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Ugwendum D, Mbome Y, Arrey Agbor DB, Burkhanova U, Offor R, Okorie IJ, Gorantla A, Amokaye FA, Atere M, Nfonoyim J. Methylphenidate-Induced Non-ischemic Heart Failure With Reduced Ejection Fraction and Mild Pulmonary Hypertension. Cureus 2024; 16:e55604. [PMID: 38586757 PMCID: PMC10995454 DOI: 10.7759/cureus.55604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/09/2024] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is commonly diagnosed during childhood. Patients present with hyperactive-impulsive behavior and/or inappropriate inattention which may persist through adulthood. Central nervous system stimulants have been used to manage patients with ADHD. Methylphenidate which is used as a first-line therapy has been shown to have adverse cardiovascular effects in these patients. This is a case of a young male with a history of ADHD since childhood on methylphenidate who was diagnosed with acute non-ischemic heart failure with an ejection fraction of 15-20%. Methylphenidate-induced heart failure is the rare adverse effect seen in ADHD patients who are on this medication. Our patient was started on goal-directed medical therapy for heart failure and was discharged with an implantable cardioverter defibrillator (LifeVest®, ZOLL, Pittsburgh, PA) because of his persistently low left ventricular ejection fraction. It is important for physicians to always consider heart failure as a possible cardiovascular adverse effect when starting patients on methylphenidate for the management of ADHD.
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Affiliation(s)
- Derek Ugwendum
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Yolande Mbome
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | | | - Umida Burkhanova
- Cardiology, State University of New York (SUNY) Downstate Medical Center, Brooklyn, USA
| | - Rita Offor
- Internal Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, USA
| | | | - Asher Gorantla
- Cardiology, State University of New York (SUNY) Downstate Medical Center, Brooklyn, USA
| | | | - Muhammed Atere
- Cardiology, State University of New York (SUNY) Downstate Medical Center, Brooklyn, USA
| | - Jay Nfonoyim
- Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA
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Clark ED, Perin J, Herrmann N, Brawman‐Mintzer O, Lanctôt KL, Lerner AJ, Mintzer J, Padala PR, Rosenberg PB, Sami S, Shade DM, van Dyck CH, Porsteinsson AP. Effects of methylphenidate on neuropsychiatric symptoms in Alzheimer's disease: Evidence from the ADMET 2 study. Alzheimers Dement (N Y) 2023; 9:e12403. [PMID: 37538343 PMCID: PMC10394740 DOI: 10.1002/trc2.12403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/08/2023] [Accepted: 05/25/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Methylphenidate has been shown to improve apathy in patients with Alzheimer's disease (AD). The authors evaluated the impact of methylphenidate on neuropsychiatric symptoms (NPS) of AD, excluding apathy, using data from the Apathy in Dementia Methylphenidate Trial 2 (ADMET 2) study. METHODS A secondary analysis was conducted on data from the ADMET 2 study to determine the effect of methylphenidate on Neuropsychiatric Inventory (NPI) scores outside of apathy. Caregiver scores were compared from baseline to month 6 in 199 participants receiving methylphenidate (20 mg/day) or placebo regarding the presence or absence of individual neuropsychiatric symptoms, emergence of new symptoms, and individual domain scores. RESULTS No clinically meaningful improvement was observed in any NPI domain, excluding apathy, in participants treated with methylphenidate compared to placebo after 6 months. A statistical difference between groups was appreciated in the domains of elation/euphoria (P = 0.044) and appetite/eating disorders (P = 0.014); however, these findings were not considered significant. DISCUSSION Methylphenidate is a selective agent for symptoms of apathy in patients with AD with no meaningful impact on other NPS. Findings from this secondary analysis are considered exploratory and multiple limitations should be considered when interpreting these results, including small sample size and use of a single questionnaire.HIGHLIGHTS: Methylphenidate was not associated with significant improvement on the Neuropsychiatric Inventory in domains outside of apathy.Methylphenidate did not show a statistically significant emergence of new neuropsychiatric symptoms (NPS) throughout the 6-month treatment period compared to placebo.Methylphenidate appears to be a highly selective agent for apathy in Alzheimer's disease, potentially supporting catecholaminergic dysfunction as the driving force behind this presentation of symptoms.
