Talk:Methylphenidate

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Long term effects & Psychosis[edit]

If psychosis is not a likely long term effect, it should not be in the long term effects section. This is misleading. — Preceding unsigned comment added by 168.18.83.47 (talk) 06:56, 8 November 2013 (UTC)

Recent NYT source[edit]

I found a recent NYT source about this:

WhisperToMe (talk) 11:39, 31 January 2012 (UTC)

Proper Labeling of Non-credentialed Critics[edit]

Neither Neil Bush nor Gary Null has any medical credentials of any kind. Their inclusion is puzzling. Bush could rightfully claim a place in an article about his famous relatives but has no other qualifications. Any other fame he has arises from various accusations of misdeeds chronicled in his Wikipedia entry, including the S&L Crisis, improper government grants from a program initiated by his brother as US President, and insider trading.

Gary Null, on the other hand, is a self-styled alternative health guru who has been widely deemed as a crackpot by the medical establishment and mainstream media as can be seen on the Wikipedia page covering him. He has even denounced his own products and insisted that there is no proof for the link between HIV and AIDS.

Wouldn't it make more sense to have a paragraph stating the following?

Some celebrities have drawn attention by criticizing Ritalin, such as Neil Bush and Gary Null. These criticisms have not been addressed in medical literature.

Then, after this paragraph, there could be links to relevant articles. This approach would prevent the mistaken perception that these people are part of any instrumental public debate, while not directly addressing the issue of whether they are dangerous publicity hounds or sincere laypeople.

76.226.73.229 (talk) 21:39, 5 February 2012 (UTC)

I agree and I have deleted text regarding Gary Null and trimmed the Neil Bush text down to a single sentence. Let me know what you think. Thanks.--Literaturegeek | T@1k? 22:06, 5 February 2012 (UTC)
Symbol support vote.svg Alfie↑↓© 10:34, 6 February 2012 (UTC)

"Similar to heroin" Stop the false claims using false citations.[edit]

"The abuse pattern of methylphenidate is very similar to heroin and amphetamines"

Really? Reread page 407 of your cited source. It doesn't say it has an abuse potential similar to heroin. Yet this baseless claim occurs twice in the methylphenidate entry.

What it says is:

"Methylphenidate also has potential for abuse, and the abuse pattern is very similar to cocaine and amphetamines."

That comment itself cites:

Breggin P, Breggin G. The hazards of treating ADHD with Ritalin. J Coll Stud Psychother 1995;10:55-72. http://www.breggin.com/index.php?option=com_content&task=view&id=123

The closest Breggin comes to comparing methylphenidate to heroin is:

"The Food and Drug Administration (FDA) classifies methylphenidate in a high-addiction category, Schedule II, which also includes amphetamines, morphine, opium, and barbiturates."

But there's a difference between abuse potential and abuse patterns. (Regardless, not even your source's source mentions heroin, which BTW is Schedule I.)

Aside from this outright dishonesty, the methylphenidate entry is again being loaded down against methylphenidate. Statements are made as dire and shocking as possible and repeated. Every potential side effect is listed and detailed in ways you never see for other drugs whose side effects are more common. It clearly resorts to fear mongering.

The logical thing to consider, if this gets more lopsided again, like before re contraversies, is to create completely new entries for, say, the unabridged listing of side effects and abuse potential of methylphenidate.

For now I'm removing this heroin comment leaving the amphetamine part. Please don't reenter the false heroin statement again. You've been warned.

Box73 (talk) 11:59, 11 February 2012 (UTC)

I know this is from months ago, but you have no right saying "You've been warned." Wikipedia isn't an autocracy where you can tell others what to do and intimidate through comments such as that. In the future, just state your disagreement in a pleasant manner. C6541 (TC) 18:17, 29 August 2012 (UTC)
Likewise, time wise... Forgive my reaction but if an editor continues to repost copy equating Ritalin to heroin, then just passively accept that it might continue to happen? Let me repeat that he/she reposted the "Ritalin is like heroin" comments in the article text, which amounts to baseless fear mongering. How often have you read through the credible looking pseudoscientific references? I did in this case and it takes time. Others don't, but given a citation, accept it as true. It's the stuff of antipsychiatry and intelligent design and many other flavors of nonsense.
In the future please try to first appreciate the overall situation and understand an allusion ("you've been warned") re reporting an editor for such behavior. (Here's another rather autocratic sounding intimidating phrase: "Content that violates any copyrights will be deleted.")
Wikipedia isn't an autocracy but there is authority or else there will anarchy. I appreciate what you're saying about being cordial but appreciate what I'm complaining about.
Box73 (talk) 23:56, 8 April 2014 (UTC)

Euphoria an "adverse effect"?[edit]

