Methylphenidate-Induced Enuresis: 3 Case Reports

Uzun, Necati; Karatoprak, Serdar

doi:10.1097/wnf.0000000000000422

Cited by 3 publications

(6 citation statements)

References 8 publications

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“…We found that about one in ten children had a 20% or greater increase in HR, sBP, or dBP in the 3 h following the initial dose, and that about one in five had a similar increase after 1 week of treatment. These data indicate a lack of tolerance to the cardiovascular effects of MPH, at least in the short-term, and are consistent with the conclusions of previous reports [ 1 , 16 ]. One patient (0.2%) had sustained tachycardia, without subjectively reported palpitations, in the first 3 hours after first MPH dosing with 10 mg.…”

Section: Discussionsupporting

confidence: 93%

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Acute Tolerability of Methylphenidate in Treatment-Naïve Children with ADHD: An Analysis of Naturalistically Collected Data from Clinical Practice

et al. 2022

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ObjectivesThe acute tolerability of methylphenidate (MPH) in children with attention-deficit/hyperactivity disorder (ADHD) has been studied mainly in research samples. Taking advantage of the mandatory test-dose procedure required for starting MPH in Italy, this study aimed to assess the incidence of intolerable adverse events after initial exposure to MPH in routine clinical practice. Methods The medical records of 480 consecutively treated, previously drug-naïve children and adolescents with ADHD (90% male, mean age 10.6 ± 3.0 years) were retrospectively analyzed. All children received an initial single dose of MPH immediate release (5 or 10 mg) followed by a 4-hour direct medical observation. Heart rate and blood pressure were measured at dosing and 1, 2, and 3 hours afterwards. If the first dose was well tolerated, the child continued treatment with MPH 5-20 mg daily, and was reassessed a week later. Results Eleven patients (2.3%, 95% CI 1.1-4.1) interrupted treatment within a week of initiation because of the following adverse events: irritability (n = 3), tics worsening (n = 3), reduced appetite (n = 1), enuresis (n = 1), hallucinations (n = 1), hyperfocus (n = 1), and 'rebound' behavioral worsening (n = 1). The most common adverse events were reduced appetite (20%), irritability (14.2%), headache (10.6%), sleep problems (9.4%), stomachache (9.4%), and tics (5%). Intellectual disability increased the risk of any adverse event in general and of irritability in particular. No cardiovascular symptom was clinically reported. However, routine assessments of vital signs during the first 3 hours after the first dose of MPH showed that 9% of the children had a 20% increase in heart rate, 8.8% had a 20% increase in diastolic blood pressure and 4.5% had a 20% increase in systolic blood pressure. Of these, 25.2% still had an elevated heart rate 1 week later. Conclusions Among stimulant-naïve children in clinical practice, the incidence of acute MPH intolerance can be estimated to be between 1.2 and 4.1%. An asymptomatic elevation in cardiovascular parameters can be observed in about 1 out of 10 children and warrants monitoring during ongoing treatment.

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Section: Discussionsupporting

confidence: 93%

“…This finding is consistent with existing literature on tics and stimulant medications [ 15 ]. A small number of children (14 or 2.9%) reported enuresis, which is not an adverse event typically associated with stimulant treatment, even though it has been anecdotally reported [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Tolerability of Methylphenidate in Treatment-Naïve Children with ADHD: An Analysis of Naturalistically Collected Data from Clinical Practice

et al. 2022

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“…Upon our review of the literature and as in our patient, it appears that enuresis develops in a dose-dependent fashion 8–11 . It is postulated that, at higher doses, MPH antagonizes α1 adrenergic receptors 12 in the internal urethral sphincter producing urinary incontinence by decreasing the sphincter pressure 7 (please see Table 1 for a list of the cases of MPH-induced enuresis).…”

