scholarly journals Transition from Methylphenidate to Atomoxetine: reasons for switching and clinical outcome

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S69-S70
Author(s):  
Fabrizia Cassar ◽  
Giovanni Grech ◽  
Bertha Grech ◽  
Joseph Cassar
Keyword(s):  
Side Effects ◽  
Clinical Outcome ◽  
Behavior Disorder ◽  
Clinical Excellence ◽  
First Line ◽  
Nice Guidelines ◽  
Hyperactivity Disorder ◽  
Study Results ◽  
Dose Recommendations ◽  
Line Drug

AimsAttention Deficit Hyperactivity Disorder (ADHD) is a behavior disorder originating in childhood comprising of a constellation of features including inattention, impulsivity, and hyperactivity. The National Institute of Clinical Excellence (NICE) Guidelines 2018 recommends methylphenidate as a first line pharmacological agent for treatment of children aged 5 years and over with ADHD. Lisdexamfetamine, dexamfetamine and atomoxetine are recommended in this order if methylphenidate is not tolerated or if symptoms did not respond to separate 6-week trials. Our aim was to, assess the transition of methylphenidate to atomoxetine, the reasons for switching and its clinical outcome in order to make recommendations to current practice regarding treatment of ADHD.MethodThe study examined a total of 53 children between 0-16 years of age who were being treated for ADHD with atomoxetine at CYPS till September 2018. Data was collected from patients’ files retrospectively by using a proforma based on the NICE guidelines 2018 ADHD: diagnosis and management.ResultOut of 53 patients’ on atomoxetine in September 2018, 49 were included in the study. Results recorded side-effects as the main reason for switching from methylphenidate to atomoxetine. Unwanted side-effects were documented in 71.7% of patients of which 57.9% exhibited more than 1 side-effect with the two commonest side-effects documented being weight loss and decreased appetite. The audit highlighted the fact that the correct dose of atomoxetine was only administered in 17.2% of children with 56.9% of patient's being given a higher dose than recommended. Initial weight was not documented in 19% and hence, ideal dose could not be calculated. Overall, atomoxetine was shown to be an effective treatment. Out of the 40 patients documented to have hyperactivity this symptom was decreased in 82.5% whilst 82.9% were shown to have increased concentration. 35 patients had documented impulsivity and this was decreased in 62.9% of cases. 11 patients had documented anxiety with 72.7% being treated effectively with atomoxetine. 31% of patients’ had documented side-effects with 16% of these being tics. 20% of patient's required augmentation.ConclusionThe results indicate that the majority of doctors at CYPS in Malta adhered to the NICE guidelines 2018 and atomoxetine was proven to be efficacious as a second line drug in the treatment of ADHD. However, better adherence to NICE guidelines is required when it comes to the calculation of appropriate dosage. Our prediction is had dose recommendations according to weight been adhered to there may have been less side-effects documented.

scholarly journals Methotrexate Toxicity: Molecular Mechanisms and Management

2021 ◽  
pp. 204-217
Author(s):  
Riyadh S. Almalki ◽  
Hala Eweis ◽  
Fatemah Kamal ◽  
Dina Kutbi
Keyword(s):  
Side Effects ◽  
Cancer Chemotherapy ◽  
Pulmonary Toxicity ◽  
Molecular Mechanisms ◽  
Hematological Toxicity ◽  
Comprehensive Understanding ◽  
First Line ◽  
Cutaneous Toxicity ◽  
Gi Toxicity ◽  
Line Drug

Methotrexate (MTX) is the most widely used drug in cancer chemotherapy and is considered to be the first-line drug for the treatment of a number of rheumatic and non-rheumatic disorders. The pulmonary toxicity, hepatotoxicity of MTX are two of its major side effects. Other toxicities such as endocrinological toxicity, GI toxicity, cutaneous toxicity, hematological toxicity, fatal malfunction or loss, and malignancy can also occur, but at a significantly lower rate of prevalence. This review aims to provide a comprehensive understanding of the molecular mechanisms of methotrexate toxic effects and Lastly, we discussed the management of this toxicity.

