Methylphenidate Tablets Research Articles

Effect of mecobalamin combined with holographic copper acupuncture and scraping technique on tinnitus symptoms in patients with sudden sensorineural hearing loss

Purpose: To examine the effect of methylcobalamin combined with holistic copper acupuncture and scraping technique in ameliorating tinnitus symptoms in patients with sudden sensorineural hearing loss. Methods: 80 patients with sudden sensorineural hearing loss from Department of Otolaryngology, The Hefei First People’s Hospital, Hefei, China were selected as subjects for this study. They were divided into control and study groups, respectively, with 40 patients in each group, based on the different treatment interventions received by the patients. Conventional interventions included the use of Ginkgo biloba extract, Tianmasu injection, dexamethasone pharmacological treatments. The control group received methylphenidate tablets in addition to the conventional treatment, while the study group received further intervention comprising the combination of holistic copper acupuncture and scraping technique on the ear, in addition to the treatment received by the control group. The evaluated outcomes included efficacy, auditory threshold levels, and Pittsburgh Sleep Quality Index (PSQI) score. Results: The overall efficacy of the treatment in the control group was 77.5 %, whereas, it was significantly higher in the study group at 97.5 % (p < 0.05). Prior to treatment, there were no significant differences in pure tone audiometry thresholds between the two groups (p > 0.05). However, post-treatment, the study group exhibited significantly lower pure tone audiometry thresholds compared to the control group (p < 0.05). Before PSQI scores were similar for the two groups (p > 0.05). However, after treatment, the PSQI scores in the study group were significantly lower than those in the control group (p < 0.05). Conclusion: The combined application of methylcobalamin, holistic copper acupuncture, and scraping technique is effective for the treatment of patients with sudden sensorineural hearing loss. This integrated treatment approach significantly alleviates tinnitus and improves sleep-related symptoms in patients with sudden sensorineural hearing loss. Furthermore, it promotes the recovery of pure tone audiometry thresholds and other related parameters.

Transient Right Ventricular Failure from Intravenous Injection of Methylphenidate Tablets

Methylphenidate (MPH) is a sympathomimetic stimulant used to manage adult narcolepsy and attention deficit hyperactivity disorder (ADHD), which is frequently abused. We present the case of a 37-year-old female who developed acute right ventricle (RV) failure after the self-injection of IV MPH. While difficult to prove causation, the temporal relationship between self-injection and symptom onset suggests a role for MPH in this patient’s acute RV failure. Other causes for acute RV failure were ruled out: she had no prior history of PH, ECG was not consistent with ischemia, computed tomography angiography (CTA) was negative for pulmonary embolism (PE), and Right heart catheterization (RHC) was not consistent with left ventricular failure. While there are case reports of persistent PH with chronic IV MPH use, this case describes the only reported incident of transient acute RV failure after IV MPH use.

Methylphenidate as Needed for Fatigue in Patients With Advanced Cancer. A Prospective, Double-Blind, and Placebo-Controlled Study

ContextCancer-related fatigue is a highly prevalent symptom with a strong negative impact on patients' daily life. ObjectivesTo evaluate the efficacy of methylphenidate as needed for the management of fatigue in patients with advanced cancer. MethodsA prospective, controlled, double-blind, and paired design, where the patient was her and/or his own control. Patients with advanced cancer with a tiredness score of ≥50 on a 0–100 visual analogue scale (VAS) were included. Patients were given 10 placebo and 10 methylphenidate tablets numbered 1–20 packed in blocks of four with two active and two placebo tablets (randomly arranged). Patients taking minimum three tablets were regarded evaluable. Primary effect parameters were mean differences in VAS for tiredness after two and five hours. With 28 evaluable patients, the study had a power of 0.90 to detect a mean difference of 15 between active and placebo. ResultsThirty-eight patients were enrolled to get 28 evaluable patients. Mean tiredness score before taking the tablets was 75 for placebo and 72 for methylphenidate on VAS (0–100). Mean changes (decrease) for methylphenidate after two and five hours were 20 and 17, respectively, and eight and five for placebo. Comparing mean differences, a significant decrease for methylphenidate compared with placebo was observed after two hours (P = 0.004) and five hours (P = 0.001), respectively. ConclusionIn this controlled and double-blind study in patients with advanced cancer, methylphenidate as needed was significantly more effective than placebo in relieving fatigue after two and five hours.

