Methylphenidate poisoning: An evidence-based consensus guideline for out-of-hospital management

Clinical Toxicology

Volumn 45, Issue 7, 2007, Pages 737-752

  Scharman, Elizabeth J ^a   Erdman, Andrew R ^a   Cobaugh, Daniel J ^a   Olson, Kent R ^a   Woolf, Alan D ^a   Caravati, E Martin ^a   Chyka, Peter A ^a   Booze, Lisa L ^a   Manoguerra, Anthony S ^a   Nelson, Lewis S ^a   Christianson, Gwenn ^a   Troutman, William G ^a  

^a American Association of Poison Control Centers   (United States)

Author keywords

Methylphenidate poisoning; Poison control centers standards; Practice guidelines

Indexed keywords

CHARCOAL; IPECAC; METHYLPHENIDATE; MONOAMINE OXIDASE INHIBITOR; TRANYLCYPROMINE;

ABDOMINAL PAIN; AGITATION; APPETITE SUPPRESSION; BEHAVIOR; CONVULSION; DRUG ABUSE; DRUG FORMULATION; DRUG INFORMATION; DRUG INTOXICATION; DRUG OVERDOSE; DYSTONIA; EMERGENCY HEALTH SERVICE; EMERGENCY WARD; HALLUCINATION; HEADACHE; HEALTH CARE PERSONNEL; HEART ARRHYTHMIA; HUMAN; HYPERACTIVITY; INGESTION; INSOMNIA; IRRITABILITY; LETHARGY; MORTALITY; MYDRIASIS; NAUSEA; PATIENT CARE; PATIENT REFERRAL; POISON CENTER; PREGNANCY; RESPIRATORY ARREST; RESUSCITATION; REVIEW; SIDE EFFECT; SOMNOLENCE; TACHYCARDIA; THORAX PAIN; VOMITING;

AMBULATORY CARE; CENTRAL NERVOUS SYSTEM STIMULANTS; CHILD; CHILD, PRESCHOOL; CONSENSUS; EMERGENCY MEDICAL SERVICES; EVIDENCE-BASED MEDICINE; HEALTH PLANNING GUIDELINES; HUMANS; INFANT; METHYLPHENIDATE; POISON CONTROL CENTERS; POISONING;

EID: 36749080890     PISSN: 15563650     EISSN: 15569519     Source Type: Journal    
DOI: 10.1080/15563650701665175     Document Type: Review

References (80)