Side Effects of Medications and Mitigation Strategies

2016 ◽  
Author(s):  
John Burger
Keyword(s):  
Side Effects ◽  
Treatment Strategies ◽  
Mitigation Strategies ◽  
Common Side Effect ◽  
Post Traumatic Stress ◽  
First Line ◽  
Hyperactivity Disorder ◽  
Sexual Side Effects ◽  
Sexual Symptoms ◽  
Post Traumatic

Sexual dysfunction is a common side effect of many common medications, including the first-line agents for treating post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and attention-deficit hyperactivity disorder (ADHD). Selective serotonin and norepinephrine reuptake inhibitors have been especially well studied. This chapter reviews the different classes of medications used to treat PTSD, TBI, and ADHD that can cause sexual side effects as well as several strategies important in understanding the source of sexual symptoms. Specific mitigation strategies are then reviewed, including changing the dose, switching within a class, switching to a different class, adding an augmenting agent, watching and waiting, and taking drug holidays. Key research supporting each strategy is presented and discussed with consideration for the typical responses of both men and women. Strength of research is also weighed. Finally, some considerations for future treatment strategies are considered.

scholarly journals Tacrolimus versus Cyclosporine- Comparative Evaluation as First line drug in Vernal keratoconjuctivitis

2018 ◽  
Vol 9 (2) ◽  
pp. 128-135 ◽  
Author(s):  
Rashmi Kumari ◽  
Bhawesh Chandra Saha ◽  
Bibhuti Prasanna Sinha ◽  
Nilesh Mohan
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Comparative Study ◽  
Comparative Evaluation ◽  
Subjective Symptom ◽  
First Line ◽  
Symptom Scores ◽  
Double Blinded ◽  
Line Drug ◽  
Ocular Sign

Introduction: The aim of the study was to evaluate and compare the efficacy, side effects and recurrence rate of vernal kerato conjunctivitis (VKC) with 0.03% tacrolimus and 0.05% cyclosporin.Material and method: A prospective randomised double blinded comparative study was conducted at a tertiary eye center. 46 Patients of VKC between March 2015- August 2015 were randomly divided into two groups and treated for 6weeks with either Tacrolimus(0.03%) eye ointment BD or Cyclosporine (0.05%) eyedrops QID.The main outcome measures were scoring and comparison of Total subjective symptom scores (TSSS) and Total objective ocular sign scores (TOSS) within and between the Groups at each follow up.Thirty two patients, sixteen from each group, with comparable baseline characters were analysed.Results: With treatment both TSSS and TOSS decreased consistently in both groups without any adverse effects but an increase in scores was noticed within two weeks after drug withdrawal.Conclusion: Both drugs are equally effective and safe in VKC but with short lasting effect.

scholarly journals ADHD in adolescence and adulthood, with a special focus on the dopamine transporter and nicotine

2006 ◽  
Vol 8 (1) ◽  
pp. 29-36
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Dopamine Transporter ◽  
Adult Adhd ◽  
Special Focus ◽  
Symptom Change ◽  
Comorbid Disease ◽  
First Line ◽  
Hyperactivity Disorder ◽  
Noradrenaline Reuptake ◽  
Line Drug

The persistence of attention deficit hyperactivity disorder (ADHD) into adolescence and adulthood has now been accepted as a clinical entity. The rate of prevalence among adults is assumed to be from 2% to 4%. With increasing age, a symptom change has to be considered; disturbance of attention becomes more prominent, whereas hyperactivity often diminishes or changes to inactivity. Neuroimaging studies show a high striatal dopamine transporter (DAT) availability in most adults with ADHD; this can be reduced by stimulants. Nicotine seems to have a stimulant-like action on the DAT. In most adults with ADHD, therapy has to be multimodal, combining psychotherapy and medication. Methylphenidate is the first-line drug in adult ADHD; further options are amphetamine and noradrenaline reuptake inhibitors. Nonresponders to methylphenidate seem to have no elevated DAT availability prior to therapy. Combination with other psychiatric disorders occurs frequently in adults with ADHD; in these patients additional pharmacological treatment with special regard to the comorbid disease is recommended.

