Psychiatric Drugs and Medications Q 26
Use of methylphenidate for attention deficit disorders in children can result in:
A. Tourette's syndrome
B. Growth suppression
C. Growth spurt
D. A and B
Correct Answer: D. A and B
Use of Ritalin does not cause a growth spurt. Instead, it can cause Tourette’s syndrome and growth suppression in children. Medical conditions that are not compatible with methylphenidate include glaucoma, severe hypertension, motor tics, and Tourette syndrome or a family history of Tourette syndrome. In children, it is particularly important to evaluate their growth curve for a stable progression in height and weight since methylphenidate has demonstrated growth suppression when used on a daily, long-term basis. The medication should either be readjusted or discontinued if children are not in a healthy percentile on their growth curve.
Option C: Methylphenidate blocks the reuptake of two neurotransmitters, norepinephrine (NE) and dopamine, by presynaptic neurons. More specifically, it inhibits the transporters of these neurotransmitters, increasing the concentration of dopamine and NE in the synaptic cleft. Overall, this creates its classic stimulant effect within the central nervous system (CNS), mainly in the prefrontal cortex. It chemically derives from phenethylamine and benzylpiperazine. It undergoes metabolism by the liver to ritalinic acid through a process called de-esterification via carboxylesterase CES1A1.
Option D: Insomnia and nervousness are the most commonly reported adverse effects in patients on methylphenidate. Other frequent side effects mainly involve the CNS (dizziness, headache, tics, restlessness/akathisia), gastrointestinal (nausea/vomiting, dry mouth, decreased appetite, weight loss, abdominal pain), and cardiovascular systems (tachycardia, and palpitations). Dermatologically, patients can complain of excessive sweating and ulceration of their digits. Some patients may even develop blurry vision or decreased libido. Patients are more prone to become easily agitated, irritable, or depressed and go through mood swings/lability).