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Objective To identify the cardiovascular effects of long-acting methylphenidate administered for twelve weeks in Indonesian children with ADHD.
Methods This was an 18-week, time series study on children with ADHD who were given 20 mg of long-acting methylphenidate for twelve weeks. During the study period we made ten serial observations of the subjects, including before, during and 6 weeks following drug administration. We included drug naive children with ADHD between the ages of 7 – 10 years. Children with mental retardation and chronic physical or mental disorders were excluded. Blood pressure was measured by sphygmomanometer with a child’s cuff at the brachial artery. We also collected data on heart rate, side effects, complaints and other medications used during the study. Repeated analysis was performed on the data with a P level of 0.05.
Results Twenty-one subjects were recruited for this study. Mean blood pressure fluctuated insignificantly during the research period, for both mean systolic and mean diastolic blood pressures (P=0.115 and P=0.059). Mean heart rate also fluctuated insignificantly (P=0.091). All fluctuations were within the normal ranges. During the study, there were complaints of dizziness, nausea, and gastrointestinal upset, but they were reportedly mild and disappeared before the second week of observation.
Conclusion Administration of 20 mg long-acting methylphenidate for twelve weeks in children with ADHD altered mean blood pressures and heart rates, but within the normal range for children of their age. However, cardiovascular risk observation is still needed when administering methylphenidate to children with ADHD, especially for those using the medication long-term.[Paediatr Indones. 2011;51:282-7].
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2. Nissen SE. ADHD drugs and cardiovascular risk. N Engl J Med. 2006;354:1445-8.
3. Tardy J, Pariente J, Leger A, Dechaumont-Palacin S, Gerdelat A, Guiraud V, et al. Methylphenidate modulates cerebral post-stroke reorganization. Neuroimage. 2006;33:913-22.
4. Wigal SB. Efficacy and safety limitations of attention-deficit hyperactivity disorder pharmacotherapy in children and adults. CNS Drugs. 2009;23:21-31.
5. Goldman RD. ADHD stimulants and their effect on height in children. Can Fam Physician. 2010;56:145-6.
6. Hyman SE. Methylphenidate-induced plasticity: what should we be looking for? Biol Psychiatry. 2003;54:1310-1.
7. Krause KH, Dresel SH, Krause J, La Fouqere C, Ackenheil M. The dopamine transporter and neuroimaging in attention deficit hyperactivity disorder. Neurosci Biobehav Rev. 2003;27:605-13.
8. Steele M, Weiss M, Swanson J, Wang J, Prinzo R, Binder C. A randomized, controlled effectiveness trial of OROS-methylphenidate compared to usual care with immediate-release methylphenidate in ADHD. Can J Clin Pharmacol. 2006;3:51-62.
9. Ritalin LA (metilphenidate extended release capsule). Ritalin LA Prescribing Information. Novartis Pharmaceuticals Corporation 2007, East Hanover, New Jersey.
10. Brandon CL, Marinelli M, White FJ. Adolescent exposure to methylphenidate alters the activity of rat midbrain dopamine neurons. Biol Psychiatry. 2003;54:1338-44.
11. Vles JS, Feron FJ, Hendriksen JG, Jolles J, van Kroonenburgh MJ, Weber WE. Methylphenidate down-regulates the dopamine receptor and transporter system in children with attention deficit hyperkinetic disorder (ADHD). Neuropediatrics. 2003;34:77-80.
12. Dixon AL, Prior M, Morris PM, Shah YB, Joseph MH, Young AM. Dopamine antagonist modulation of amphetamine response as detected using pharmocological MRI. Neuropharmacology. 2005;48:236-45.
13. Russell VA, Sagvolden T, Johansen EB. Animal model of attention-deficit hyperactivity disorder. Behav Brain Funct. 2005;1:1-9.
14. Volkow ND, Wang GI, Fowler JS, Logan I, Jayne M, Franceschi D, et al. ’Nonhedonic’ food motivation in humans involves dopamine in the dorsal striatum and methylphenidate amplifies this effect. Synapse. 2002;44:175-80.
15. Volkow ND, Wang GJ, Fowler JS, Ding YS. Imaging the effect of methylphenidate on brain dopamine: new model on its therapeutic actions for attention-deficit/hyperactivity disorder. Biol Psychiatry. 2005;57:1410-15.
16. Grund T, Lehman K, Bock N, Rothenberger A, Teuchert-Noodt G. Influence of methylphendiate on brain development-an update of recent animal experiments. Behav Brain Funct. 2006;2:2-8.
17. Marsteller DA, Gerasimov MR, Schiffer WK, Geiger JM, Barnett CR, Borg JS, et al. Acute handling stress modulates methylphenidate-induced catecholamine overflow in the medial prefrontal cortex. Neuropsychopharmacology. 2002;27:163-70.
18. Biederman J, Mick E, Faraone SV. Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptoms type. Am J Psychiatry. 2000;157:816-8.
19. Wilens TE, Hammerness PG, Biederman J, Kwon A, Spencer TJ, Clark S, et al. Blood pressure changes associated with medication treatment of adults with attention- deficit/hyperactivity disorder. J Clin Psychiatry. 2005;66:253-9.
20. Burke DT, Lee SR, Goldstein R, Schutzbank J, Chae H. Effects of long-acting methylphenidate on heart rate and blood pressure among patients with acquired brain injury. J Applied Res. 2005;5:534-42.
21. Chavez B, Sopko MA Jr, Ehret MJ, Paulino RE, Goldberg KR, Angstadt K, et al. An update on central nervous system stimulant formulations in children and adolescents with attention-deficit/hyperactivity disorder. Ann Pharmacother. 2009;43:1084-95.
22. Leonard BE, McCartan D, White J, King DJ. Methylphenidate, a review of its neuropharmacological, neuropsychological and adverse clinical effects. Hum Psychopharmacol. 2004;19:151-80.
23. Wilens TE, Biederman J, Lerner M; Concerta Study Group. Effects of once-daily osmotic-release methylphenidate on blood pressure and heart rate in children with attention-deficit/hyperactivity disorder: results from a one-year follow-up study. J Clin Psychopharmacol. 2004;24:36-41.
24. Wilens T, McBurnett K, Stein M, Lerner M, Spencer T. ADHD treatment with once-daily OROS methylphenidate: final results from a long-term open-label study. J Am Acad Child Adolesc Psychiatry. 2005;44:1015-23.
25. Sheehan D, Shytle KM. Mini International Neuropsychiatry Interview (MINI) for kid. University of South Florida; 2004.
26. Machin D, Campbell MJ, Fayers PM, Pinol APY. Sample size tables for clinical studies. London: Blackwell Science Ltd; 1997.p37- 68
27. Saputro D. Childhood hyperkinetic disorder in Jakarta-Indonesia, new screening instrument development, prevalence study, pathophysiological research, and therapy approach. [dissertation]. Yogyakarta: Gajah Mada University; 2004.