Pediatric Methylphenidate Exposures: 7-Year Experience of Poison Centers in the United States

Abstract

This study was undertaken to evaluate trends and toxicity of pediatric methylphenidate exposures; 1993 to 1999 national poison center data were analyzed. There were 12,917 exposures, increasing from 927 in 1993 to 2,445 in 1999. The majority of children during the entire study period experienced no effect (60.3%) or minor effects (28.7%), with no fatalities. Most common reasons were unintentional general or therapeutic errors in children under 13 years and suicide attempt in adolescents. Adolescents were more likely to experience clinical toxicity, hospitalizations and more serious outcomes. The trend of increasing frequency of methylphenidate exposures reported to poison centers exactly parallels increasing therapeutic use.

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References

1. Safer DJ , Zito JM , Fine EM. Increased methylphenidate usage for attention deficit disorder in the 1990s. Pediatrics. 1996;98:1084-1088.

2. Zito JM , Safer DJ , dos Reis S , et al. Trends in the prescribing of psychotropic medications to preschoolers.JAMA. 2000;283:1025-1030.

3. Litovitz TL , Clark LR , Soloway RA. 1993 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am JEmerg Med. 1994;12:546-584.

4. Litovitz TL , Klein-Schwartz W , White S , et al. 1999 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. 2000;18:517-574.

5. Goldman LS , Genel M , Bezman RJ , et al. Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. JAMA. 1998;279:1 100-1107.

6. Kimbo HC , Cross JT , Abernathy DR. Pharmacokinetics and clinical effectiveness of methylphenidate. Clin Pharmacokinet. 1999;37:457-470.

7. Stecyk O , Loludice TA , Demeter S , et al. Multiple organ failure resulting from intravenous abuse of methylphenidate hydrochloride. Ann Emerg Med. 1985;14:597-599.

8. Mehta H , Murray B , Loludice TA. Hepatic dysfunction due to intravenous abuse of methylphenidate hydrochloride.JClin Gastroenterol. 1984;6:149-151.

9. Sherman CB , Hudson LD , Peirson DJ. Severe precocious emphysema in intravenous methylphenidate (Ritalin) abusers. Chest. 1987;92:1085-1087.

10.

10. Levine B , Caplan YH , Kauffman G. Fatality resulting from methylphenidate overdose. J Anal Toxicol. 1986;10:209-210.

11.

11. Garland EJ. Intranasal abuse of prescribed methylphenidate. J Am Acad Child Adolesc Psychiatry. 1998;37:573-574.

12.

12. Massello W , Carpenter DA. A fatality due to the intranasal abuse of methylphenidate (Ritalin).JForens Sci. 1999;44:220-221.

13.

13. Jaffe SL. Intranasal abuse of prescribed methylphenidate by an alcohol and drug abusing adolescent with ADHD. JAm Acad Child Adolesc Psychiatry. 1991;30:773-775.

14.

14. Goyer PF , Davis GC , Rapoport JL Abuse of prescribed stimulant medication by a 13-year-old hyperactive boy. J Am Acad Child Psychiatry. 1979;18:170-175.

15.

15. Foley R , Mrvos R , Krenzelok EP. A profile of methylphenidate exposures. J Toxicol Clin Toxicol. 2000;38:625-630.

16.

16. White SR , Yadao CM. Characterization of methylphenidate exposures reported to a regional poison control center. Arch Pediatr Adolesc Med. 2000;154:1199-1203.

17.

17. Erickson SJ , Duncan A. Clonidine poisoning-an emerging problem: Epidemiology, clinical features, management and preventative strategies. JPaediatr Child Health. 1998;34:280-282.