scholarly journals A study of clozapine and long-term hospitalisation rates

2004 ◽  
Vol 28 (8) ◽  
pp. 285-288 ◽  
Author(s):  
Alan A. Woodall ◽  
David B. Menkes ◽  
Thomas R. Trevelyan ◽  
Colin P. Lanceley
Keyword(s):  
Side Effects ◽  
Older Patients ◽  
Clinical Excellence ◽  
Clinical Implications ◽  
Treatment Resistant ◽  
Nice Guidelines ◽  
Resistant Disease ◽  
Factors Influencing ◽  
The Mean

Aims and MethodThe aim of the study was to investigate the use of clozapine in treatment-resistant schizophrenia and its impact on hospitalisation rates when prescribed in accordance with National Institute for Clinical Excellence (NICE) guidelines. Case records were examined of patients admitted to the psychiatric unit of Glan Clwyd Hospital between 1996 and 2001.ResultsOf 59 patients identified as having treatment-resistant schizophrenia, 83% had been considered for clozapine, 48% were taking clozapine, 20% had refused the drug and 15% had stopped taking it because of side-effects. The mean annual hospitalisation rate for patients receiving clozapine for a minimum of 3 years was 13.5 days, markedly lower than those not receiving this drug (34.0 days, P=0.03). Older patients were less likely to have been offered clozapine (P=0.006).Clinical ImplicationsThis study supports the NICE guidelines recommending clozapine for patients with treatment-resistant disease. Clozapine is offered less often to older patients; factors influencing this require investigation.

scholarly journals Can parents believe websites’ information about methylphenidate’s side effects?

2021 ◽  
pp. archdischild-2020-320007
Author(s):  
Tom Arsac England ◽  
David Tuthill
Keyword(s):  
Side Effects ◽  
Search Engines ◽  
Information Source ◽  
Online Information ◽  
Hyperactivity Disorder ◽  
Frequent Use ◽  
Accessible Information ◽  
The Uk ◽  
Global Population ◽  
Line Drug

BackgroundAttention deficit and hyperactivity disorder (ADHD) is one of the most common behavioural disorders, affecting around 5% of the global population. Methylphenidate is recommended as the first-line drug treatment for ADHD for children over the age of 5 in the UK. It can have many side effects and it is important that families are well informed. Other than their healthcare professionals and friends, the major information source for families is the internet.AimsTo evaluate the validity of online information regarding the adverse effects of methylphenidate.MethodsSide-effects of methylphenidate hydrochloride listed in the British National Formulary for Children (BNFC) were taken as the ‘gold standard’ and compared with online websites for accuracy. The first 10 websites found on each of nine different search engines were used as comparators.ResultsFrom the 90 hits, 10 top hits found in each of 9 search engines, 25 unique websites were identified. A quarter (six sites; 24%) documented only side-effects that all appeared in the BNFC. Three quarters (19 websites; 76%) had at least one side-effect that did not appear in the BNFC; with six websites documenting more than five side-effects not found in the BNFC.ConclusionsMethylphenidate’s frequent use makes it important that the general public are provided with accurate, reliable and easily accessible information. Most websites have dependable quality information on side effects, but several seem to list excessive side-effects.

scholarly journals Promoting Good Practice in Cognitive-Behavioural Psychotherapies

2005 ◽  
Vol 33 (2) ◽  
pp. 129-130 ◽  
Author(s):  
Paul Salkovskis
Keyword(s):  
Good Practice ◽  
Clinical Excellence ◽  
Line Treatment ◽  
First Line ◽  
Interpersonal Therapy ◽  
Nice Guidelines ◽  
Psychological Therapies ◽  
Self Help ◽  
Cognitive Behavioural ◽  
Treatment Medication

