Methylphenidate- Psychostimulant- Palliative care (PCF-4)
Drug Name:Methylphenidate- Psychostimulant- Palliative care (PCF-4)
List Of Brands:
Indication Type Description:
Drug Interaction
Indication
Adverse Reaction
Contra-Indications
Dosages/ Overdosage Etc
Drug Interaction:
| Drug interaction |
| Methylphenindate may inhibit the metabolism of warfarin, TCA s and phenytoin |
| Its action are antagonized by antipsychotics |
Indication:
| Methlphenindate- Psychostimulant-(PCF-4) |
| General Information- Antidepressants |
| Preferred antidepresants in palliative care |
| First Line- |
| Psychostimulant eg methylphenidate |
| Particularly if prognosis > 2-4 weeks |
| start with 2.5mg -5mg b.d.(on waking /breakfast time and noon lunchtime |
| If neccesary increase by daily increments of 2.5mg b.d to 20mg b,d. |
| Occassionally higher doses are necessary eg 30mg b.d or 20mg t.d.s |
|
eg. 30mg b.d or 20mg t.d.s
|
| SSRI, eg setraline or citalopram |
| Particularly if prognosis > 2-4 weeks and if associated with anxiety |
| no antimuscarinic effects, but may cause an initial increase in anxiety |
| if necessary prescribe diazepam at bedtime |
| Start with setraline 50mg or citalopram 10mg once daily increasing the latter |
| to 20mg after 1 week |
| if no improvement after 4 weeks or only partial improvement after 6 -8 weeks, either |
| either incease the dose by setraline 50mg or citalopram |
| or switch a second line of antidepressants |
| maximum daily dose of seratline 200mg or citalopram 60mg |
| low likelyhood of a withdrawal (discontinuation ) syndrome |
| Second line- |
| Alternative SSRI, eg sertline or citalopram |
| dose as above |
| Mitrazapine |
| Acts on receptors , it is not a MARI. A good choice for |
| patients with anxiety/agitation |
| start with 15mg bed time |
| if little or no improvement after 2 weeks increase to |
| 30mg at bed time |
| if no response after 4 weeks, consider third line options |
| Third line options |
| seek advice from a psychiatrist |
| switch antidepressant |
| combine SSRI with mirtazapine, olanzapine or quetiapine |
Adverse Reaction:
| Undesirable effects- |
| Very common (>10%) - |
| nervousness, and insomnia (at the beginning of treatment,can be controlled by |
| reducing the dose |
| Common (< 10% >1%)- |
| headache, dizziness, dyskinesia,tachcardia, paliptatations,arrhythmias, |
| increase in blood pressure,abdominal pain,nausea,vomiting,(when starting treatment, |
| but may be alleviated by concurrent food intake), decreased appetite(transient), |
| dry mouth, rash, pruritus, urticaria,fever,arthalgia,scalp hair loss |
Contra-Indications:
| CONTRAINDICATION |
| Cautions |
| Cardiovasascular disease (eg severe hypertension, arrhythmias, and angina) |
| psychiatric illness, (eg. anxiety ,psychosis,and addiction), epilepsy,(possible lowering of |
| seizure threshold), hyperthyroidism, closed angle glaucoma |
| Contra indications |
| Severe anxiety or agitation, motor tics, hyperthyroidism, severe angina, cardiac arrhythmias, |
| glaucoma |
Dosages/ Overdosage Etc:
| Dose- |
| Individual dose titration is necessary to maximize benefit and minimize |
| Start with 2.5mg-5mg ( on waking/breakfast time and noon lunchtime) |
| If necessary , increase by daily increments of 2.5- 5mg b.d |
| usual maximum 20mg b.d (occassionally even higher dose are necessary |
| eg. 30m b.d or 20mg t.d.s |
|
Start with 2.5mg-5mg ( on waking/breakfast time and noon lunchtime)
|
| RITALIN * |
| NOVARTIS * |
| 10mg 28 days @ 10mg b.d |