Faking it: the use of imitation drugs in research interviews

ABSTRACTThis paper documents the identification and selection of substances to mimic illicit drugs for a sequence of interviews used to document the preparation methods of PWID. In a sequence of interviews, PWID were asked to demonstrate the preparation of their drug of choice. The preparation of drugs including heroin, crack cocaine, methamphetamine, ‘homebake’ morphine and various oral preparations (including morphine tablets and capsules, methylphenidate tablets and capsules) were documented. In place of the drug, inert ‘fake’ drugs were used to ensure safety and security. To ensure the robustness of the research the fake drug material needed to have a similar appearance and physical properties to the real drug. This paper presents the range of materials used in order to aid other researchers who may have a need to mimic illicit drugs.

Patterns of Methylphenidate Use and Assessment of Its Abuse among the General Population and Individuals with Drug Dependence

Purpose: The aim of this study was to describe the extent of methylphenidate (MPH) abuse and characterize its patterns by following several cases involving intravenous administration of crushed MPH tablets. Methods: First, a drug reimbursement database (covering 4 million inhabitants) was explored to assess the magnitude of MPH abuse among the general population, and second, a specific study based on individuals with drug dependence was performed to describe abusers' characteristics (n = 64), patterns of abuse and clinical implications. Results: From 2005 to 2011, the number of patients who were dispensed MPH at least once increased by 166%. The patients with ‘deviant' patterns of MPH consumption were mainly male adults with opiate maintenance treatment reimbursements. MPH abusers had precarious living conditions. Half of them consumed MPH daily by intravenous route and reported amphetamine-like effects (cardiovascular events, weight loss, psychiatric adverse events). Conclusion: Given the increase of MPH use, it is important to warn the scientific community about possible MPH abuse, especially in individuals with drug dependence. This study has facilitated public health intervention and dissemination of information related to MPH abuse among health care professionals at local and national levels.

Steady-state bioavailability of extended-release methylphenidate (MPH-MLR) capsule vs. immediate-release methylphenidate tablets in healthy adult volunteers.

The objective of the study was to determine the relative bioavailability of an extended-release multilayer bead formulation of methylphenidate hydrochloride (MPH-MLR) 80mg vs. methylphenidate immediate-release (IR; Ritalin(®)) tablets as single and multiple doses in the fed state. A single-center, multiple-dose, randomized, open-label, two-period crossover study conducted in 26 healthy adults assigned to 4days of once-daily MPH-MLR 80mg or IR methylphenidate 25mg three times daily. MPH-MLR 80mg produced reproducible biphasic profiles of plasma methylphenidate concentrations characterized by a rapid initial peak, followed by a moderate decline reaching a plateau ~5 h post dose, then a gradual increase culminating in an attenuated second peak ~7h post dose. Maximum concentration was lower for MPH-MLR 80mg than IR methylphenidate 25mg three times daily on day 1 (23.70 vs. 31.47ng/mL); exposure was similar. The geometric mean ratios (MPH-MLR/IR methylphenidate [90% CI]) of log-transformed area under the plasma drug concentration-time curve to the last measurable observation (day 1: 0.88 [84.75-91.80]; day 4: 0.84 [81.16-86.94]), and area under the plasma drug concentration extrapolated to infinity (day 1: 0.93 [88.57-97.28]; day 4: 0.88 [84.48-91.17]) were within the 80-125% bioequivalence range. The mean±SD MPH-MLR 80-mg capsule day 4 area under the plasma drug concentration vs. time curve from 0 to 4h (74.5±15.2ng·h/mL) was greater than IR methylphenidate 25mg three times daily (66.0±17.4ng·h/mL), confirming steady-state levels during the study period. All treatment regimens were safe and well tolerated. MPH-MLR 80-mg capsule once daily or IR methylphenidate 25mg three times daily provides comparable maximum methylphenidate concentrations and systemic exposure in the fed state.

