The methylphenidate ( MFD) is a psychostimulant , better known by the trademark Ritalin in English-speaking countries, Rubifen , Spain, and Ritalin others.
methylphenidate use is widespread enough in our schoolchildren and adolescents with no history of complications or occurrence of significant side effects, perhaps the product of not being taken into account and therefore unwanted. That is why we want to draw attention to relating the experience with a patient who had hypertension, clearly related to the administration of this challenging and suspend disappeared.
report: School male 8 years old with a history of hypertension and maternal great-grandfather. Six months before he was diagnosed with Attention Deficit Disorder and Methylphenidate treatment was started, being checked regularly, but no records of blood pressure. Four days before admission began with abdominal pain, intermittent that was accentuated with the times and not accompanied by another event. Consulted in the emergency unit, where they found persistently elevated blood pressures, fluctuating between 158/88 and 170/105 and between 78 and 98 pulses per minute. Physical examination was normal, with large and symmetric pulses and no murmurs or abdominal paravertebral. The fundus was normal. Cardiological evaluation was requested, which was normal and ruled out secondary hypertension. Methylphenidate was discontinued, indicating only antihypertensive therapy within 24 hours and reaching a satisfactory outcome progressively to normal pressures after the first week of suspension.
talk: Methylphenidate is an effective stimulant in the treatment of various neuropsychiatric disorders, but is specifically used in children in Attention Deficit Disorder. It has a very good absorption, with peak plasma concentration about two hours and elimination half-life is 2 to 7 hours, is metabolized in the liver specifically and only 1% is excreted in urine. Its side effects include fatigue, behavioral problems, lack of appetite, ataxia (incoordination in the movement of body parts ) , dizziness, hepatotoxicity (liver disease drug-induced toxic ) , tachycardia and hypertension , recently Klein-Schwartz, reviewed the indications and abuse of methylphenidate, calling attention to the marked increase in use, both therapeutic and abuse, attempted suicide, overdosing by mistake, etc, reviewing widely complications and side effects. In the age of 70 and 80 are publications, which draw attention to the cardiovascular complications in children and adolescents, mainly tachycardia and hypertension and its toxicity recientemente5 evaluated in 759 adolescents of which in 70% of cases had a history of abuse of this drug, being that 172 of them were hospitalized due to complications that threatened the patient, the most common of these were found in 31.7% tachycardia, agitation and irritability in 25.7% and hypertension in 11.5% . The evolution in these cases was good in the short and long term, mainly when methylphenidate abuse was not associated with another drug. Brown and Sexson review the effect of methylphenidate after two weeks of treatment in a randomized double-blind study on the cardiovascular system in black teenagers. The highest dose used was 0.5 mg / kg and found a significant increase in blood pressure both systolic and diastolic, and therefore recommend careful monitoring of the pressure as indicated by this drug, especially in black patients.
Unfortunately there are few publications about it and there is no known national studies, so we do not know exactly what the magnitude of this problem, although anecdotal experience of verbal communication seems that the incidence of tachycardia and hypertension is low, but its significance should be carried out prospective studies to show us the true incidence of complications with the use of methylphenidate and thereby also establish appropriate controls and careful to avoid them.
report: School male 8 years old with a history of hypertension and maternal great-grandfather. Six months before he was diagnosed with Attention Deficit Disorder and Methylphenidate treatment was started, being checked regularly, but no records of blood pressure. Four days before admission began with abdominal pain, intermittent that was accentuated with the times and not accompanied by another event. Consulted in the emergency unit, where they found persistently elevated blood pressures, fluctuating between 158/88 and 170/105 and between 78 and 98 pulses per minute. Physical examination was normal, with large and symmetric pulses and no murmurs or abdominal paravertebral. The fundus was normal. Cardiological evaluation was requested, which was normal and ruled out secondary hypertension. Methylphenidate was discontinued, indicating only antihypertensive therapy within 24 hours and reaching a satisfactory outcome progressively to normal pressures after the first week of suspension.
talk: Methylphenidate is an effective stimulant in the treatment of various neuropsychiatric disorders, but is specifically used in children in Attention Deficit Disorder. It has a very good absorption, with peak plasma concentration about two hours and elimination half-life is 2 to 7 hours, is metabolized in the liver specifically and only 1% is excreted in urine. Its side effects include fatigue, behavioral problems, lack of appetite, ataxia (incoordination in the movement of body parts ) , dizziness, hepatotoxicity (liver disease drug-induced toxic ) , tachycardia and hypertension , recently Klein-Schwartz, reviewed the indications and abuse of methylphenidate, calling attention to the marked increase in use, both therapeutic and abuse, attempted suicide, overdosing by mistake, etc, reviewing widely complications and side effects. In the age of 70 and 80 are publications, which draw attention to the cardiovascular complications in children and adolescents, mainly tachycardia and hypertension and its toxicity recientemente5 evaluated in 759 adolescents of which in 70% of cases had a history of abuse of this drug, being that 172 of them were hospitalized due to complications that threatened the patient, the most common of these were found in 31.7% tachycardia, agitation and irritability in 25.7% and hypertension in 11.5% . The evolution in these cases was good in the short and long term, mainly when methylphenidate abuse was not associated with another drug. Brown and Sexson review the effect of methylphenidate after two weeks of treatment in a randomized double-blind study on the cardiovascular system in black teenagers. The highest dose used was 0.5 mg / kg and found a significant increase in blood pressure both systolic and diastolic, and therefore recommend careful monitoring of the pressure as indicated by this drug, especially in black patients.
Unfortunately there are few publications about it and there is no known national studies, so we do not know exactly what the magnitude of this problem, although anecdotal experience of verbal communication seems that the incidence of tachycardia and hypertension is low, but its significance should be carried out prospective studies to show us the true incidence of complications with the use of methylphenidate and thereby also establish appropriate controls and careful to avoid them.
Source.
Dr. Carlos Saieh A. , Rev Chil Pediatr 75 (1), 80-80, 2004.
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