Clinical use of a modified release methylphenidate in the treatment of childhood attention deficit hyperactivity disorder

Abstract

Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed neurobehavioural disorder in childhood, affecting over 5% of children worldwide. As well as the core symptoms of inattention, hyperactivity and impulsivity, patients often exhibit learning difficulties and impairment in social functioning. The frequency of referral is higher for boys than for girls (about 2:1), and girls are generally older at the time of referral.Pharmacological therapy is considered the first-line treatment for patients with severe ADHD and severe impairment. Stimulant medications are licensed in the UK for the management of ADHD in school-age children and young people, and are effective in controlling ADHD symptoms.While immediate-release preparations of methylphenidate (MPH) have proven effective in the treatment of ADHD, there are a number of problems associated with their use, most notably compliance, stigma and medication diversion. Modified release preparations are now available that overcome the need for multiple daily dosing, and which offer different MPH release profiles, thereby enabling the physician to match the medication to the patient's particular requirements.This review describes the diagnosis, referral and treatment pathways for patients with ADHD in the UK and the practical considerations when initiating pharmacological treatment. The clinical experience of treating ADHD with a modified-release MPH preparation (Equasym XL®) is illustrated with case studies.

Drug Treatment Patterns of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents in Germany: Results from a Large Population-Based Cohort Study

“…These formulations overcome the need for the multiple daily doses that are necessary with immediate release (IR) formulations because of their short half-life (Takon 2011), and are generally considered to be as effective as the IR formulations (Coghill and Seth 2006). The MR MPH formulations differ in their MPH release profiles, thereby enabling the physician to match the medication to the patient's particular requirements (Takon 2011). Reduced compliance and an increased potential for missed doses have been discussed as potential limitations of IR MPH formulations, together with an uneven coverage through the day and stigmatization by peers when administering IR MPH at lunch time in school (Coghill and Seth 2006).…”

“…CONCERTA Ò , launched in January 2003, was the first MR MPH, followed by Medikinet Ò retard (launched on February 1, 2005), Equasym Ò Retard (launched on September 15, 2006), and RITALIN LA Ò (launched on December 1, 2007). These formulations overcome the need for the multiple daily doses that are necessary with immediate release (IR) formulations because of their short half-life (Takon 2011), and are generally considered to be as effective as the IR formulations (Coghill and Seth 2006). The MR MPH formulations differ in their MPH release profiles, thereby enabling the physician to match the medication to the patient's particular requirements (Takon 2011).…”

Increased oxidative stress in children with attention deficit hyperactivity disorder

“…[5][6][7] The first-line treatment for patients with severe ADHD is considered pharmacological therapy, such as methylphenidate. 8 Curative therapy is not recommended for this disorder because the precise cause is not known.…”

Cluster-randomized, controlled 12-month trial to evaluate the effect of a parental psychoeducation program on medication persistence in children with attention-deficit/hyperactivity disorder

“…Of note, the presence of learning difficulties increased the likelihood of treatment discontinuation by approximately three-fold in our investigation. It has been suggested that learning difficulties have an impact on adherence to pharmacologic treatment and that ADHD patients with learning difficulties may have a poorer response to pharmacologic treatment compared with those without this comorbidity 45–47…”