Efficacy and Safety of OROS Methylphenidate in Adults With Attention-Deficit/Hyperactivity Disorder

Adler, Lenard A.; Zimmerman, Brenda; Starr, H. Lynn; Silber, Steve; Palumbo, Joseph; Orman, Camille; Spencer, Thomas

doi:10.1097/jcp.0b013e3181a390ce

Cited by 101 publications

(59 citation statements)

References 44 publications

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“…ADHD medication has been shown to have advantageous short-term effects on ADHD symptoms (Adler, et al, 2009; Banaschewski, et al, 2006; Findling, 2008; Findling, et al, 2008; Koesters, et al, 2009; Kooij, et al, 2010; Newcorn, et al, 2008; Svanborg, et al, 2009; Young, et al, 2011), and, similar to a study on drug related criminality (Lichtenstein, et al, 2012), our data suggest a concomitant association between stimulant ADHD treatment and lower rates of substance abuse. Even though short-term effects might be beneficial, there has been a persistent concern that treatment with stimulant medication could lead to long-term development of substance abuse (Singh, 2008; Winhusen, et al, 2011), and our previous study did not explore long-term associations with drug abuse and only addressed drug related criminality (i.e., not deaths or hospitalizations, which were more common than convictions).…”

Section: Discussionsupporting

confidence: 84%

“…Randomized controlled studies suggest that ADHD medication have beneficial short-term effects on symptoms of ADHD (Adler et al, 2009; Banaschewski et al, 2006; Findling, 2008; Findling et al, 2008; Koesters, Becker, Kilian, Fegert, & Weinmann, 2009; Kooij et al, 2010; Newcorn et al, 2008; Svanborg et al, 2009; Young, Sarkis, Qiao, & Wietecha, 2011). This is supported by a recent large study indicating significant associations between ADHD medication and reductions in criminality while under treatment (Lichtenstein et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

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Stimulant ADHD medication and risk for substance abuse

Chang

Lichtenstein

Halldner

et al. 2013

Child Psychology Psychiatry

175

110

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Background There are persistent concerns of long-term effects of stimulant ADHD medication on the development of substance abuse. Methods Using Swedish national registers, we studied all individuals born 1960–1998 and diagnosed with ADHD (26,249 men and 12,504 women). We investigated the association between stimulant ADHD medication in 2006 and substance abuse during 2009. Substance abuse was indexed by substance-related death, crime, or hospital visits. Results ADHD medication was not associated with increased rate of substance abuse. Actually, the rate during 2009 was 31% lower among those prescribed ADHD medication in 2006, even after controlling for medication in 2009 and other covariates (hazard ratio: 0.69; 95% confidence interval: 0.57–0.84). Also the longer duration of medication, the lower the rate of substance abuse. Similar risk reductions were suggested among children and when investigating the association between stimulant ADHD medication and concomitant short-term abuse. Conclusions We found no indication of increased risks of substance abuse among individuals prescribed stimulant ADHD medication; if anything, the data suggested a long-term protective effect on substance abuse. Although stimulant ADHD medication does not seem to increase the risk for substance abuse, clinicians should remain alert to the potential problem of stimulant misuse and diversion in ADHD patients.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Stimulant ADHD medication and risk for substance abuse

Chang

Lichtenstein

Halldner

et al. 2013

Child Psychology Psychiatry

175

110

View full text Add to dashboard Cite

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“…Our study findings are comparable with those reported by Adler et al using a flexible dose range of osmotic-release oral system (OROS) methylphenidate (36–108 mg/day), wherein adult ADHD patients initiating therapy at 36 mg/day with weekly increments of 18 mg/day showed good safety and tolerability outcomes [8, 9]. In their study, the protocol was designed to reach the minimal effective dose rather than optimizing the dose.…”

Section: Discussionsupporting

confidence: 89%

Open-Label Dose Optimization of Methylphenidate Modified Release Long Acting (MPH-LA): A Post Hoc Analysis of Real-Life Titration from a 40-Week Randomized Trial

