. Severe cardiovascular issues possible with isocarboxazid, isoflurane, linezolid, phenelzine, selegiline. Increased risk of dyskinesias with risperidone (NOT exhaustive)
Dr Sharon Rees @reesprescribe
Day 7: High increases have been seen in ADHD prescribing & #methylphenidate use in UK. This has been reported as increased by approximately 80% since 2015 (NHS England), across all age groups
EARN YOUR CPD CERTIFICATE
With the help of Prescribing and Therapeutics Training Ltd and the Journal of Prescribing Practice, you can earn your 1-hour CPD certificate
In addition to the tweets, read the monograph on methylphenidate and the SPCs for methylphenidate. Once you have completed this, answer the 10 questions. Submit your answers to reesprescribe@gmail.com. If you answer at least eight out of 10 questions correctly, you will receive your CPD certificate via email.
Further reading on #methylphenidate
- Methylphenidate : https://bnf.nice.org.uk/drugs/methylphenidate-hydrochloride/
- Methylphenidate : https://www.medicines.org.uk/emc/product/8726/smpc#gref
- Methylphenidate is a strong central nervous system stimulantTRUE or FALSE?
- Methylphenidate has been licensed for decades for ADHD symptom managementTRUE or FALSE?
- Methylphenidate is a controlled drugTRUE or FALSE?
- Which of the following is TRUE?
- Methylphenidate cannot be taken with food
- Methylphenidate is not licensed for children under 6 years
- Methylphenidate has poor oral absorption
- Methylphenidate is always taken as modified release tablet
- It is safe to mix methylphenidate with alcoholTRUE or FALSE?
- Which of the following is TRUE?
- Methylphenidate blocks the actions of dopamine
- Methylphenidate inhibits the release of dopamine
- Methylphenidate has a euphoric effect at therapeutic doses
- Methylphenidate increases dopamine availability
- Methylphenidate is thought to improve concentration by activating an inhibitory part of the brain which helps control impulsivenessTRUE or FALSE?
- Methylphenidate is contraindicated if there is cardiovascular diseaseTRUE or FALSE?
- There are multiple severe drug-drug interactions for methylphenidateTRUE or FALSE?
- There is abuse potential with Methylphenidate, especially if used in high doses or intra-nasallyTRUE or FALSE?