A TREATMENT FOR
CHILDREN WITH HYPERACTIVITY
DRUG:-
METHYLPHENIDATE
| Drug |
Brand names |
Forms available |
Tablets
|
Capsules
|
Liquid
|
Injection
|
| Methylphenidate |
Ritalin
Equasym
Concerta XL |
|
|
|
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"Concerta XL"
capsules are a controlled release, once-daily version.
The capsule releases methylphenidate in a varied way over
about 6 hours, meaning that it is unnecessary to take it
a tablet three times a day.
 What is it used for ?
Methylphenidate is a stimulant
which can be used to help as part of the treatment for
the symptoms of hyperactivity or Attention Deficit (Hyperactivity)
Disorder (ADHD). It is usually used where other
treatments have not worked. It will be used along with
educational, social and psychological help.
Methylphenidate can help the child's abilities to
concentrate and to reduce overactivity and destructive
behaviour. It is usually available from specialist
centres only, and from GPs under "shared care"
agreements with specialist centres. It also has been and
is used sometimes to help narcolepsy, depression in the
elderly and for ADHD in adults (not just children). The
text here is based upon use in children.
In the UK, the National Institute
for Clinical Excellence (NICE) have looked at the role of
methylphenidate. NICE is part of the governments overall
strategy for health care. They reported on
methylphenidate in 2000 and their web site is www.nice.org.uk.
How does it work ?
It is not clear how the drug works.
It seems to help to reduce impulsiveness and behavioural
problems. It may act by stimulating the part of the brain
responsible for concentrating. Sometimes antidepressants
can also help.
How should I give it ?
The tablets should be swallowed
with at least half a glass of water whilst sitting or
standing so that they reach the stomach and do not stick
in the throat. "Concerta XL" should be
swallowed whole, although the capsules are very hard so
it's difficult to do much else.
When should I give it ?
Give the dose as directed on the
medicine label. You should take it at regular times each
day. Taking the tablets at meal times may make it easier
to remember as there is no problem about taking
methylphenidate with or after food. As methylphenidate is
a stimulant, it is best not to take any doses after about
4pm in the afternoon as this might otherwise cause lack
of sleep.
How long will it take to work ?
The effect from a single tablet
will occur within a matter of minutes or hours. Concerta
XL releases methylphenidate over 6-8 hours. An optimum
effect should be seen within a couple of weeks or so,
reaching its maximum in about 4-6 weeks. If there is no
apparent effect within a weekmor so, it is unlikely the
drug will help.
How long will my child need to keep
taking it for ?
You should talk about this with
your doctor as people respond differently. Children
usually need to take methylphenidate for some time after
it has been started. If it works, your child may need to
take methylphenidate for quite a long time. It will
probably be stopped or reduced once or twice a year to
see if your child still needs it.
Is it addictive ?
Methylphenidate is a stimulant
drug, as are the amphetamines and caffeine (in tea and
coffee). In adults, it is possible that the drug can be
addictive because it can be taken for its stimulant
effect. In children, this is unlikely because the child
is not taking it in order to get a stimulant effect.
Abnormal behaviour could occur and so you should talk to
your doctor about any unusual developments. Its use is
restricted to special cases.
Can I stop giving it suddenly ?
If methylphenidate was stopped
suddenly it is possible that "withdrawal"
effects might be seen. These would include extreme
tiredness, increased appetite and depression. If this was
to happen by accident, then starting the tablets again
would get rid of these effects. This is not generally a
problem as (a) the drug has a low dependence potential
when used for properly diagnosed ADHD/hyperactivity and (b)
sometimes the drug is used only during school terms and
there seems to be few problems with missing the drug
during holidays.
What should I do if I forget to give it ?
If you remember within two hours of
when the next dose is due, then give the missed dose (unless
it is after 4pm in the afternoon, see the previous page).
Otherwise, start again when you remember. Do not give two
doses at the same time to "catch up". This
might produce more side effects and upset your child.
What sort of side-effects might occur ?
The main side effects are
nervousness, lack of sleep, lack of appetite and stomach
ache. These can sometimes be reduced by changing the dose
or changing the times of the doses. You should keep an
eye on your child's growth (height and weight) as
sometimes the drug can slow this growth down, although
your child will still end up the height they would have
done. Less often, side effects such as feeling of
sickness and skin rash can occur.
Will it make my child drowsy ?
This is unlikely as the drug is
generally stimulant, but it can happen in a very few
children.
Will it cause my child to put on weight ?
Again this is very unlikely, as
many children will have a reduced appetite.
Are there any foods or drinks that my
child should avoid ?
There are no known problems with
food or drink with methylphenidate.
Will it affect my child's other
medication ?
Some anticonvulsants such as
phenytoin ("Epanutin"), phenobarbitone and
primidone, some anticoagulants and some blood pressure
treatments may be affected by methylphenidate. Always
make sure your doctor or pharmacist knows what drugs your
child is taking.
If my child is on the contraceptive pill, how will it
be affected ?
There are no known problems.
Will my child need blood tests ?
It is now considered that it is not
necessary to do blood tests whilst a person is taking
methylphenidate.
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