Fatal Oral Methylphenidate Intoxication with Postmortem Concentrations

Methylphenidate (MPD) is a widely prescribed stimulant used primarily for the treatment for attention-deficit/hyperactivity disorder (ADHD). Suicide attempts involving MPD ingestion have been well described; however, deaths attributed solely to MPD ingestion have not been reported. A 62-year-old woman was found dead on her floor. The only discrepancy in among her medication quantities was that >three hundred 10 mg MPD tablets were missing. Analysis utilizing gas chromatography-mass spectrometry revealed elevated postmortem MPD peripheral and central blood, liver and vitreous humor concentrations. Considering both the central blood to peripheral blood ratio (0.89) and the liver to peripheral blood ratio (3.3), MPD does not appear subject to significant postmortem redistribution. With no other identifiable cause of death, we report what appears to be the first isolated MPD ingestion associated with a fatality.

Severe toxicity due to injected but not oral or nasal abuse of methylphenidate tablets

Non-medical use of methylphenidate is increasing. Little is known about potential acute medical complications associated with recreational use of methylphenidate. To identify medical problems associated with methylphenidate abuse. Retrospective case series of methylphenidate abuse cases presenting to an inner city emergency department. We identified 14 cases of methylphenidate abuse between 2003 and 2010. Ten of these patients abused methylphenidate alone while four co-ingested other drugs, mainly alcohol. The route of ingestion was oral in nine patients, nasal in one and intravascular in four. Severe toxicity was exclusively observed in users who injected the drug. Two cases involved accidental intra-arterial injection and resulted in tissue necrosis leading to the amputation of a forearm and of fingertips, respectively. Clinical findings in the non-serious cases included mild to moderate symptoms and signs of sympathetic nervous stimulation such as agitation, tachycardia, hypertension, anxiety, hallucination, headache, tremor and dizziness. Nine of the fourteen patients were taking methylphenidate as a prescribed drug. Eight patients were former or current multiple substance abusers. Methylphenidate misuse is not a significant burden for emergency departments in Switzerland. Oral and nasal administration of methylphenidate did not result in severe toxicity. However, injection of crushed methylphenidate pills lead to serious local toxicity. Most patients with methylphenidate abuse had a prescription for the drug indicating deviation from medical use. A history of multiple substance use may be a risk factor for non-medical use of methylphenidate.

Case report: intoxication with high dose of long-acting methylphenidate (Concerta®) in a suicidal 14-year-old girl

A 14-year-old girl with suicidal ideation was presented to the paediatric hospital about 2 h after ingestion of 21 long-acting methylphenidate (MPH) 54-mg tablets (1,134 mg Concerta(®)). At admission signs of sympathomimetic syndrome were observed like agitation, visual hallucinations, slight hypertension, and sinus tachycardia. Treatment included prevention of absorption (30 g activated charcoal orally) and careful observation related to the overstimulation of the sympathic system. Despite the intake of charcoal, the serum concentrations of MPH were 107 and 93 ng/ml 2.5 and 22 h after ingestion of MPH tablets. No support of vital functions was necessary. The girl made a full recovery and was discharged after 3 days of care at the paediatric clinic and referred to the child and adolescent psychiatric department. Exposure to a huge overdose of long-acting MPH exhibited acute sympathomimetic toxicity but no life-threatening symptoms in this patient. Thus this case report suggests that patients intoxicated with high dose long-acting MPH formulations can recover without sequelae when managed properly.

Successful lung transplantation for talcosis secondary to intravenous abuse of oral drug

Talcosis due to intravenous injection of oral drugs can cause severe pulmonary disease with progressive dyspnea even when drug use is discontinued. We describe a 54-year-old woman with severe emphysema who underwent left lung transplantation. The patient had a remote history of intravenous injection of crushed methylphenidate (Ritalin) tablets. Chest computed tomography showed severe emphysematous changes, more prominent in the lower lobes. Microscopic examination of the extracted lung demonstrated multinucleated giant cells with birefringent crystals, compatible with talcosis. At follow-up, daily symptoms were completely alleviated and lung function was good. We recommend that lung transplantation be considered as a viable option in the treatment of talcosis.