On the list of adverse side-effects, euphoria is listed as one of them. While some people (especially drug prohibitionists) would consider euphoria as an "adverse effect", describing it as such is an oxymoron. While euphoria may be followed by dysphoria or other unpleasant symptoms, the euphoria itself cannot be adverse, as part of the word means "well." I doubt any patient taking it for a medical condition (even if they abhor taking drugs to get high) would claim the possible euphoria induced with the drug is as bad as some of the other entries on the list. The only thing I recommend is that "euphoria" be removed from that list, as it is very confusing. Eridani (talk) 17:33, 20 February 2012 (UTC)

It may seem odd from a rational perspective, but those that conduct clinical trials on pharmaceuticals consider euphoria to be an adverse effect. I believe that this is because it can prevent the drug from being a safe and effective treatment. Google will find you a bunch of examples of this, but here's one:
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/EndocrinologicandMetabolicDrugsAdvisoryCommittee/UCM292317.pdf
-Exercisephys
As a clinical outcome, euphoria is an unwanted side effect in a drug intended for long-term. You're right that euphoria itself is not adverse but its presence can encourage abuse of the medication. An expectation of euphoria can lead the patient to believe that the drug in losing its effect when the euphoria is not present, as will be the case with rising tolerance.
Methylphenidate can have some mood-lifting benefit for ADHD patients with co-mordbid depression however the aim there is to return the patient to the normal range rather than push them into the positive. That's not to say that patients are not to feel good but, as is the case with healthy, unmedicated people, these feelings, especially euphoria, should come as a response to events and improvements in their life and outlook rather than the medication. 92.24.205.0 (talk) 10:55, 25 July 2014 (UTC)

Deletion of comment about "piperidine class"[edit]

I deleted the statement that methylphenidate belongs to the piperidine class of compounds because there really is no such thing, unless one is referring to simple alkyl-substituted piperidines like coniine. The presence of the phenyl ring and the carbomethoxy group in the structure of methylphenidate are just as important as the piperidine ring, and one could as easily (and equally meaninglessly) say that methylphenidate belonged to the "phenylacetate" class. More importantly, though, the structural parallels between cocaine and methylphenidate should not be over-emphasized: what happens to the pharmacological properties of methylphenidate if you add a methyl group to the nitrogen (increasing the similarity to cocaine)? What happens to the properties of cocaine if you substitute a piperidine ring for the tropane ring-system? Unless you can answer these questions, then pointing out these similarities in structure is not useful, as it has no predictive value. I might add in passing that meperidine also contains a piperidine ring and a phenylacetate moiety. Does this mean that meperidine shares pharmacological/clinical properties with cocaine and methylphenidate? Sure, they're all CNS-active drugs.Xprofj (talk) 00:07, 1 July 2012 (UTC)

Having done a bit more reading, I have to modify my own comments, above. Apparently, if you make certain piperidine analogs of cocaine, you still have significant DAT activity (even if there isn't much locomotor action). See: A. Kozikowski et al. (1998) J. Med. Chem. 41 1962-1969. I haven't followed up this now 14 year-old paper, so some clinical pharmacology may have been done on the compounds since it was published.Xprofj (talk) 17:09, 1 July 2012 (UTC)

I don't really have much to comment about the other stuff, but pethidine has pharmacological similarities to cocaine, they are both DNRIs (granted cocaine has affinity for serotonin too) and pethidine fully substitutes for cocaine. C6541 (TC) 19:18, 1 July 2012 (UTC)

Bioequivalence of Concerta and Teva-methylphenidate ER-C (Canadian generic)[edit]

I have just edited one section that stated Concerta is bioequivalent to Teva-methylphenidate ER-C. This is actually not the case, as their delivery mechanisms are not even remotely close to each other. Some governments (notably the province of Ontario) consider them to be interchangeable, but that is based on a requirement that the release of the active ingredient falls within 80-125% of the original drug over time. Under this definitition, even the original Ritalin SR could be considered equivalent to Concerta. Bottom line is, people in provinces that allow substitutions between these two drugs need to be very careful. Personally, I switched to the generic for a month last year, and it was probably the worst I've ever been since I started taking medication for my ADHD at about age 7. — Preceding unsigned comment added by 137.186.43.205 (talk) 06:25, 20 November 2012 (UTC)

This blog is reliable because it is written by a respected, practicing psychiatrist in Oakville, Ontario (the homepage for his practice is available at http://www.drhandelman.com/). — Preceding unsigned comment added by 137.186.43.205 (talk) 08:51, 20 November 2012 (UTC)

At the very least, I don't think the page should definitively state that the drugs are equivalent, when every province but Ontario does not consider them as such in their provincial forumlaries. — Preceding unsigned comment added by 137.186.43.205 (talk) 09:00, 20 November 2012 (UTC)