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Affiliation(s)
- Emily D. Clark
- Alzheimer's Disease Care, Research and Education Program (AD‐CARE), Department of PsychiatryUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Jamie Perin
- Department of International HealthJohns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Nathan Herrmann
- Sunnybrook Research InstituteUniversity of TorontoTorontoOntarioCanada
| | - Olga Brawman‐Mintzer
- Ralph H. Johnson VA Medical Center, Department of PsychiatryMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Krista L. Lanctôt
- Hurvitz Brain Science Research Program, Sunnybrook Research Institute, Departments of Psychiatry and PharmacologyUniversity of TorontoTorontoOntarioCanada
| | - Alan J. Lerner
- Department of NeurologyUniversity Hospitals Cleveland Medical CenterCase Western Reserve University School of MedicineClevelandOhioUSA
| | - Jacobo Mintzer
- Ralph H. Johnson VA Medical Center, Department of PsychiatryMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Prasad R. Padala
- Central Arkansas Veterans Healthcare SystemBaptist Health‐University of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Paul B. Rosenberg
- Departments of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Susie Sami
- Department of NeurologyUniversity Hospitals Cleveland Medical CenterCase Western Reserve University School of MedicineClevelandOhioUSA
| | - David M. Shade
- Department of EpidemiologyJohns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Christopher H. van Dyck
- Departments of Psychiatry, Neurology, and NeuroscienceYale School of MedicineNew HavenConnecticutUSA
| | - Anton P. Porsteinsson
- Alzheimer's Disease Care, Research and Education Program (AD‐CARE), Department of PsychiatryUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
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Bach P, Hayashi K, Milloy MJ, Nosova E, Kerr T, Wood E, Fairbairn N. Characterising the increasing prevalence of crystal methamphetamine use in Vancouver, Canada, from 2006-2017: A gender-based analysis. Drug Alcohol Rev 2020; 39:932-940. [PMID: 32666650 DOI: 10.1111/dar.13126] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 05/06/2020] [Accepted: 06/08/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Methamphetamine use is increasing in North America and is associated with numerous negative health effects and social harms. As drug-related harms are often gendered, this study sought to examine the differential impacts of gender on the trends, risk factors and health implications of crystal methamphetamine use among a Canadian cohort of people with high rates of injection polysubstance use. METHODS Data were collected from two prospective cohorts of people who inject drugs in Vancouver, Canada. We examined trends in reported crystal methamphetamine use from 2006-2017 using the Cochrane-Armitage test for trend. We used multivariable generalised estimating equations, stratified by gender, to determine independent risk factors and health outcomes associated with crystal methamphetamine use. RESULTS In total, 1984 participants were included in the study, including 694 (35%) women. The prevalence of reported crystal methamphetamine use within the previous 6 months rose from 19% in 2006 to 36% in 2017, with a rise seen in both genders (P < 0.001). Reported crystal methamphetamine use was associated with numerous risk behaviours and drug-related harms in both genders, and in women it was associated with an increase in experiences of sexual violence (adjusted odds ratio 1.64, 95% confidence interval 1.18, 2.27). CONCLUSIONS These findings demonstrate the rising prevalence of reported crystal methamphetamine use in Vancouver in a cohort with high rates of polysubstance use. This work highlights drug and sex-related risk behaviours associated with crystal methamphetamine use for both genders, and underscores the need to develop strategies to address the growing use of crystal methamphetamine.
