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Side effects of methylphenidate and desipramine alone and in combination in children
C S Pataki1, G A Carlson, K L Kelly
1Department of Psychiatry, New York University School of Medicine, NY 10016.
Insights
Combining methylphenidate and desipramine in children with ADHD and depression increased side effects, including nausea and heart rate changes. However, these side effects were comparable to those of desipramine alone.
Area of Science:
- Pediatric Psychiatry
- Pharmacology
- Clinical Psychology
Background:
- Attention-deficit hyperactivity disorder (ADHD) and depression frequently co-occur in children.
- Pharmacological interventions for these conditions often involve stimulant and non-stimulant medications.
Purpose of the Study:
- To evaluate the side effect profiles of methylphenidate and desipramine when administered alone and in combination.
- To compare the safety of combination therapy versus monotherapy in hospitalized children.
Main Methods:
- A double-blind, placebo-controlled, crossover design was employed.
- Medications included methylphenidate, desipramine, their combination, and placebo.
- Side effects, electrocardiograms (EKGs), pulse, and blood pressure were monitored regularly.
Main Results:
- Combined methylphenidate and desipramine treatment led to significantly more frequent side effects, such as nausea, dry mouth, and tremor, compared to monotherapy or placebo.
- Increased ventricular heart rate was observed with combination therapy.
- Desipramine monotherapy was associated with a prolonged PR interval and higher heart rate compared to baseline.
Conclusions:
- Combination therapy with methylphenidate and desipramine resulted in a higher incidence of side effects in children.
- The observed side effects during combined treatment were clinically similar in nature and severity to those associated with desipramine monotherapy.
Objective:
To investigate side effects of methylphenidate and desipramine alone and in combination in hospitalized children with symptoms of attention-deficit hyperactivity disorder and depression.
Method:
A double-blind placebo controlled crossover design was used to investigate each medication alone and in combination. Side effect ratings and EKGs were done weekly. Pulse and blood pressure were monitored daily.
Results:
Nausea, dry mouth, and tremor were present in at least twice as many children on combined methylphenidate and desipramine compared with any other condition. Nausea/vomiting, headaches, other aches, refusal of food, and feeling "tired" were significantly more frequent during the combined methylphenidate plus desipramine condition when compared with either methylphenidate alone or with baseline. Significantly higher ventricular heart rate was found on combined methylphenidate plus desipramine compared with desipramine alone, methylphenidate alone, and baseline. Prolonged PR interval and significantly higher heart rate occurred during desipramine alone compared with baseline.
Conclusions:
During the several-month duration of the study, there were more frequent side effects during combined methylphenidate plus desipramine treatment than with either medication alone. Clinically, side effects present during combined medication appeared to be similar to and no more serious than those associated with desipramine alone.