Overhaul[edit]

My edit (difference in revisions)
My edit (as oldid)

Okay this article was getting way too long and large (in data size) and was very messy reading. Some of the problems I noticed:

  1. The lede was way too long, it shouldn't be any bigger than two paragraphs
  2. There was a lot of redundant information, for example I found a paragraph explaining methylphenidate's mode of action about 5 times repeated throughout the article
  3. The sections were not really organized well
  4. Paragraphs read like a giant block of text, they needed to be broken up. This is one of Wikipedia's biggest issues with pages like this
  5. A couple things read like an essay
  6. As aforementioned, the article was getting too long. 107,082 bytes is extremely large for an article, I cut it down to 88,175 bytes which is still large but it should be more manageable.
  7. Some parts seemed needlessly technical, remember to always strive for simplicity when explaining something.

Anyway I hope some others will look over my change and see what further needs to be done. I'd recommend against expanding the article again until issues are worked out with how the page reads, there is still a lot of room for improvement in prose and paragraph structuring. Best regards, C6541 (TalkContribs) 06:21, 28 November 2012 (UTC)

Legitimacy of source[edit]

How do people feel about this source?

"Attention deficit/hyperactivity disorder (ADHD) in children: rationale for its integrative management"

It's currently used in three places, but it's in an alternative medicine journal and seems biased. — Preceding unsigned comment added by Exercisephys (talkcontribs) 01:07, 2 December 2012 (UTC)

How is all alternative medicine treated in regards to Wikipedia:Identifying reliable sources (medicine)? In general I do not think AltMed stuff should be used for citations unless it is being used in reference to an actual alternative practice. With the one [39] citation which talks about how methylphenidate treatment should not be indefinite, well I think this is a common recommendation by doctors. C6541 (TalkContribs) 01:09, 3 December 2012 (UTC)

Weak Coverage of Neurobiology[edit]

The neurological effects of methylphenidate are discussed very briefly in this article in the subsection "ADHD and stimulant dynamics in general", and not with much clarity. I don't know enough about the subject in general to develop an accurate and concise description, but it's definitely needed. Here's one source to get the ball rolling:

http://www.ncbi.nlm.nih.gov/pubmed/21029780

Exercisephys (talk) 01:22, 2 December 2012 (UTC)

These things could use a total re-write, if I can get around to it I will. C6541 (TalkContribs) 01:10, 3 December 2012 (UTC)

Isomer - comment moved from image page[edit]

Hi all, I'm not a scientist but while looking at the image page for the skeletal diagram I found the following comment and decided to move it here where it could be addressed. It's been there since 2009! -

"This is an ISOMER of methylphenidate! The ACTUAL formula is the same molecular formula, only the double-bonded oxygen is over the benzyl group, and the methoxy group is directly above the nitrile group (like a mirror image of the top portion of the image already shown)."

Thanks, Lithoderm 22:47, 30 December 2012 (UTC)

Methylphenidate-stereoisomers 2D-skeletal.png
Hi Lithoderm! The comment at commons was made by an IP (as his/her only SCREAMING contribution to WP). Actually there are four steroisomers of MPH (to the right). In a simple skeleton formula (without specifying stereochemistry and conformation) it's irrelevant how the formula is drawn. BTW, even if stereochemistry is of concern, the double-bonded oxygen is never "over the benzyl group" (whatever that means). ;-) Alfie↑↓© 14:03, 1 January 2013 (UTC)

Restricted rotation analog (of methylphenidate)[edit]

Is there a name for the following substance?: http://pubs.acs.org/doi/abs/10.1021/jm061354p

Image:

Http://pubs.acs.org/appl/literatum/publisher/achs/journals/content/jmcmar/2007/jmcmar.2007.50.issue-11/jm061354p/production/images/medium/jm061354pn00001.gif

If so a page should be made on it. 24.20.95.50 (talk) 04:00, 15 January 2013 (UTC)

Rescheduled in the UK[edit]

As Class B. See http://webarchive.nationalarchives.gov.uk/+/http://www.homeoffice.gov.uk/drugs/drugs-law/Class-a-b-c/ I've updated the article accordingly but it doesn't seem to be linking to the page for Class B as it does with other articles, even though I appear to be doing exactly as they have done (they don't actually link the class B page (e.g. The page on Dextroamphetamine) 198.61.226.43 (talk) 10:57, 24 January 2013 (UTC)

Abreaction?![edit]

In subsection "Treatment emergent psychosis" it states, "Normally any abreaction will show within 3 hours.[74]" where the reference -- 74 -- is to a text on methylphenidate toxicity. Abreaction -- the psychodynamic cathartic phenomenon -- in the context a section on drug adverse reactions? Surely not? Did the editor mean "an adverse reaction" and foolishly assumed that 'abreaction' == 'adverse reaction'. Is using a dictionary that painful? 114.76.75.113 (talk) 08:15, 11 April 2013 (UTC)