Suicidality in Adolescents and Adults with Fetal Alcohol Spectrum Disorders

Dear Editor: Suicide is the ninth leading cause of death in the US and the third leading cause for Americans aged 15 to 24 years (1). In Canada, suicide rates are higher (2). Fetal alcohol spectrum disorders (FASD) are common and preventable developmental disabilities with a prevalence of 1 in 100 (3). Previous reports suggest that individuals with FASD are at risk for suicide (4,5). An individual with a typical clinical profile for FASD will evidence several risk factors for suicide (for example, impulsivity, a comorbid mood disorder, and substance abuse problems) and should be monitored closely, irrespective of intellectual ability. We report pilot study data and 2 case studies to illustrate the underappreciated risk of suicide in adolescents and adults with FASD and its clinical manifestation. A pilot study (6) examined 11 adults with FASD (3 men and 8 women, aged 18 to 30 years, with IQs ranging from 72 to 113) drawn from the Fetal Alcohol Syndrome Follow-up Study database of the University of Washington Fetal Alcohol and Drug Unit. It found that approximately one-half the subjects reported at least 1 life-time suicide attempt on the Lifetime Parasuicide/Suicide Attempt Count (LPS, 7). History of mental illness was not a selection criterion, and only one subject was receiving any mental health treatment (medication management only) at the time of the interview. When each subject's most serious self-harm incident was evaluated for intent and lethality (8), 2/11 subjects (18%) had a severe suicide attempt, 3/11 (27%) had a moderate-risk attempt, 1/11 (9%) had a low-risk attempt, and 5/11 (46%) had no lifetime attempts. These rates of lifetime suicide attempts are higher than the general population rate of 4.6% reported in the National Comorbidity Study (9). The following case studies illustrate that the lethality of a suicide attempt or self-harm behaviour often does not correlate with degree of intent in patients with FASD. case Report 1 The first case is that of an adopted Native man, aged 19 years, with full fetal alcohol syndrome, normal intellectual abilities, and a long history of attention-deficit hyperactivity disorder and affective instability. He was enraged with his parents because he felt they were smothering him by setting strict curfews. However, he was unable to express his feelings verbally and instead expressed them through a suicide attempt. Intending to kill himself, he took 8 to 10 methylphenidate tablets (10 mg) and slashed his right shoulder, but he did not understand that he had taken a sublethal dose. In a family session the day after his suicide attempt, he was better able to verbalize his feelings and expressed overwhelming suicidal urges arising from his feeling trapped. …

Abuse and toxicity of methylphenidate.

The therapeutic use of methylphenidate for the management of attention-deficit hyperactivity disorder in children is increasing. As therapeutic use increases, the risk increases of unintentional overdoses, medication errors, and intentional overdoses caused by abuse, misuse, or suicide gestures and attempts. Side effects during therapy, which include nervousness, headache, insomnia, anorexia, and tachycardia, increase linearly with dose. Clinical manifestations of overdoses include agitation, hallucinations, psychosis, lethargy, seizures, tachycardia, dysrhythmias, hypertension, and hyperthermia. Methylphenidate tablets can be abused orally, or they can be crushed and the powder injected or snorted. Despite its abuse potential, there is disagreement regarding the extent to which methylphenidate is being diverted from legitimate use to abuse in preteens and adolescents.

Comparison of Dissolution between Regular-Release and Halves of Extended-Release Methylphenidate Tablets

Objective: To compare the in vitro dissolution of methylphenidate hydrochloride from regular-release tablets to halves of extended-release tablets. Design: Regular-release 10-mg methylphenidate tablets and halves of 20-mg extended-release tablets from two manufacturers (MD Pharmaceuticals, Inc., and Ciba Pharmaceutical Company) were dissolved according to the USP method specified for regular-release methylphenidate tablets. Samples were collected at 0.25, 0.5, 0.75, 1, 2, 3, 3.5, 4, 5, 6, and 7 hours. Methylphenidate concentration was determined by HPLC. Results: Regular-release methylphenidate tablets had statistically greater cumulative dissolution at all sample collection times of 2 hours or less compared with halves of extended-release tablets. The most dramatic difference occurred in the first 30 minutes, at which time the difference in cumulative dissolution was 63% (generic) and 55% (Ritalin). At 3 hours and thereafter, there was no significant difference in cumulative dissolution. Conclusions: Despite being cut in half, extended-release methylphenidate still does not dissolve as fast as regular-release tablets. Halving methylphenidate extended-release tablets may be a clinically acceptable means of achieving a prolonged-acting 10-mg dose.

