TITLE

Efficacy of two once-daily methylphenidate formulations compared across dose levels at different times of the day: Preliminary indications from a secondary analysis of the COMACS study data

AUTHOR(S)
Sonuga-Barke, Edmund J. S.; Swanson, James M.; Coghill, David; DeCory, Heleen H.; Hatch, Simon J.
PUB. DATE
January 2004
SOURCE
BMC Psychiatry;2004, Vol. 4, p28
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Methylphenidate (MPH) is commonly prescribed in the treatment of Attention-Deficit/ Hyperactivity Disorder or ADHD. Concerta and Metadate CD are once-daily formulations of MPH using different delivery mechanisms resulting in different pharmacokinetic profiles. A recent study (COMACS) showed that for near-milligram (mg) equivalent daily doses, Metadate CD provides greater symptom control in the morning (1.5 through 4.5 hours post-dose), while Concerta provides greater control in the early evening (12 hours post-dose). Non-inferential comparison of effects for different dose levels of the two formulations suggested that equivalent levels of morning symptom control could be obtained with lower daily doses of Metadate CD than Concerta; the situation being reversed in the evening. The current paper presents a secondary analysis that provides a statistical test of these observations. Method: The COMACS study was a multi-center, double-blind crossover study of Metadate CD, Concerta and placebo with each treatment administered for 1 week. Children were assigned on the basis of their pre-trial dosage to either high (Metadate CD 60 mg; Concerta 54 mg), medium (Metadate CD 40 mg; Concerta 36 mg) or low doses (Metadate CD 20 mg; Concerta 18 mg) of MPH, and attended a laboratory school on the 7th day for assessment at 7 sessions across the day. For the post-hoc comparisons across dose levels presented here, total SKAMP scores with the active treatments (adjusted for placebo response) were analyzed using an analysis of covariance, with a combined measure modeling placebo response across all time period as the covariate. Results: Symptom control from 1.5 through 6.0 hours post-dose was as good with lower doses of Metadate CD (20 and 40 mg) as with higher doses of Concerta (36 and 54 mg, respectively). Lower daily doses of Concerta (18 and 36 mg) and higher doses of Metadate CD (40 and 60 mg, respectively) gave equivalent control at 7.5 and 12 hours with Metadate CD giving better control from 1.5 through 6.0 hours post-dose. Conclusions: Different delivery profiles of Metadate CD and Concerta can be exploited to limit total daily exposure to MPH while at the same targeting a specific, especially clinically significant, period of the day. These results need to be confirmed in a study in which children are randomly allocated to different dose levels of the two formulations and plasma MPH concentrations are assessed simultaneously.
ACCESSION #
29323669

 

Related Articles

  • What Teachers and Parents Should Know About Ritalin. Pancheri, Christina; Prater, Mary Anne // Teaching Exceptional Children;Mar/Apr99, Vol. 31 Issue 4, p20 

    Provides information about the stimulant medication, Ritalin. Generic name; Demand for the drug in the United States; Pros and cons of the drug; Side effects; Ways on how parents and teachers can become informed about Ritalin; Responsibilities of teachers regarding information dissemination on...

  • Long-Term Safety of Stimulant Use for ADHD: Findings from Nonhuman Primates. Volkow, Nora D // Neuropsychopharmacology;Nov2012, Vol. 37 Issue 12, p2551 

    The article discusses various reports on safety of chronic stimulant published within the issue including one by K.E. Gill and colleagues on methylphenidate and another by P.L. Soto and colleagues on long-term exposure to oral methylphenid.

  • Stimulant Eases Mental Problems. Helquist, Michael // Advocate;8/15/89, Issue 531, p24 

    Reports on the efficacy of the drug Ritalin if used to improve mood and energy.

  • Methylphenidate use rises markedly among Israeli children.  // PharmacoEconomics & Outcomes News;4/22/2006, Issue 501, p8 

    Focuses on a study which reported an increase in the use of methylphenidate among children in Israel, particularly among girls. Data used to assess the change in methylphenidate use; One-year prevalence rates of methylphenidate use in Israel; Result of the analysis of age-specific data.

  • Swedish court case after Ritalin upset. Edwards, Vivien // New Zealand Doctor;5/18/2005, p20 

    Focuses on a case involving the diagnosis of neuropsychiatric disorders in Swedish children with the use of stimulant methylphenidate or Ritalin. Issues arising from the case; Increase in the number of school children who attend Sarskolan, a school for intellectual disability, in Gothenburg...

  • Altered responsiveness to cocaine in rats exposed to methylphenidate during development. Andersen, Susan L.; Arvanitogiannis, Andreas; Pliakas, Andrea M.; LeBlanc, Celeste; Carlezon, William A. // Nature Neuroscience;Jan2002, Vol. 5 Issue 1, p13 

    Evidence in laboratory animals indicates that exposure to stimulants produces sensitization to their rewarding effects, a process that in humans would be expected to increase the risk of substance abuse. However, therapeutic administration of stimulants such as methylphenidate (MPH) in children...

  • Pay attention: ritalin acts much like cocaine. Vastag, Brian; Vastag, B // JAMA: Journal of the American Medical Association;8/22/2001, Vol. 286 Issue 8, p905 

    Discusses the effects on the brain of drugs of addiction, including methylphenidate, or ritalin. How ritalin, when injected, is similar to cocaine; Way that ritalin works; Results of a study by psychiatrist Nora Volkow; Identification of the brain's dopamine system as a major player in...

  • Sub Thalamic Nucleus Deep Brain Stimulation: Iraqi Case Series. Hasan, Zaki N.; Faraj, Moneer K.; Aljabiry, Aqeel K.; Al-Atraqchy, Ahmad A. S.; Kamel, Mohamed A. S. // Iraqi Journal of Medical Sciences;2012, Vol. 10 Issue 2, p154 

    Background Sub thalamic nucleus (STN) Deep brain stimulation (DBS) electrodes are implanted into STN and programmed by external pulse generator. DBS alleviates the cardinal Parkinson disease symptoms and reduce the need for levodopa and related drugs and eventually reduces levodopa-related motor...

  • Contribution of drug doses and conditioning periods to psychomotor stimulant sensitization. Todtenkopf, Mark S.; Carlezon Jr., William A. // Psychopharmacology;May2006, Vol. 185 Issue 4, p451 

    Discusses a research on the contribution of drug doses and conditioning periods to psychomotor stimulant sensitization. Materials and methods; Psychostimulant drugs that cause sensitization to the locomotor-stimulating actions in rats; Results of the study.

  • Normal rocuronium sensitivity after titrated intraoperative sugammadex. McLoughlin, P. D. // Anaesthesia & Intensive Care;Mar2012, Vol. 40 Issue 2, p352 

    The author discusses the use of small titrated doses of sugammadex for the intraoperative reversal of the action of muscle relaxant, rocuronium, and to allow temporary surgical nerve stimulation during a neck dissection in a 78-year-old man with metastatic melanoma. The mechanism of action of...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics