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Adverse response to methylphenidate in combination with valproic acid
1Child Development Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Methylphenidate (MPH) combined with valproic acid may cause severe adverse effects like dyskinesia in children with epilepsy and ADHD. Caution is advised when using this medication combination due to potential serious side effects.
Area of Science:
- Pediatric Neurology
- Child Psychiatry
- Clinical Pharmacology
Background:
- Attention-deficit hyperactivity disorder (ADHD) is common in children with epilepsy.
- Methylphenidate (MPH) is increasingly used for ADHD symptoms in epileptic children.
- Valproic acid is a common antiepileptic drug (AED) used in this population.
Purpose of the Study:
- To report adverse effects of combining methylphenidate (MPH) with valproic acid in children.
- To highlight potential risks associated with this common co-prescription.
Main Methods:
- Case report of two children with epilepsy and ADHD.
- Observation of adverse events following MPH administration while on valproic acid therapy.
Main Results:
- Two children developed rapid and severe dyskinesia and bruxism.
- These adverse effects occurred when MPH was co-administered with valproic acid.
Conclusions:
- Caution is warranted when prescribing MPH for ADHD in children taking valproic acid.
- Potential for serious and persistent side effects necessitates careful monitoring.
- Further prospective studies are needed to evaluate the safety of valproic acid and MPH combination.
Abstract:
The use of methylphenidate (MPH) in combination with antiepileptic drugs is gaining acceptance for children with epilepsy who have the symptoms of attention-deficit hyperactivity disorder (ADHD). We report two cases of an adverse effect of dyskinesia and bruxism when MPH was given to children maintained on valproic acid. These adverse effects were rapid and severe. Because of the potential for serious and persistent side effects from this combination of medications, caution is warranted in the treatment of ADHD with MPH for children taking valproic acid. Further prospective studies of the use of valproic acid and MPH in combination are required.