Huß¹,

Ginsberg

Arngrim

et al. 2014

Clin Drug Investig

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Background and ObjectivesIn the management of attention-deficit hyperactivity disorder (ADHD) in adults it is important to recognize that individual patients respond to a wide range of methylphenidate doses. Studies with methylphenidate modified release long acting (MPH-LA) in children have reported the need for treatment optimization for improved outcomes. We report the results from a post hoc analysis of a 5-week dose optimization phase from a large randomized, placebo-controlled, multicenter 40-week study (9-week double-blind dose confirmation phase, 5-week open-label dose optimization phase, and 26-week double-blind maintenance of effect phase).MethodsPatients entering the open-label dose optimization phase initiated treatment with MPH-LA 20 mg/day; up/down titrated to their optimal dose (at which there was balance between control of symptoms and side effects) of 40, 60, or 80 mg/day in increments of 20 mg/week by week 12 or 13. Safety was assessed by monitoring the adverse events (AEs) and serious AEs. Efficacy was assessed by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Attention-Deficit Hyperactivity Disorder Rating Scale (DSM-IV ADHD RS) and Sheehan Disability Scale (SDS) total scores.ResultsAt the end of the dose confirmation phase, similar numbers of patients were treated optimally with each of the 40, 60, and 80 mg/day doses (152, 177, and 160, respectively) for MPH-LA. Mean improvement from baseline in the dose confirmation phase in total scores of DSM-IV ADHD RS and SDS were 23.5 ± 9.90 and 9.7 ± 7.36, respectively.ConclusionsDose optimization with MPH-LA (40, 60, or 80 mg/day) improved treatment outcomes and was well-tolerated in adult ADHD patients.

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“…Methylphenidate (MPH) appears to be an effective and safe treatment in adults with ADHD in doses up to 1.3 mg/kg 6–8, but so far evidence is lacking on the efficacy of stimulant pharmacotherapy to treat comorbid ADHD and SUD. Several randomized clinical trials (RCT) of pharmacotherapy for ADHD in SUD, primarily cocaine dependence, have evaluated the utility of MPH in current users 9–11 and in recently abstinent users 12.…”

Section: Introductionmentioning

confidence: 99%

Methylphenidate for attention deficit hyperactivity disorder and drug relapse in criminal offenders with substance dependence: a 24‐week randomized placebo‐controlled trial

et al. 2013

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AimTo test the efficacy and safety of osmotic release oral system (OROS) methylphenidate (MPH) in doses up to 180 mg/day to treat attention deficit hyperactivity disorder (ADHD) and prevent any drug relapse in individuals with a co-diagnosis of ADHD and amphetamine dependence.DesignRandomized placebo-controlled 24-week double-blind trial with parallel groups design.SettingParticipants were recruited from medium security prisons in Sweden. The medication started within 2 weeks before release from prison and continued in out-patient care with twice-weekly visits, including once-weekly cognitive behavioural therapy.ParticipantsFifty-four men with a mean age of 42 years, currently incarcerated, meeting DSM-IV criteria for ADHD and amphetamine dependence.MeasurementsChange in self-reported ADHD symptoms, relapse to any drug use (amphetamine and other drugs) measured by urine toxicology, retention to treatment, craving and time to relapse.FindingsThe MPH-treated group reduced their ADHD symptoms during the trial (P = 0.011) and had a significantly higher proportion of drug-negative urines compared with the placebo group (P = 0.047), including more amphetamine-negative urines (P = 0.019) and better retention to treatment (P = 0.032).ConclusionsMethylphenidate treatment reduces attention deficit hyperactivity disorder symptoms and the risk for relapse to substance use in criminal offenders with attention deficit hyperactivity disorder and substance dependence.

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Efficacy and Safety of OROS Methylphenidate in Adults With Attention-Deficit/Hyperactivity Disorder

Abstract: In a dose escalation ranging from 36 to 108 mg/d, OROS methylphenidate is effective and well tolerated in the management of ADHD in adults.

Cited by 101 publications

References 44 publications

Stimulant ADHD medication and risk for substance abuse

Stimulant ADHD medication and risk for substance abuse

Open-Label Dose Optimization of Methylphenidate Modified Release Long Acting (MPH-LA): A Post Hoc Analysis of Real-Life Titration from a 40-Week Randomized Trial

Methylphenidate for attention deficit hyperactivity disorder and drug relapse in criminal offenders with substance dependence: a 24‐week randomized placebo‐controlled trial

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