1. Goldman LS, Genel M, Bezman RJ, Slanetz PJ. Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. JAMA 1998; 279:1100-1107.
2. Olfson M, Marcus SC, Weissman MM, Jensen PS. National trends in the use of psychotropic medications by children. J Am Acad Child Adolesc Psychiatry 2002; 41:514-521.
3. Zuvekas SH, Vitiello B, Norquist GS. Recent trends in stimulant medication use among U.S. children. Am J Psychiatry 2006; 163:579-585.
4. Okie S. ADHD in adults. N Engl J Med 2006; 354:2637-2641.
5. Watson WA, Litovitz TL, Rodgers GC, Klein-Schwartz W, Reid N, Youniss J, Flanagan A, Wruk KM. 2004 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2005; 23:589-666.
6. Drug Facts and Comparisons. St. Louis, MO: Wolters Klewer Health, 2006.
7. Volkow ND, Wang GJ, Fowler JS, Gatley SJ, Logan J, Ding YS, Hitzemann R, Pappas N. Dopamine transporter occupancies in the human brain induced by therapeutic doses of oral methylphenidate. Am J Psychiatry 1998; 155:1325-1331.
8. Solanto MV. Neuropsychopharmacological mechanisms of stimulant drug action in attention-deficit hyperactivity disorder: A review and integration. Behav Brain Res 1998; 94:127-152.
9. Breggin PR. Psychostimulants in the treatment of children diagnosed with ADHD: Risks and mechanism of action. Int J Risk Saf Med 1999; 12:3-35.
10. Klein-Schwartz W, McGrath J. Poison centers' experience with methylphenidate abuse in pre-teens and adolescents. J Am Acad Child Adolesc Psychiatry 2003; 42:288-294.
11. Brown RT, Amler RW, Freeman WS, Perrin JM, Stein MT, Feldman HM, Pierce K, Wolraich ML. Treatment of attention-deficit/hyperactivity disorder: Overview of the evidence. Pediatrics 2005; 115:e749-757.
12. Stein MA, Sarampote CS, Waldman ID, Robb AS, Conlon C, Pearl PL, Black DO, Seymour KE, Newcorn JH. A dose-response study of OROS methylphenidate in children with attention-deficit/hyperactivity disorder. Pediatrics 2003; 112:e404.
13. Young JG. Methylphenidate-induced hallucinosis: Case histories and possible mechanisms of action. J Dev Behav Pediatr 1981; 2:35-38.
14. Rothschild CJ, Nicol H. Allergic reaction to methylphenidate. Can Med Assoc J 1972; 106:1064.
15. Feldman H, Crumrine P, Handen BL, Alvin R, Teodori J. Methylphenidate in children with seizures and attention-deficit disorder. Am J Dis Child 1989; 143:1081-1086.
16. Hemmer SA, Pasternak JF, Zecker SG, Trommer BL. Stimulant therapy and seizure risk in children with ADHD. Pediatr Neurol 2001; 24:99-102.
17. Nissen SE. ADHD drugs and cardiovascular risk. N Engl J Med 2006;354:1445-1448.
18. Brown CS. Treatment of attention-deficit hyperactivity disorder - a critical review. DICP Ann Pharmacother 1991; 25:1207-1213.
19. Coffey B, Shader RI, Greenblatt DJ. Pharmacokinetics of benzodiazepines and psychostimulants in children. J Clin Psychopharmacol 1983; 3:217-225.
20. Kimko HC, Cross JT, Abernethy DR. Pharmacokinetics and clinical effectiveness of methylphenidate. Clin Pharmacokinet 1999; 37:457-470.
21. Wolraich ML, Doffing MA. Pharmacokinetic considerations in the treatment of attention-deficit hyperactivity disorder with methylphenidate. CNS Drugs 2004; 18:243-250.
22. Dexmethylphenidate (Focalin) for ADHD. Med Lett Drugs Ther. 2002: 44:45-46.
23. Lacy CF, Armstrong LL, Goldman MP, Lance LL. Drug Information Handbook. 14th ed. Hudson (OH): Lexi-Comp, 2006.
24. Hansten PD, Horn JR. Hansten and Horn's drug interactions analysis and management. St. Louis: Facts and Comparisons, 2006.
25. Drug Interaction Facts. St Louis: Facts and Comparisons, 2006.
26. Sherman M, Hauser GC, Glover BH. Toxic reactions to tranylcypromine. Am J Psychiatry 1964; 120:1019-1021.
27. Feinberg SS. Combined stimulants with monoamine oxidase inhibitors: A review of uses and one possible additional indication. J Clin Psychiatry 2004; 65:1520-1534.
28. Gara L, Roberts W. Adverse response to methylphenidate in combination with valproic acid. J Child Adolesc Psychopharmacol 2000; 10:39-43.
29. Markowitz JS, DeVane CL, Boulton DW, Nahas Z, Risch SC, Diamond F, Patrick KS. Ethylphenidate formation in human subjects after the administration of a single dose of methylphenidate and ethanol. Drug Metab Dispos 2000; 28:620-624.
30. Coetzee M, Kaminer Y, Morales A. Megadose intranasal methylphenidate (Ritalin) abuse in adult attention deficit hyperactivity disorder. Subst Abus 2002; 23:165-169.