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Affiliation(s)
- Paxton Bach
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Ekaterina Nosova
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
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Chou WJ, Wang LJ, Lin CH, Liang SY, Chen VCH, Hou YM, Huang RR, Chou MC, Shang CY, Ho CP, Lai MC. Social adjustment and family function after drug switch from IR-methylphenidate to OROS-methylphenidate in patients with attention-deficit/hyperactivity disorder. Neuropsychiatr Dis Treat 2018; 14:2783-2791. [PMID: 30425496 PMCID: PMC6205135 DOI: 10.2147/ndt.s176913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This prospective, single-arm, open-label, 8-week, multicenter study investigated the effectiveness of switching from immediate-release methylphenidate (IR-MPH) to osmotic controlled-release methylphenidate (OROS-MPH) in patients with attention-deficit/hyperactivity disorder (ADHD). PATIENTS AND METHODS Overall, 296 patients with ADHD (mean age: 9.5 years) already on IR-MPH treatment were enrolled. Upon enrollment, a flexible dose of OROS-MPH was administered, replacing IR-MPH. Patients were assessed at baseline and weeks 2, 4, and 8 using the Swanson, Nolan, and Pelham version IV scale (SNAP-IV) and the Clinical Global Impression for ADHD symptoms. The Social Adjustment Inventory for Children and Adolescents assessed social functions, and the Chinese Health Questionnaire (CHQ) and Family Adaptation, Partnership, Growth, Affection, and Resolve evaluated parental and family functions. RESULTS Switching from IR-MPH to OROS-MPH yielded significant improvements in all ADHD symptoms, as rated by parents, teachers (SNAP-IV), and study investigators (Clinical Global Impression). CHQ scores and all Social Adjustment Inventory for Children and Adolescents subscores except spare time scores improved significantly. Patients with poor IR-MPH adherence had greater improvements in teacher-rated SNAP-IV and mothers' mental health (CHQ) after switching. CONCLUSION Switching from IR-MPH to OROS-MPH improved patients' behavioral ADHD symptoms and social adjustment, and mental health of patients' mothers. This was most evident in patients who previously exhibited poor IR-MPH adherence.
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Affiliation(s)
- Wen-Jiun Chou
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung,
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung,
| | - Chien-Ho Lin
- Department of Psychiatry, Chimei Medical Center, Tainan
| | | | | | | | - Rong-Rong Huang
- Department of Child and Adolescent Psychiatry, Kai-Suan Psychiatric Hospital, Kaohsiung
| | - Miao-Chun Chou
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung,
| | - Chi-Yung Shang
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Chi-Pui Ho
- Department of Child and Adolescent Psychiatry, Kai-Suan Psychiatric Hospital, Kaohsiung
| | - Meng-Chuan Lai
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
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Nielsen NP, Wiig EH, Bäck S, Gustafsson J. Processing speed can monitor stimulant-medication effects in adults with attention deficit disorder with hyperactivity. Nord J Psychiatry 2017; 71:296-303. [PMID: 28413936 DOI: 10.1080/08039488.2017.1280534] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Treatment responses to methylphenidate by adults with ADHD are generally monitored against DSM-IV/DSM-V symptomatology, rating scales or interviews during reviews. AIMS To evaluate the use of single- and dual-dimension processing-speed and efficiency measures to monitor the effects of pharmacological treatment with methylphenidate after a short period off medication. METHODS A Quick Test of Cognitive Speed (AQT) monitored the effects of immediate-release methylphenidate in 40 previously diagnosed and medicated adults with ADHD. Processing speed was evaluated with prior prescription medication, without medication after a 2-day period off ADHD medication, and with low-dose (10/20 mg) and high-dose (20/40 mg) methylphenidate hydrochloride (Medikinet IR). RESULTS Thirty-three participants responded to the experimental treatments. One-way ANOVA with post-hoc analysis (Scheffe) indicated significant main effects for single dimension colour and form and dual-dimension colour-form naming. Post-hoc analysis indicated statistical differences between the no- and high-dose medication conditions for colour and form, measures of perceptual speed. For colour-form naming, a measure of cognitive speed, there was a significant difference between no- and low-dose medication and between no- and high-dose medications, but not between low- and high-dose medications. CONCLUSIONS Results indicated that the AQT tests effectively monitored incremental effects of the methylphenidate dose on processing speed after a 2-day period off medication. Thus, perceptual (colour and form) and cognitive speed (two-dimensional colour-form naming) and processing efficiency (lowered shift costs) increased measurably with high-dose medication. These preliminary findings warrant validation with added measures of associated behavioural and cognitive changes.
