[ad_1]
A new meta-badysis examined the administration of methylphenidate in randomized clinical trials and cohort studies in patients with ADHD.
Researchers at the University of Sydney sought to determine the maximum possible dosage of methylphenidate, as efficacy increases in parallel with the dosage. They discovered a lack of dosage research, as well as frequent compliance with pharmaceutical companies' recommendations, regardless of scientific support or lack thereof.
In an interview with MD Magazine ©Lead researcher Alison Poulton, MD, MB, discussed the importance of these findings and how methylphenidate dosage research is expected to progress in the future.
MD Mag: What do you think was the most important conclusion of the meta-badysis?
Poulton: This study reveals that there is no discernible evidence on the dose limits of stimulant drugs used to treat children and adolescents with ADHD, affecting approximately 10% of children. The results suggest that the current dosing guidelines are inadequate.
The dosing recommendations do not recognize any clinical dilemmas in patients who may not be adequately treated within the specified dose range. This may mean that some patients are undertreated or that prescribing physicians may start adding other drugs, which increases the risk of adverse effects and drug interactions.
Why is there so much previous research on the maximum possible dosage of methylphenidate?
I think there are several reasons for the lack of published research on the use of stimulants at higher doses. The currently approved dose range corresponds to the dose range chosen by the pharmaceutical industry during the initial trials.
Drug trials are expensive and the chosen dose range is appropriate for most patients. It may not be cost-effective for industry to fund higher dose studies that may be badociated with higher risk.
It is possible that individual physicians have already used higher doses in a small number of patients, but may be reluctant to admit an "unspecified" prescription. In addition, it may be difficult to publish a small series of cases, as medical journals often favor large multicenter, prospective and randomized studies.
These studies require funding and any sponsor should probably insist on staying within the approved dose range, because of the medico-legal risk badociated with the "off-label" prescription. And so the cycle continues.
What should be the next step in methylphenidate dosage research?
After a drug has been tested and is freely available, the collective experience accumulates. Physicians have a duty to respond to the needs of their patients and to do their best to find the most effective treatment.
Therefore, they may try to use a drug in people older or younger than those who participated in the trials, or in people with more complex mental health. They may also try to use a wider dose range. I believe that there are cases in the community of using stimulants at higher doses. Physicians should be encouraged to collaborate within their professional badociations and to publish their combined experiences.
Source link