Effect on Dissolution from Halving Methylphenidate Extended-Release Tablets

To determine the effect on in vitro dissolution from cutting methylphenidate extended-release tablets in half. Ritalin-SR (Ciba Pharmaceutical Co.) and generic methylphenidate extended-release (MD Pharmaceutical Inc.) tablets were dissolved in water according to the method prescribed by the US Pharmacopeia under two conditions: whole and halved. Samples were collected at 15, 30, and 45 minutes and at 1, 2, 3, 3.5, 4, 5, 6, and 7 hours. Methylphenidate content was determined by HPLC. Halving the tablets caused a statistically significant increase in cumulative dissolution as early as 15 minutes. The difference in cumulative dissolution reached its maximum for both Ritalin-SR and generic methylphenidate extended-release tablets at 2 hours. At this time point, the percent dissolution of the whole versus halved tablets was 57% versus 74% (Ritalin-SR), respectively, and 49% versus 67% (generic), respectively. The dissolution profiles of halved and whole extended-release methylphenidate tablets were parallel from this point through the 7-hour collection period. At 7 hours, however, there was no difference in the cumulative dissolution of halved versus whole tablets. While statistical differences during in vitro dissolution do exist and pharmacokinetic ramifications have not yet been determined, the absolute differences in dissolution between halved and whole tablets are not great. Halving methylphenidate extended-release tablets may be a clinically acceptable means of achieving a small increment/decrement in dose without converting to a regular-release tablet.

The absorption of sustained‐release methylphenidate formulations compared to an immediate‐release formulation

A crossover study in 18 subjects evaluated the plasma concentration-time profile of two different 20 mg sustained-release (SR) methylphenidate (MPH) tablets administered before breakfast, compared to a 10 mg immediate-release (IR) tablet administered before breakfast and again 5 h later, before lunch. Plasma MPH concentrations were determined using a sensitive and precise gas chromatography-mass spectrometry method, incorporating a deuterated internal standard. The mean peak MPH concentration was 6.4 ng ml-1 for the IR product versus 4.6 ng ml-1 and 4.8 ng ml-1 for the two SR formulations. Peak concentrations occurred at 3.3 h after dosing with the SR products, compared to 1.5 h after the first dose of the IR product. The extent of absorption for the three products, as determined from areas under the plasma concentration-time curves, were within 5 per cent of each other. There was no significant difference in rate or extent of absorption between the two SR formulations.

Retinal Detachment and Vitreous Hemorrhage due to Talc Emboli

INTRAOCULAR talc particles have been described after intravenous (IV) injection of dissolved methylphenidate hydrochloride tablets.^1,2Presumably the talc, which is used as a filler in the methylphenidate tablet, is captured in the retinal capillaries, usually in the macular region. Although mild reductions in visual acuity after a talc injection have been reported,³in most cases visual acuity has been normal. We report a case of bilateral severe visual loss secondary to talc emboli. <h3>Report of a Case</h3> A 42-year-old black man was seen in December 1979 complaining of decreased vision. A "curtain" had descended into his visual field five days previously, but the patient could not tell if it was noted while using the right or left eye. The patient had been a heroin addict from 1968 to 1976. He then changed to IV injections of dissolved methylphenidate tablets, injecting from two to six tablets a day. He

Fatal pulmonary hypertension from intravenous injection of methylphenidate (ritalin) tablets

Intravenous injection of tablet forms of methylphenidate (Ritalin) is a particularly hazardous and increasingly common practice among drug addicts. Large amounts of talc used as filler in the oral form of the drug lead to widespread obstruction of the pulmonary vascular bed by talc granulomas. A case is presented in which this practice produced pulmonary hypertension, cor pulmonale, and death within seven months.

Complications of Injecting Dissolved Methylphenidate Tablets

The parenteral injection of dissolved methylphenidate hydrochloride tablets provoked a cutaneous reaction in 16 patients who chronically used drugs. Biopsies from five patients showed foreign body reactions to talc or cornstarch. Pulmonary granulomata were seen in two patients who died as a consequence of drug abuse, and one patient with bacterial endocarditis on the tricuspid valve had talc granulomata in portions of the valve removed at surgery.

Complications of injecting dissolved methylphenidate tablets

Complications of injecting dissolved methylphenidate tablets