The National Institute of Clinical Excellence (NICE) guidelines for anxiety (Panic and Generalized Anxiety Disorder) and depression were finally launched in December 2004, after much delay (see www.nice.org.uk). Given that these were such important documents, it might seem surprising that the launch went almost entirely unnoticed. Why was it surprising? Because the recommendations were ground breaking. CBT was identified as the first line treatment pretty much across the board, with huge resource implications. It is not the business of NICE to comment on resources (or the lack of these). However, it was noted in the anxiety guidelines that CBT should be available promptly from appropriately trained and supervised therapists. In many (if not most) areas, this strongly implies a huge change in emphasis in the delivery of psychological therapies. The (implicit) implications are staggering. With the honourable exception of Interpersonal Therapy in depression, other psychological therapies were not advocated – at all. In anxiety, combination treatment (medication and CBT) was not recommended as a first or second line treatment. Some medication (antipsychotic) was ruled out. Guided self-help (based on CBT principles) was “third choice”. So the explicit recommendation is that good quality, empirically grounded psychotherapies (CBT, CBT and IPT in depression) should be widely and promptly available, whereas therapies without an empirical basis were not recommended.

A case report of the efficacy and usefulness of asenapine in the treatment of a cancer patient with delirium and aphagia

2018 ◽  
Vol 17 (04) ◽  
pp. 488-491 ◽  
Author(s):  
Kyoko Osawa ◽  
Satoshi Ukai ◽  
Toshiyuki Kuriyama
Keyword(s):  
Palliative Care ◽  
Case Report ◽  
Drug Therapy ◽  
Side Effects ◽  
Cancer Patient ◽  
First Line ◽  
Sublingual Tablet ◽  
Oral Medications ◽  
End Stage ◽  
Line Drug

AbstractObjectiveControlling hyperactive and mixed delirium is extremely important for the continuation of cancer treatment in palliative care. In general, oral antipsychotics are the first-line drug therapy for delirium; however, oral administration is problematic in patients presenting dysphagia. In this case report, we describe an end-stage cancer patient with aphagia who developed delirium and responded to sublingual antipsychotic asenapine for treating delirium. We also discuss the effectiveness of asenapine in hyperactive delirium as well as its usefulness for treating delirium in palliative care.MethodA cancer patient with delirium was treated with several oral antipsychotics commonly used to treat delirium but did not respond to any of them. The patient subsequently developed aphagia with progression of the disease. Sublingual asenapine was therefore given to treat delirium.ResultAsenapine was effective in treating delirium without causing any obvious side effects.Significance of resultsIn the present case, asenapine was effective in treating hyperactive delirium that did not respond to commonly used antipsychotics. Because asenapine is a sublingual tablet, it can be used in patients with dysphagia and aphagia. In addition, this drug is anticipated to diminish the burden of end-stage patients from taking oral medications. Furthermore, its management is easier compared with injections, and can therefore also be easily used in homecare patients. Based on these perspectives, asenapine may become an important option for treating delirium in palliative care.

Attention Deficit and Disruptive Behavior Disorder Symptoms

2001 ◽  
Vol 17 (1) ◽  
pp. 25-35 ◽  
Author(s):  
G. Leonard Burns ◽  
James A. Walsh ◽  
David R. Patterson ◽  
Carol S. Holte ◽  
Rita Sommers-Flanagan ◽  
...  
Keyword(s):  
Attention Deficit ◽  
Rating Scales ◽  
Behavior Disorder ◽  
Disruptive Behavior Disorder ◽  
Subjective Rating ◽  
Time Interval ◽  
Assessment Procedure ◽  
Frequency Count ◽  
Hyperactivity Disorder ◽  
Oppositional Defiant

Summary: Rating scales are commonly used to measure the symptoms of attention deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). While these scales have positive psychometric properties, the scales share a potential weakness - the use of vague or subjective rating procedures to measure symptom occurrence (e. g., never, occasionally, often, and very often). Rating procedures based on frequency counts for a specific time interval (e. g., never, once, twice, once per month, once per week, once per day, more than once per day) are less subjective and provide a conceptually better assessment procedure for these symptoms. Such a frequency count procedure was used to obtain parent ratings on the ADHD, ODD, and CD symptoms in a normative (nonclinical) sample of 3,500 children and adolescents. Although the current study does not provide a direct comparison of the two types of rating procedures, the results suggest that the frequency count procedure provides a potentially more useful way to measure these symptoms. The implications of the results are noted for the construction of rating scales to measure the ADHD, ODD, and CD symptoms.

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