Ritalin

Methylphenidate

Methyla-phenyl-2-piperi-dineearetate hydrochloride

Manufactured by Ciba-Geneva, a division of Novartis Pharmaceuticals

Indications

FDA approved medication for attention deficit disorders and narcolepsy.Also being used as treatment for depression and cognitive impairment in cancer patients, stroke patients and mentally ill elderly patients.

Physiological effect

Methylphenidate is a central nervous system stimulant.Its effect is not completely understood, but it creates a stimulant effect by activating the brain stem arousal system and cortex. Methylphenidate blocks dopamine and norepineprine transporters.Therapeutic doses of oral Methylphenidate block 50-75% of dopamine transporters, increasing extra cellular dopamine concentration in the brain.

How does this effect attention deficit disorders?

Studies show that people with ADD and ADHD have higher levels of dopamine transporters in their brain, which results in low concentrations of dopamine.This dopamine deficit in ADHD would be temporarily relieved by methylphenidate.

Methylphenidate amplifies weak dopamine signals in people with attention deficit disorders.This enhances task specific signals, improving attention and decreasing distractibility in activities that normally do not hold the attention of those with attention deficit disorders.Dopamine is involved with the motivation and reward system; therefore an increase in dopamine would enhance the salience of a task.

How does it affect Narcolepsy?

Methylphenidate acts on the cerebral cortex and subcortical structures (thalamus) to increase motor activity and mental alertness and decrease fatigue.

Contraindications

Marked anxiety, tension, and agitation are contra indications to Ritalin; the drug may aggravate these symptoms.Also patients with glaucoma, motor tics, touretts syndrome and during treatment with monoamine oxidase inhibitor.

Drug interactions

Ritalin may inhibit metabolism of coumarin anticoagulants, anticonvulsants (Phenobarbital, diphenyldantoin, primidone), phenylbutazone and tricyclic drugs (imipramine, clomipramine, desipramine).Adverse affects reported in use with chlonidine.

Side effects

Nervousness and insomnia are the most common.Hypersensitivity including skin rash, urticaria, fever, arthraglia, exfoliative dermatitis, erythema multiforme with histopathological findings of necrotizing vascultitis, and thrombocytopenic purpura.Also anorexia, nausea, dizziness, palpitations, headache, dyskinesia, drowsiness, tachycardia, angina, cardiac arrhythmia, abdominal pain, and weight loss during prolonged therapy, abnormal liver function, psychotic symptoms of hallucinations and paranoia.There have been rare reports of Tourette’s syndrome, toxic psychosis.In children, loss of appetite, abdominal pain, weight loss, insomnia, and tachycardia may occur more frequently.Ritalin is also found to retard growth by disrupting cycles of growth hormone released by the pituitary gland.

Dosage

Adults: 20-40 mg daily, divided into 2-3 doses.Should be taken 30-45 minutes before meals.

Children (6yrs and over): start with 5mg twice daily with gradual increments of 5-10 mg weekly.

Ritalin is available in 5, 10 and 20 mg tablets and SR tablets of 20 mg.Ritalin SR is a sustained release tablet.

Warnings

Ritalin should be given with caution to patients with a history of drug dependence, alcoholism and emotionally unstable patients.Ritalin should not be prescribed to women of childbearing age as it was found to have teratogenic effect in rabbits.

Ritalin Facts

-Ritalin has no effect on IQ or academic achievement.

-Only acts to make children more manageable, compliant and obedient.

-Has only suppressive behavioral effects; the reduction of spontaneous behavior, flattening of emotions, apathetic, lacking age typical variety and frequency of emotional expression.

-A large percent of children become robotic, lethargic, depressed or withdrawn and uninterested in their environment.

-listed as a type II drug by the DEA

-Ritalin inhibits the exploratory drive: curiosity, initiative, spontaneity and emotional responsiveness.

“By reducing the most highly developed aspects of human nature-the impulses for freedom, spontaneity, curiosity, initiative, emotional expression and sociability-Ritalin makes children more manageable in a boring, unstimulating and otherwise frustrating environment.”

Peter R. Breggin, M.D.

Suggested reading: Talking back to Ritalin.By Peter Breggin, M.D.