Effects of methylphenidate on height, weight and blood biochemistry parameters in prepubertal boys with attention deficit hyperactivity disorder: an open label prospective study

Abstract

Background: Adverse effects of stimulants on growth in children have long been studied, but the results remain to be clarified, because metabolic changes or predictors accompanying the growth deviations were not sufficiently studied. Objective: This open label-prospective study investigated the effects of methylphenidate (MPH) on weight, height, blood biochemistry in children with attention deficit hyperactivity disorder (ADHD). Method: Prepubertal boys treated with MPH in Child and Adolescent Psychiatry Clinic at Antalya Training and Research Hospital in Health Sciences University, Turkey were recruited. Height and weight z-scores and fasting blood samples were taken at baseline and 6 th month. Changes were compared by paired-samples t-test or Wilcoxon signed-rank test. Any association between the changes in growth and biochemical values was analyzed by Spearman’s Rank-Order Correlation. The statistical significance threshold was p<0.01. Results: 31 boys aged 74 to 104 months were enrolled in the study sample (mean=87.6, Standard Deviation (SD)=9.2). Osmotic release oral system-MPH (18 mg/day) was used in 77.4% (N=24) and immediate release-MPH (5 mg three times a day) in 22.5% (N=7). Average daily drug dose was 0.66 mg/kg (SD=0.12). Baseline weight z-score was 0.63 (SD=1.12), decreased significantly at 6 months (0.24 [SD=1.04]) (Z=-4.44, p=0.000, r=0.5) (median z-score was 0.53 at baseline, -0.11 at 6 months). Baseline height z-score (0.23[SD=0.87]) was not suppressed significantly at 6 months (0.28[SD=0.85])(t(30) = ‒1.50, p =0.14). Glucose (t(30) = -4.33, p =0.000, r=0.6), creatinine (t(30)=-3.28, p =0.003, r =0.5) and 25OH-VitD (N=29, Z=-3.98, p =0.000, r =0.5) increased but alkaline phosphatase (ALP) decreased (t(28)=3.63, p =0.001, r =0.5). The differences in W-SDS and ALP were positively correlated ( r =0.47, p =0.009). Conclusions: Our results indicate the importance of monitoring blood variables that may accompany growth changes early in MPH treatment and should be further assessed in larger samples.

Desvelando os efeitos adversos do metilfenidato na atenção infanto-juvenil

“…A Tricotilomania também se caracteriza como um impulso de "Tique" em arrancar/puxar fios de cabelo do couro cabeludo e em cílios 21 . Irritabilidade, nervosismo e agitação também se apresentaram como efeitos adversos ao uso de metilfenidato 4,25,26 e podem estar associados com quadros de "tiques" e movimentos involuntários.…”

“…A redução do apetite é um efeito colateral associado ao uso do Metilfenidato 4,5,21,22,24-27 e está diretamente relacionada com a perda de peso, incômodos estomacais e algia abdominal 4,21,22,24,27,28 . Outros sintomas como náuseas, emagrecimento, boca seca, gosto amargo na boca, sensação de intensificação do metabolismo corporal, sensação de fraqueza e cansaço estão associados com perda do apetite e do desenvolvimento da estatura 4,21,22,24 .…”

“…A diminuição do apetite, consequentemente a perda de peso, pode desencadear desvios de crescimento que originem alterações metabólicas na estrutura óssea e modificações nos parâmetros bioquímicos sanguíneos relacionados como indicativos desses distúrbios, mas os estudos sobre esse assunto ainda são claros e também muito escassos 21 .…”

Possible Association between Methylphenidate and Mandibular Bone Characteristics Detected by Dental Panoramic Radiograph in Children and Adolescents with ADHD

“…In the last 40 years, there has been a debate whether psychostimulants—specifically methylphenidate—affect growth in children who use them. Some studies have shown that these medications may affect the child’s weight at the start of treatment [ 12 , 14 , 15 , 16 ] and possibly affect height in the range of 1 to 2 cm after longer-term therapy [ 17 , 18 , 19 , 20 , 21 ]. Other studies have reported that height is affected by higher doses of psychostimulants [ 22 , 23 ], more so in those who start treatment before puberty [ 24 , 25 ].…”