Caution is being advised in the prescribing of methylphenidate for the treatment of attention deficit hyperactivity disorder, according to an analysis published today.
The drug <!, also known as Ritalin, Concerta, Medikinet, and Equasym,> was first prescribed for this condition more than 50 years ago, and is now widely used. So researchers led by Professor Ole Jakob Storebo, from the Psychiatric Research Unit in Region Zealand, Denmark, investigated its effects.
Their new Cochrane Review is "one of the most comprehensive assessments to date on the benefits and harms of a widely prescribed drug used to treat attention deficit hyperactivity disorder".
It incorporates findings from all of the available randomised controlled trials of methylphenidate, that is, 185 trials involving over 12,000 children or adolescents. Studies were mainly based in the US, Canada, or Europe.
Analysis indicates that the drug "led to modest improvements in symptoms, general behaviour, and quality of life", but adverse effects included sleep problems and loss of appetite.
But the researchers add that the results may not be altogether reliable, as many of the children and their parents were likely to be aware of whether they were given the drug itself, or an alternative. In addition, some results were missing.
Overall, the experts are uncertain about effects of methylphenidate, despite all of this prior research. More caution is recommended, due to the possibility of increased sleeplessness and appetite loss.
Professor Storebo says: "This review highlights the need for long-term, large, better-quality randomised trials so that we can determine the average effect of this drug more reliably."
Co-author Dr Camilla Groth adds: "Clinicians prescribing methylphenidate must take account of the poor quality of the evidence, monitor treatment carefully, and weigh up the benefits and adverse effects."
Storebo, O. J. et al. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database of Systematic Reviews 2015, Intervention review 25 November 2015 doi: 10.1002/14651858.CD009885.pub2 [abstract]
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