31. Klein-Schwartz W. Abuse and toxicity of methylphenidate. Curr Opin Pediatr 2002; 14:219-223.
32. Lewman LV. Fatal pulmonary hypertension from intravenous injection of methylphenidate (Ritalin) tablets. Hum Pathol 1972; 3:67-70.
33. Massello W, 3rd, Carpenter DA. A fatality due to the intranasal abuse of methylphenidate (Ritalin). J Forensic Sci 1999; 44:220-221.
34. Raskind M, Bradford T. Methylphenidate (Ritalin) abuse and methadone maintenance. Dis Nerv Syst 1975; 36:9-12.
35. Teter CJ, McCabe SE, Boyd CJ, Guthrie SK. Illicit methylphenidate use in an undergraduate student sample: Prevalence and risk factors. Pharmacotherapy 2003; 23:609-617.
36. Shaneyfelt TM, Mayo-Smith MF, Rothwangl J. Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA 1999; 281:1900-1905.
37. Shiffman RN, Shekelle P, Overhage JM, Slutsky J, Grimshaw J, Deshpande AM. Standardized reporting of clinical practice guidelines: A proposal from the Conference on Guideline Standardization. Ann Intern Med 2003; 139:493-498.
38. Dart RC, ed. Medical Toxicology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2004:1051-1062.
39. Ford MD, Delaney KA, Ling LJ, Erickson T, eds. Clinical Toxicology. Philadelphia: WB Saunders, 2001.
40. Goldfrank LR, Flomenbaum NE, Lewin NA, Howland MA, Hoffman RS, Nelson LS, eds. Goldfrank's Toxicologic Emergencies. 7th ed. New York: McGraw-Hill; 2002.
41. Haddad LM, Shannon MW, Winchester JF, eds. Clinical Management of Poisoning and Drug Overdose. 3rd ed. Philadelphia: WB Saunders, 1998.
42. Olson KR, ed. Poisoning & Drug Overdose. 4th ed. New York: McGraw-Hill, 2004.
43. Methylphenidate management. In: Klasco RK, ed. Poisindex system. Greenwood Village (CO): Thomson Micromedex; edition expires March 2006.
44. Kratochvil CJ, Greenhill LL, March JS, Burke WJ, Vaughan BS. The role of stimulants in the treatment of preschool children with attention-deficit hyperactivity disorder. CNS Drugs 2004; 18:957-966.
45. Bailey B, Letarte A, Abran MC. Methylphenidate unintentional ingestion in preschool children. Ther Drug Monit 2005; 27:284-286.
46. Foley R, Mrvos R, Krenzelok EP. A profile of methylphenidate exposures. J Toxicol Clin Toxicol 2000; 38:625-630.
47. Kim ME, Oderda GM, Klein-Schwatrz W. Toxicity of methylphenidate ingestions in children [abstract]. Vet Hum Toxicol 1989; 31:371.
48. Marquardt KA, Alsop JA, Lamb JP, Lai C, Walsh MJ, Albertson TE. Methylphenidate ingestions: Comparison of drug formulations [abstract]. J Toxicol Clin Toxicol 2004; 42:728.
49. White SR, Yadao CM. Characterization of methylphenidate exposures reported to a regional poison control center. Arch Pediatr Adolesc Med 2000; 154:1199-1203.
50. Robertson J, Shilkofski N, eds. The Harriet Lane Handbook: A Manual for Pediatric House Officers. ed 17. Philadelphia: Mosby, 2005:879.
51. Wender PH, Reimherr FW, Wood D, Ward M. A controlled study of methylphenidate in the treatment of attention deficit disorder, residual type, in adults. Am J Psychiatry 1985; 142:547-552.
52. Ahmann PA, Waltonen SJ, Olson KA, Theye FW, Van Erem AJ, LaPlant RJ. Placebo-controlled evaluation of Ritalin side effects. Pediatrics 1993; 91:1101-1106.
53. Aman MG, Kern RA, McGhee DE, Arnold LE. Fenfluramine and methylphenidate in children with mental retardation and ADHD: Clinical and side effects. J Am Acad Child Adolesc Psychiatry 1993; 32:851-859.
54. Arnold LE, Christopher J, Huestis R, Smeltzer DJ. Methylphenidate vs. dextroamphetamine vs. caffeine in minimal brain dysfunction: Controlled comparision by placebo washout design with Bayes' analysis. Arch Gen Psychiatry 1978; 35:463-473.
55. Barkley RA, McMurray MB, Edelbrock CS, Robbins K. Side effects of methylphenidate in children with attention deficit hyperactivity disorder: Systemic, placebo-controlled evaluation. Pediatrics 1990; 86:184-192.
56. Biederman J, Quinn D, Weiss M, Markabi S, Weideman M, Edson K, Karlsson K, Pohlmann H, Wigal S. Efficacy and safety of Ritalin® LA™, a new, once daily, extended-release dosage form of methylphenidate, in children with attention deficit hyperactivity disorder. Paediatr Drugs 2003; 5:833-841.
57. Charach A, Ickowicz A, Schachar R. Stimulant treatment over five years: Adherence, effectiveness, and adverse effects. J Am Acad Child Adolesc Psychiatry 2004; 43:559-567.