Section: Discussionmentioning

confidence: 55%

“…4 Although there are studies in the literature showing that methylphenidate is effective in the treatment of enuresis accompanying ADHD, cases of enuresis occurring during the use of methylphenidate have been reported, albeit rarely. [7][8][9][10][11] In our case, immediate-release methylphenidate (10 mg and 20 mg) and ER-MPH (27 mg and 36 mg) were used after diagnosis in the past years, but enuresis did not develop. It was learned from the information obtained from the parents and the school that the patient had a moderate improvement in ADHD symptoms when he was last used ER-MPH (36 mg).…”

Section: Discussionmentioning

confidence: 75%

“…The genetic, physiological, and neurological mechanism of this association has not been clarified yet 4 . Although there are studies in the literature showing that methylphenidate is effective in the treatment of enuresis accompanying ADHD, cases of enuresis occurring during the use of methylphenidate have been reported, albeit rarely 7–11 …”

Section: Discussionmentioning

confidence: 99%

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Case Report: Dose-Dependent Enuresis in Methylphenidate Use

2022

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ObjectivesAttention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood. Although enuresis is a very common disorder in child diagnosed with ADHD, it may also develop because of methylphenidate.MethodsAuthors report here on a child case of ADHD that developed a probable enuresis related to methylphenidate.Results and ConclusionsClinicians should be aware that methylphenidate used in ADHD causes dose-dependent enuresis.

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Efficacy and Safety of Methylphenidate and Atomoxetine in Medication-Naive Children with Attention-Deficit Hyperactivity Disorder in a Real-World Setting

Zhang,

Yin,

You

et al. 2023

Drugs R D

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Background and Objective Methylphenidate (MPH) and atomoxetine (ATX) are the most common medications used to treat attention-deficit hyperactivity disorder (ADHD) in China; however, despite this, there is still a paucity of studies comparing their efficacy and safety, particularly for different characteristics. To address the lack of research, a real-world prospective cohort study was conducted to examine these properties of MPH and ATX, and to analyze correlations associated with age, sex, and different ADHD presentation. Methods Children with ADHD meeting the eligibility criteria were recruited from January 2016 to July 2021. Study participants were treated with either MPH or ATX prescribed in the real-world setting, and were followed up for 26 weeks. Clinical efficacy response and adverse events (AEs) were recorded and measured. Subgroup analysis was performed to examine the efficacy response and AEs associated with age, sex, and different ADHD presentation. Results A total of 1050 children were recruited and 29 children were lost to follow-up. Of the 1021 children remaining, 533 were treated with MPH and 488 were treated with ATX. No significant differences were found in intelligence quotient, age, sex, or ADHD presentation between the MPH- and ATX-treated groups ( p > 0.05). The response rates were 84.6% in the MPH-treated group and 63.3% in the ATX-treated group. Subgroup analysis of response rate demonstrated that the treatment effect of MPH over ATX was consistent across subgroups except in the girls (odds ratio [OR] 2.09, 95% confidence interval [CI] 0.97–4.7) and the hyperactive/impulsive presentation group (OR 2.88, 95% CI 0.77–12.76). A total of 47.8% of children experienced AEs during MPH treatment, significantly lower than the rate of 56.8% during ATX treatment ( p < 0.05). The incidence of AEs in the MPH-treated group was higher in young children (<8 years: 56.8%; 8–10 years: 47.2%) and lower in children over 10 years of age (29.0%). Conclusions Overall, MPH was more effective and better tolerated than ATX. The incidence of AEs in children treated with MPH varied with age, and was higher in young children and lower in children over 10 years of age.

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Methylphenidate-Induced Enuresis: 3 Case Reports

Cited by 3 publications

References 8 publications

Acute Tolerability of Methylphenidate in Treatment-Naïve Children with ADHD: An Analysis of Naturalistically Collected Data from Clinical Practice

Acute Tolerability of Methylphenidate in Treatment-Naïve Children with ADHD: An Analysis of Naturalistically Collected Data from Clinical Practice

Case Report: Dose-Dependent Enuresis in Methylphenidate Use

Efficacy and Safety of Methylphenidate and Atomoxetine in Medication-Naive Children with Attention-Deficit Hyperactivity Disorder in a Real-World Setting

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