Apologies[edit]

My apologies about the "Hydrochloride" addition, I was wrong. Well... it's called Methylphenidate Hydrochloride, but only in certain circumstances. Jakebarrington (talk) 12:14, 14 May 2013 (UTC)

No problem. ;-) All salts dissociate in solution and only the base (or acid of other drugs) permeate through membranes and reach the systemic circulation. That's why we have only the bases'/acids' CAS numbers etc. linked in the drugbox. Though currently all formulations of methylphenidate contain the hydrochloride, this may change in the future and is irrelevant from a pharmacological point of view. If a reader searches for methylphenidate hydrochloride she will end up here anyway (since we have a redirect in place). Alfie↑↓© 15:31, 19 May 2013 (UTC)

Certainly off-topic.[edit]

In the chapter of text called "substance dependence" the second part is describing some research done +5 years ago about possibly suitable agents to be used as replacement therapy for cocaine dependence. The text goes, as per my judgement, a bit astray when it goes on about researched substituted benztropine analogs which is of little intrest to anyone wanting information about methylphenidate. The text is also very difficult to read and too rich in insignificant details to be easily understood. This part should be scrubbed, heavily edited and/or moved to another page entirely ("cocaine" page?)

The first sentence of the second part of this text covers three rows of text, contains 60 words, and an impressive 6 ","-signs. Perhaps the author should stay away from the methylphenidate.

(excuse my poor english, iḿ Swedish).

"Ex.Ritalin"[edit]

Means "Example Ritalin"? Pubserv (talk) 19:39, 30 July 2013 (UTC)

Probably (was introduced by this edit without a summary). However, this is not consistent with drug articles in general. Removed. Alfie↑↓© 18:35, 31 July 2013 (UTC)

NRI mediated behavior[edit]

I don't see how the behavioral effects could be primarily mediated via noradrenaline reuptake inhibition when dopamine/phenethylamine are greatly affected by methylphenidate, along with effluxion in other neurotransmitter systems of the CNS (ex: acetylcholine, glutamate). Even ignoring the reductionist component, it's probably not true considering a large body of research indicates ADHD involves dopaminergic (technically, phenethylaminergic) hypofunction.

I'm leaving the text in for a few days, after which I'll delete it unless someone can find a recent secondary medical source. Seppi333 (talk) 06:55, 11 September 2013 (UTC)

Peripheral cortex?[edit]

In the introduction, it is stated that "ADHD and other similar conditions are believed to be linked to sub-performance of the dopamine, norepinephrine, and glutamate processes in the brain, primarily in the prefrontal cortex and peripheral cortex". What is the "peripheral cortex" of the brain? — Preceding unsigned comment added by 62.195.45.181 (talk) 08:30, 11 September 2013 (UTC)

Comparison to cocaine[edit]

I've censored the text relating mph to cocaine in the lead because they have distinct pharmacology and neuroplasticity-related effects. The comparison with cocaine also serves to relate its stigma with methylphenidate. This material could be explained just as well without any comparison to other drugs; if someone could rewrite this and then decensor it, the article quality would be better.Seppi333 (talk) 18:11, 6 October 2013 (UTC)

I agree that can can be a stigmatization tactic, but you have to remember that the two drugs are nearly indistinguishable pharmacologically. I may revert your censor because of how much vital information it removes. Exercisephys (talk) 19:19, 6 October 2013 (UTC)
The simplest reason I can think of for not making that comparison is that unlike cocaine, MPH isn't a topical anaesthetic. For pharmacological differences, as far as I know, mph doesn't modulate AMPA receptors during prolonged use like cocaine does. It's true that they both ultimately affect catecholamine neurotransmission via their mechanism of action, but that mechanism isn't the same for (but not limited to) the reasons I just mentioned. I'll probably just edit out the comparison myself now since I have time to do so.Seppi333 (talk) 20:53, 6 October 2013 (UTC)
Edit: I just realized I also unwittingly censored the entire medical uses section - that wasn't intentional. In any event, I've changed the relevant text and removed the censor.Seppi333 (talk) 21:07, 6 October 2013 (UTC)

Nikpapag edit[edit]

"Methylphenidate possesses some pharmacological similarities to cocaine. When injected intravenously, it has similar euphoria to that of both caffeine and cocaine but a much longer half life duration than cocaine.[1][2][3]"

Comments:

  • neuropsychiatryreviews.com Not a reliable source for medical content, please see WP:MEDRS
  • http://learn.genetics.utah.edu/content/addiction/issues/ritalin.html Not a reliable source
  • Psychiatric nursing: contemporary practice whilst this is potentially a reliable source, it doesn't contain anything about IV methylphenidate, or state any comparison with caffeine or cocaine. The sources must support the content you enter, otherwise it is basically wp:Vandalism. If you continue to add medical content which is based on unreliable sources, or sources which do not support the content, you will get banned. Lesion (talk) 10:53, 8 October 2013 (UTC)
The utah.edu page seems like a perfectly acceptable tertiary source, though perhaps a little less informative and neutral than is desirable. The NpsychReview page appears to be down to me, and the Contemporary nursing book does not appear to support the claim.
"Methylphenidate possesses some pharmacological similarities to cocaine[2]
Would be quite acceptable to me for inclusion within the article. The comment about half life could easily be cited elsewhere. The comments about IV use should be supported, especially regarding caffeine.Testem (talk) 12:02, 8 October 2013 (UTC)
  • Rm these sources from the lead, where it is especially important to have reliable sources. Whether peripheral cortex is supported or not by the emedicine source I can't comment on, because I can't access it. Can someone verify this please. Nikpapag, you appear to have a loose interpretation of how sources can be used to support content, so I am questioning when you say that it is not supported by the source. Lesion (talk) 11:46, 8 October 2013 (UTC)

Neuropsych reviews is a dead link, but the same source can be found on google ([1]). It is personal opinion, unreferenced, self published. Neuropsychiatry reviews is not a PubMed listed journal. Secondary sources listed on Pubmed or textbooks required for MEDRS imo. For the same reasons, I also think the utah.edu page is not suitable: no references, not a publication in a peer review journal ... and someone previously agreed with me because it was already tagged with unreliable medical source. The textbook does not mention IV administration, or compare half life with cocaine or caffeine. Something went wrong at some point there, and the sources might have got confused. Feel free to add the content "Methylphenidate possesses some pharmacological similarities to cocaine[2]" back in, but I would encourage you to tag the source for eventual replacement with a MEDRS source, especially if it is to go in the lead section. Lesion (talk) 12:50, 8 October 2013 (UTC)

I concur Testem (talk) 12:55, 8 October 2013 (UTC)

Regarding the wikilinking, The old content was:

"concentration/executive functions of reasoning"

Being changed to:

"concentration/[[executive functions]] of [[verbal reasoning|reasoning]]"

This might be WP:Original research, when interpreting "reasoning" as verbal reasoning. Lesion (talk) 12:59, 8 October 2013 (UTC)

I definitely agree that http://learn.genetics.utah.edu/content/addiction/issues/ritalin.html is an unreliable source - the comparison between cocaine and ritalin is based upon chemical structure and drug class, even though every substance in this list is structurally similar to ritalin (cocaine isn't on this list btw) and the vast majority have DA-reuptake effects "like cocaine" (or rather, like any other drug in the enormous classes with DA-reuptake inhibitory effects (DRI, DNRI, SDNRI, etc).Seppi333 (talk) 17:09, 8 October 2013 (UTC)

References

  1. ^ Peter Doskoch (2002). "Why isn't methylphenidate more addictive?". NeuroPsychiatry Rev. 3 (1): 19. Archived from the original on 2009-03-30. 
  2. ^ a b c "Ritalin & Cocaine: The Connection and the Controversy". Learn.genetics.utah.edu. Retrieved on 2011-10-16.[unreliable medical source?]
  3. ^ Mary Ann Boyd (2005). Psychiatric nursing: contemporary practice. Lippincott Williams & Wilkins. pp. 160–. ISBN 978-0-7817-4916-9. Retrieved 30 April 2011. 

Neuropharmacology[edit]

To explain why cocaine is markedly pharmacologically distinct from virtually all (if not all) substituted phenethylamines, and consequently why a cocaine vs methylphenidate comparison is moot and highly misleading to the general readership:

