[Central nervous system stimulants and their potential risk of abuse in hyperkinetic disorders]

The literature on the medical use of methylphenidate for hyperkinetic disorder/AD/HD does not support that its use implies a substantial risk for substance abuse, serious complications or drug dependence. Recent pharmacokinetic studies with PET throw light on the empirical findings of low rate of abuse, as the euforigenic potential of methylphenidate taken orally appears to be very modest. Methylphenidate should be the drug of choice in the treatment of adults with hyperkinetic disorder/AD/HD. However, current substance abuse precludes use of the drug and former abuse liability and social adjustment problems are relative contraindications. There is a lack of scientific data on the use of dextroamphetamine in adults with hyperkinetic disorder/AD/HD. The drug has a higher potential for abuse than methylphenidate and should be considered as a second choice only after an individual consideration of compliance and if methylphenidate proves ineffective. Rigid control of the prescription is necessary, and a medical history of substance abuse should in our opinion preclude its use.