58. Dirksen SJ, D'Imperio JM, Birdsall D, Hatch SJ. A postmarketing clinical experience study of Metadate® CD. Curr Med Res Opin 2002; 18:371-380.
59. Efron D, Jarman F, Barker M. Side effects of methylphenidate and dexamphetamine in children with attention deficit hyperactivity disorder: Double blind, crossover trial. Pediatrics 1997; 100:662-666.
60. Firestone P, Musten LM, Pisterman S, Mercer J, Bennett S. Short-term side effects of stimulant medication are increased in preschool children with attention-deficit/hyperactivity disorder: A double-blind placebo-controlled study. J Child Adolesc Psychopharmacol 1998; 8:13-25.
61. Handen BL, Johnson CR, Lubetsky M. Efficacy of methylphenidate among children with autism and symptoms of attention-deficit hyperactivity disorder. J Autism Dev Disord 2000; 30:245-255.
62. Kelly RP, Yeo KP, Teng CH, Smith BP, Lowe S, Soon D, Read HA, Wise SD. Hemodynamic effects of acute administration of atomoxetine and methylphenidate. J Clin Pharmacol 2005; 45:851-855.
63. Kent JD, Blader JC, Koplewicz HS, Abikoff H, Foley CA. Effects of late-afternoon methylphenidate administration on behavior and sleep in attention-deficit hyperactivity disorder. Pediatrics 1995; 96:320-325.
64. Lopez F, Silva R, Pestreich L, Muniz R. Comparative efficacy of two once daily methylphenidate formulations (Ritalin® LA™ and Concerta ®) and placebo in children with attention deficit hyperactivity disorder across the school day. Paediatr Drugs 2003; 5:545-555.
65. McBride MC. An individual double blind crossover trial for assessing methylphenidate response in children with attention deficit disorder. J Pediatr 1988; 113:137-145.
66. Mulhern RK, Khan RB, Kaplan S, Helton S, Christensen R, Bonner M, Brown R, Xiong X, Wu S, Gururangan S, Reddick WE. Short-term efficacy of methylphenidate: A randomized, double-blind, placebo-controlled trial among survivors of childhood cancer. J Clin Oncol 2004;22:4743-4751.
67. Oesterheld JR, Kofoed L, Tervo R, Fogas B, Wilson A, Fiechtner H. Effectiveness of methylphenidate in Native American children with fetal alcohol syndrome and attention deficit/hyperactivity disorder: A controlled pilot study. J Child Adolesc Psychopharmacol 1998; 8:39-48.
68. Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorders with hyperactivity. Arch Gen Psychiatry 2005; 62:1266-1274.
69. Rapoport JL, Quinn PO, Bradbard G, Riddle KD, Brooks E. Imipramine and methylphenidate treatments of hyperactive boys. A double-blind comparison. Arch Gen Psychiatry 1974; 30:789-793.
70. Stowe CD, Gardner SF, Gist CC, Schulz EG, Wells TG. 24-hour ambulatory blood pressure monitoring in male children receiving stimulant therapy. Ann Pharmacother 2002; 36:1142-1149.
71. Swanson JM, Wigal SB, Wigal T, Sonuga-Barke E, Greenhill LL, Biederman J, Kollins S, Nguyen AS, DeCory HH, Hirshe Dirksen SJ, Hatch SJ. A comparison of once-daily extended-release methylphenidate formulations in children with attention-deficit/hyperactivity disorder in the laboratory school (The COMACS study). Pediatrics 2004; 113:E206-E216.
72. Wilens TE, Biederman J, Lerner M, Concerta Study G. Effects of once-daily osmotic-release methylphenidate on blood pressure and heart rate in children with attention-deficit/hyperactivity disorder - Results from a one-year follow-up study. J Clin Psychopharmacol 2004; 24:36-41.
73. Winsberg BG, Press M, Bialer I, Kupietz S. Dextroamphetamine and methylphenidate in the treatment of hyperactive-aggressive children. Pediatrics 1974; 53:236-241.
74. Schachter HM, Pham B, King J, Langford S, Moher D. How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis. CMAJ 2001; 165:1475-1488.
75. Talbot JS, Ahuja AS. Near-fatal methylphenidate misuse. Br J Psychiatry 2001; 178:278.
76. Klein-Schwartz W. Pediatric methylphenidate exposures: 7-year experience of poison centers in the United States. Clin Pediatr (Phila) 2003; 42:159-164.
77. Levine B, Caplan YH, Kauffman G. Fatality resulting from methylphenidate overdose. J Anal Toxicol 1986; 10:209-210.
78. American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC). Circulation 2005;112:1-5.
79. Keating GM, McClellan K, Jarvis B. Methylphenidate (OROS® formulation). CNS Drugs, Jun 2001; 15:495-500.
80. Lyseng-Williamson KA, Keating GM. Extended-release methylphenidate (Ritalin® LA). Drugs 2002; 62:2251-2259.