This was published by The lancet
Cocaine is a nonspecific voltage gated sodium channel blocker. This explains why it is an anaesthetic, as Nav1.7, Nav1.8 and Nav1.9 are involved in cellular communication of nociception. Specifically, hypo-functional sodium channelopathies of Nav1.7 result in reduced pain sensation - and blocking this channel is how cocaine produces anaesthesia. However, because it is a nonspecific sodium channel blocker, it blocks Nav1.1 through Nav1.6 as well. Consequently, in high doses, it possesses the effects of tetrodotoxin, in addition to other channelopathy-related symptoms, and can lead to sudden cardiac death from channelopathy of Nav1.5. In contrast, amphetamine, methylphenidate, and even methamphetamine do not affect sodium channels, and so cocaine in high doses closely resembles tetrodotoxin and other lethal voltage-gated sodium channel neurotoxins, rather than pure CNS stimulants (like methylphenidate+amphetamine).
So to repeat that, blockade of Nav1.5 is precisely what makes cocaine so much more dangerous in high doses than any phenethylamine (that I know about) and the class of CNS stimulants in general.
The cardiac risks of cocaine have virtually nothing to do with its effects on catecholamines - as both amphetamine and mph are not associated with increased cardiac risks (UNLESS there is an underlying cardiac problem in the first place) - see amphetamine physical side effects if you want (three recent FDA) citations for that.
In light of that information, whoever wrote http://web.archive.org/web/20090330105926/http://www.neuropsychiatryreviews.com/feb02/adictive.html has no clue what they're writing about, as they wrote "From a pharmacological standpoint, methylphenidate is the drug that most resembles cocaine," which is false for the reasons I just gave on voltage-gated sodium channels (note that the pharmacokinetics are entirely different from cocaine, but the clinically relevant pharmacology argument is about pharmacodynamics).
Pictogram voting info.svg Note: If you want an external source for this information, see the CNS stimulant section and sodium channels/channelopathies section of this text:
Robert Malenka, Eric Nestler, Steven Hyman. Molecular Neuropharmacology : A Foundation for Clinical Neuroscience 2nd ed. New York: McGraw-Hill Medical, 2009. Print. ISBN 978-0-07-148127-4
or this wp:medrs - quality review: PMID 20573078 (full article at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856043/?report=classic)
Seppi333 (talk) 18:38, 8 October 2013 (UTC)

From the viewpoint of drug abuse or just medicating ADHD, nothing is more close to methylphenidate than cocaine. And it is unusually close. Meth is better than speed but its not as good and not so much alike. Whatever scientific reasons there are to invalidate that comparison, they are largely irrelevant to the aforementioned application if you are sane about it. As a person with ADHD and former drug addict, and all the many people of that kind I have spoken to, I made that conclusion merely by experience. And that is probably where the whole argument stems from. C0NPAQ (talk) 09:41, 18 February 2014 (UTC)

"nothing is more close to methylphenidate than cocaine [in terms of how it feels, for me]". What about ethylphenidate? Perhaps among common drugs you are correct, but this isn't entirely suprising given that cocaine and methylphenidate are the only two common DRIs. Regardless of how they make you feel, Seppi333 has made it clear why that's unimportant above. Testem (talk) 14:24, 18 February 2014 (UTC)
Cocaine, lidocaine, benzocaine, dibucaine, prilocaine, procaine, chloroprocaine, and analogous "-caine" suffixed alkaloids constitute a drug class. Last I checked, methylphenidate wasn't spelled methylphencaine. Seppi333 (Insert  | Maintained) 17:57, 18 February 2014 (UTC)

Bias[edit]

This article has become a bias nightmare in its discussion of methylphenidate's medical uses. I don't know who is responsible for this, but I would really appreciate some assistance in cleaning it up as I have very limited time. Thanks so much. Exercisephys (talk) 16:58, 15 October 2013 (UTC)

Aggression and Criminality - "indicate"[edit]

See this edit

I agree with the labeling of indicated but I don't think it's correct to say that "studies suggest that mph is indicated", as they are indicating it, rather than suggesting that it is indicated by someone else. Testem (talk) 10:24, 17 October 2013 (UTC)

Previous wording was confusing an IP enough to want to rephrase it. I still don't like the wording "newer studies" which sounds a bit wp:weasel (see also WP:RELTIME). As an aside, note that Lichenstein et al. appears to be a primary source (WP:MEDRS). Not sure it is appropriate to detail the results of a primary study, no matter how large. Lesion (talk) 10:50, 17 October 2013 (UTC)[1][2]
I get that but I don't think the current wording is representative. I think linkifying "indicated" should be enough to avoid someone thinking there is a typo, which is distinct from confusion about the meaning in my opinion. I don't have a problem with the use of a primary source in this case.Testem (talk) 12:14, 17 October 2013 (UTC)
Respectfully, I have tweaked the wording slightly again. I cannot explicitly express what was wrong with that sentence, but it did not roll off the tongue well. Revert if you wish, I don't feel strongly about this page. Lesion (talk) 15:46, 17 October 2013 (UTC)
Looks good to me, thanks for your help. Testem (talk) 16:14, 17 October 2013 (UTC)

References

  1. ^ Lichtenstein, Paul; Halldner, Linda; Zetterqvist, Johan; Sjölander, Arvid; Serlachius, Eva; Fazel, Seena; Långström, Niklas; Larsson, Henrik (22 November 2012). "Medication for Attention Deficit–Hyperactivity Disorder and Criminality". New England Journal of Medicine 367 (21): 2006–2014. doi:10.1056/NEJMoa1203241. 
  2. ^ Pappadopulos, E; Woolston, S; Chait, A; Perkins, M; Connor, DF; Jensen, PS (2006 Feb). "Pharmacotherapy of aggression in children and adolescents: efficacy and effect size.". Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent 15 (1): 27–39. PMID 18392193.  Check date values in: |date= (help)

