A randomized, crossover evaluation of methylphenidate in cancer patients receiving strong narcotics

Abstract

Sedation may be a dose-limiting side-effect of opioid therapy in some cancer patients. This study was designed to evaluate further the use of the psychostimulant, methylphenidate, an agent that has been reported to counter-act opioid-induced sedation, in patients with cancer-related pain. Patients receiving a stable dose of an opioid for cancer-related pain were recruited for this randomized, double-blind, crossover clinical trial. In addition to their regular dose of narcotics, they received 5 days of methylphenidate followed by 5 days of placebo, or vice versa. Our data did not definitively demonstrate any statistically significant benefit for methylphenidate, but did suggest that this drug could mildly decrease narcotic-induced drowsiness and could increase night-time sleep. These data, in conjunction with other published data, suggest that methylphenidate can counteract narcotic-induced daytime sedation to a limited degree.

Fatigue and cancer: causes, prevalence and treatment approaches

“…Examples of psychostimulants include methylphenidate, modafinil, pemoline and dextroamphetamine. Controlled, randomised trials have yielded evidence to support the relative efficacy of psychostimulants in treating fatigue associated with opioid administration among cancer patients (Wilwerding et al, 1995). Bruera et al (2003) conducted a prospective open-label trial with advanced cancer outpatients who had fatigue 4 4 (0-10 scale) to evaluate the effects of patient-controlled methylphenidate for cancer-related fatigue.…”

Pharmacovigilance of the Analgesic Therapy

“…Sedation represents the best early clinical indicator of respiratory depression [18]. A number of blind studies confirm this effect which seems particularly evident for methylphenidate [19][20][21].…”

Psychopharmacology in supportive care of cancer: a review for the clinician

“…It has also been proposed for the supportive treatment of HIV patients with depression [32] or cognitive impairment [13]. While favourable responses have regularly been reported in depressed or oversedated terminally ill patients [17,35,56,68,78,99,101,102], the clinical significance of this effect has been questioned [55].…”