Frågedatum: 2002-03-25
RELIS database 2002; id.nr. 17848, DRUGLINE
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What is methylphenidate is being considered in a three-year-old mentally retarded boy with severe o



Fråga: What is methylphenidate is being considered in a three-year-old mentally retarded boy with severe obesity. Documented for the use of methylphenidate in obese children?

Sammanfattning: An extensive literature search has not revealed any information concerning the use of methylphenidate in the treatment of obesity in children. Weight loss has been reported as a side effect in children treated with methylphenidate for ADHD. Concern has also been expressed about the effect on height. Methylphenidate cannot be recommended for treatment of obesity in children. If methylphenidate is still considered in this patient, the dose should be based on the ideal bodyweight rather than of the total bodyweight to minimize the risk of overdosage. A starting dose in accordance with treatment of ADHD could be of guidance.

Svar: Methylphenidate is a piperidine derivative that is structurally related to amphetamine and is effective in the treatment of narcolepsy and attention-deficit hyperactivity disorder, ADHD (1). Amphetamine and similar drugs have been used for the treatment of obesity. Weight loss is almost entirely due to reduced food intake. The site of action is probably in the lateral hypothalamic feeding center (1). The rate of weight loss plateaus after 5 to 6 months after continuous treatment with centrally acting appetite suppressant drugs (2). Hence, continuous weight reduction usually is not observed in obese individuals without dietary restriction (1).

An extensive literature search has not revealed any information concerning the use or dosage of methylphenidate in children with obesity. Weight loss is reported as a side effect in children treated with methylphenidate for ADHD (1). The effect on height in children with ADHD treated with stimulants has been conflicting (3) and there are methodological concerns in the studies.

Methylphenidate cannot be recommended as treatment of obesity in children. If the drug is nevertheless to be used, we recommend that dosage of methylphenidate in obese children should be based on the ideal bodyweight instead of the total bodyweight to minimize the risk for overdosage. A starting dose of methylphenidate in accordance with treatment of ADHD, 0.2 mg/kg daily to 2.0 mg/kg daily given in two to three divided doses, could be of guidance. The maximum recommended dose is 60 mg daily (4). The safety and efficacy in children under 6 years of age have not been established (4).

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