Pictures[edit]

I'll probably get around to this at some point, but I'll post here as a reminder: Wikimedia has a lot of pictures that are relevant to this article, and we should insert some of them, consider how few there currently are. It would help alleviate the wall-o'-text that is the middle of this article. Exercisephys (talk) 19:46, 24 October 2013 (UTC)

Searches for methylphenidate, concerta and ritalin didn't reveal anything? Testem (talk) 19:58, 24 October 2013 (UTC)
Check the link at the bottom of the article. Exercisephys (talk) 21:10, 24 October 2013 (UTC)

Psychosis and Withdrawal - Tolerance section[edit]

I read the listed studies top to bottom and none of them said anything about Methylphenidate withdrawal causing psychosis. The specific section also mentions "rebound symptoms" can cause withdrawal. The first study listed only acknowledged the existence of rebound symptoms in one sentence. The other two studies never even referred to such a reaction.

Therefore, I have removed everything about Methylphenidate causing psychosis and other symptoms when withdrawaled from, or "rebounded" from. I believe Methylphenidate has withdrawal symptoms, however, the studies listed do not state what those are. The only symptoms that the studies mentioned where "possible side-effects of prolonged use."

I've left the information about Methylphenidate causing withdrawals, only due to the fact that Methylphendiate withdrawal is well documented. However, studies need to be cited. I would look myself, but I have other things to do at the moment. I will dedicate some time to doing so when I am able to.

For the sake of Wikipedia, don't make stuff up. It was very obvious that none of these studies mentioned what whoever wrote that section was trying to "prove". I monitor this article and specifically look for misconceptions. This was one of them. Unless you can cite two medical studies that both concluded Psychosis and the other symptoms mentioned could occur from Methylphenidate withdrawal/rebound causing them - this will always be removed.

Best regards SwampFox556 (talk) 00:15, 7 November 2013 (UTC)

EDIT:

Actually, I just noticed that the information provided in the "Tolerance" section is totally unnecessary. Withdrawal information with studies is cited a couple times throughout the article. I've just gone ahead and removed the entire section.

SwampFox556 (talk) 00:15, 7 November 2013 (UTC)

I think the information about tolerance is worthy of remaining in the article but the baby's been thrown out with the bathwater there. Testem (talk) 11:22, 7 November 2013 (UTC)
I actually thought that myself and I was planning on adding it back into the "adverse effects" section. However, it doesn't need to be it's own section. That's overkill and ultimately just confuses the reader.SwampFox556 (talk) 01:46, 9 November 2013 (UTC)

Great Drug Interaction Source[edit]

http://www.gjpsy.uni-goettingen.de/gjp-article-nevels.pdf

That's a really thorough source. I'll try to incorporate it if/when I have time. If anyone else does, I'd really appreciate the help.

Exercisephys (talk) 22:00, 22 November 2013 (UTC)

Uses#ADHD[edit]

This "A meta analysis of the literature concluded that methylphenidate quickly and effectively reduces the signs and symptoms of ADHD in children under the age of 18 in the short term but found that this conclusion may be biased due to the high number of low quality clinical trials in the literature." isn't cited; it should be fairly easy to cite. I think we should remove this sentence until it has been cited. Is this (http://www.cmaj.ca/content/165/11/1475.long) possibly the meta analysis mentioned? It mentions the publication bias ("We also detected a substantial amount of publication bias that, when used to adjust the estimates of efficacy, decreased the teacher- defined hyperactivity index estimate by 21%") and opens the interpretation section with "We have shown that short-acting methylphenidate quickly and efficaciously reduces most of the clinical manifestations of ADD in children aged 18 years and less".

It also ends with "To conclude, we found that short-acting methylphenidate was an effective short-term treatment option for children diagnosed with ADD. Yet, this finding may not be robust or completely valid." and "Finally, there is a lack of long-term randomized trial evidence. " Looking at these quotes, I think that this is the meta analysis.

77.99.153.47 (talk) 19:16, 13 February 2014 (UTC)

Should this article be semiprotected?[edit]

@Seppi333: @Boghog: Opinions? Amphetamine is, and this thing gets vandalized incessantly. Exercisephys (talk) 15:25, 10 March 2014 (UTC)

Yeah, it's pretty common and the attacks are by IP accounts so it does make sense. Testem (talk) 10:03, 11 March 2014 (UTC)
Thats more up to the reviewing admin than community consensus. Seppi333 (Insert  | Maintained) 14:16, 14 March 2014 (UTC)

dopamine neuron loss[edit]

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0033693

Someone with understanding of the subject may want to incorporate the above link into the article.

