Published: June 2010
Publications
Methylphenidate - updated guidance when treating children
Prescriber Update 31(2): 11
June 2010
The MARC has reviewed recent changes to the European product information for methylphenidate and has recommended that the New Zealand data sheets be updated to include these changes. The updated data sheets will shortly be published on the Medsafe website at: www.medsafe.govt.nz/Medicines/infoSearch.asp
The changes outline that patients being considered for methylphenidate treatment should be carefully screened for cardiovascular risk, heart disease and psychiatric disorders, including any family risk factors.
New contraindications (do not use in patients with) include:
- Diagnosis or history of severe depression, anorexic disorders, suicidal tendencies, psychotic symptoms, severe mood disorders, mania, schizophrenia, psychopathic/borderline personality disorder.
- Pre-existing cardiovascular disorders.
- Pre-existing cerebrovascular disorders.
Patients for whom methylphenidate treatment is deemed appropriate should be carefully monitored as follows:
- Blood pressure should be recorded at every dose adjustment and then at least every six months; pulse should also be recorded.
- Height, weight and appetite should be recorded at least every six months. Patients who are not gaining height or weight as expected may need a treatment break.
- Patients who develop symptoms suggestive of heart disease should undergo prompt specialist cardiac evaluation.
- Prescribers and pharmacists should look out for signs of diversion, misuse and abuse of methylphenidate.
Methylphenidate can cause or worsen some psychiatric disorders such as depression, suicidal thoughts, hostility, anxiety, agitation, psychosis and mania. Psychiatric well being should therefore be monitored in patients being treated with methylphenidate.
Further information on monitoring the psychiatric well being of young people is available in a special edition of the Best Practice Journal published in January 2010 www.bpac.org.nz/magazine/2010/youngdep/youngdep.asp?section=2 This information is also included in the Ministry of Health's funded module of bpac's decision support software.
It is also important to remember that the long-term effects of methylphenidate treatment in children are not fully understood. For patients who require long-term treatment (more than 12 months) the data sheets will recommend that a treatment holiday occur at least once a year. A treatment holiday will help determine whether methylphenidate treatment needs to be continued.