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Affiliation(s)
| | - Elisabeth H Wiig
- b Communication Disorders, Boston University & Knowledge Research Institute, Inc , Arlington , TX , USA
| | - Svante Bäck
- a Department of Psychiatry , Västervik Sjukhus , Västervik , Sweden
| | - Jan Gustafsson
- c Medical Department, Evolan Pharma AB , Danderyd , Sweden
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Pallarés JG, López-Samanes Á, Fernández-Elías VE, Aguado-Jiménez R, Ortega JF, Gómez C, Ventura R, Segura J, Mora-Rodríguez R. Pseudoephedrine and circadian rhythm interaction on neuromuscular performance. Scand J Med Sci Sports 2014; 25:e603-12. [PMID: 25515692 DOI: 10.1111/sms.12385] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 01/04/2023]
Abstract
This study analyzed the effects of pseudoephedrine (PSE) provided at different time of day on neuromuscular performance, side effects, and violation of the current doping cut-off threshold [World Anti-Doping Agency (WADA)]. Nine resistance-trained males carried out bench press and full squat exercises against four incremental loads (25%, 50%, 75%, and 90% one repetition maximum [1RM]), in a randomized, double-blind, cross-over design. Participants ingested either 180 mg of PSE (supra-therapeutic dose) or placebo in the morning (7:00 h; AM(PLAC) and AM(PSE)) and in the afternoon (17:00 h; PM(PLAC) and PM(PSE)). PSE enhanced muscle contraction velocity against 25% and 50% 1RM loads, only when it was ingested in the mornings, and only in the full squat exercise (4.4-8.7%; P < 0.05). PSE ingestion raised urine and plasma PSE concentrations (P < 0.05) regardless of time of day; however, cathine only increased in the urine samples. PSE ingestion resulted in positive tests occurring in 11% of samples, and it rose some adverse side effects such us tachycardia and heart palpitations. Ingestion of a single dose of 180 mg of PSE results in enhanced lower body muscle contraction velocity against low and moderate loads only in the mornings. These mild performance improvements are accompanied by undesirable side effects and an 11% risk of surpassing the doping threshold.
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Affiliation(s)
- J G Pallarés
- Exercise Physiology Laboratory at Toledo, University of Castilla-La Mancha, Toledo, Spain.,Genoarchitecture Group, University of Murcia, Murcia, Spain
| | - Á López-Samanes
- Exercise Physiology Laboratory at Toledo, University of Castilla-La Mancha, Toledo, Spain
| | - V E Fernández-Elías
- Exercise Physiology Laboratory at Toledo, University of Castilla-La Mancha, Toledo, Spain
| | - R Aguado-Jiménez
- Department of Health Sciences, Public University of Navarra, Pamplona, Spain
| | - J F Ortega
- Exercise Physiology Laboratory at Toledo, University of Castilla-La Mancha, Toledo, Spain
| | - C Gómez
- Bioanalysis and Analytical Services Research Group Neurosciences Program, IMIM, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - R Ventura
- Bioanalysis and Analytical Services Research Group Neurosciences Program, IMIM, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - J Segura
- Bioanalysis and Analytical Services Research Group Neurosciences Program, IMIM, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - R Mora-Rodríguez
- Exercise Physiology Laboratory at Toledo, University of Castilla-La Mancha, Toledo, Spain
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