50.0.205.237 (talk) 22:59, 3 September 2014 (UTC)

It's a primary source involving rats, so we can't use it. It appears that neuron loss only occurred with huge overdoses (10mg/kg) in the rats though, so it's probably just dopamine autoxidation that damaged the neurons. Seppi333 (Insert  | Maintained) 23:42, 3 September 2014 (UTC)

Extra (unnecessary?)comments on IV abuse[edit]

There are three comments on IV use all citing the same study "injection (particularly arterial) has sometimes led to toxic necrosis and amputation at the point of injection" and "adding a cautionary note that serious or severe outcomes such as necrosis, abscess and amputation had occurred as a result of severe toxicity at the injection site in 3 cases of abuse via arterial injection" and "A Swiss study in 2011 also concurred, noting similar findings in several studies and national analyses in that country, but noted that these findings were potentially inapplicable to the few cases of abuse via crushed MPH injection, which was the sole situation where "serious" or "severe" local toxicity was observed, leading in their study to pain, necrosis and partial limb or digit amputation in two of 14 adult cases over 8 years (14%) who mistakenly injected arterially, and inguinal abscess and fever in one who injected intravenously.[64] I believe those are results of ANY substance injected as a recreational drug. These statement would be very fitting on an article on Addiction, IV Drug Abuse or such. But they seem rather extraneous and not encyclopedic on an article about methylphenidate, however. They seem more like cautionary warnings from someone with an agenda. Only two recorded cases? I respect that some sort of cautionary might be worthwhile and maybe morally correct, but does it really belong here? The tone seems wrong to me. Are there similar statements on other medications which are subject to rare IV abuse? Does the article really benefit from the story of a couple of abusers who "mistakenly injected arterially?" I'm not sure that's really encyclopedic information.

Tumacama (talk) 19:39, 10 September 2014 (UTC)

Agree. Perhaps sweep them into a section along the lines of "like most drugs, methylphenidate can cause complications with improper intravenous use." Testem (talk) 17:24, 16 September 2014 (UTC)

Reversion of constructive edit[edit]

@Materialscientist: Regarding this reversion, I do not think it should have been marked as minor because it was not vandalism and was made in good faith. I am not even certain it should have been reverted at all. Testem (talk) 12:45, 5 December 2014 (UTC)

Given the text formatting, that looks like a WP:COPYANDPASTE copyright violation from published journal article; that's probably why he marked it as minor. Seppi333 (Insert  | Maintained) 19:16, 5 December 2014 (UTC)

We have a dexmethylphenidate page, but why not a subsection about the active isomers?[edit]

Which, for instance, is the most commonly used isomer in 'scripts? I know R-R-methylphenidate is the most active (or am I mistaken?) but that S-R-, & S-S-methylphenidate are also active. Can't the Ki values of these differing isomers at least be given on this page or the dex-methylphenidate page? 66.96.79.221 (talk) 23:52, 27 January 2015 (UTC)

IUPAC synonyms.[edit]

alpha-Phenyl-2-piperidineacetic acid methyl ester
Methyl alpha-phenyl-alpha-(2-piperidyl)acetate
Methyl alpha-phenyl-alpha-2-piperidinylacetate

All work in chemicalize.org, but in the first one the nitrogen is off. I found them here. Nagelfar (talk) 23:23, 21 March 2015 (UTC)

Restructuring[edit]

This article would do well to use/cite the current drug label of any type of FDA-approved methylphenidate prescribing information (e.g., [1]) for medical information on adverse effects, overdose, and medical uses. Same goes for the INCHEM entry on methylphenidate (this: [2])

@Doc James: This article needed a lot of work. It still has some issues, but I'm wondering what you thought about:

Seppi333 (Insert ) 03:15, 23 June 2015 (UTC)

    • Some discussion of overdose would be useful.
    • As the first drug in this class there is more controversy surrounding it than others. Sort of like the Prozac case. Thus do not see an issue with having it covered here in brief and then linking to ADHD controversies. Doc James (talk · contribs · email) 07:13, 23 June 2015 (UTC)

K, ill cut the template. ty for taking a look.
What did you have in mind for overdose in particular? Not really sure what to add to it. Seppi333 (Insert ) 07:35, 23 June 2015 (UTC)

Additional comments[edit]

Thank you Seppi333 for your edits, great stuff, way better implementation of WP:BOLD than I'd have dared to do. Also, quick question -- can someone clearly explain the whole med name bolding stuff to me? I'd love to strip out the bold on at least a few specific articles, but I thought it was always considered justified, and the documentation out there on that really sucks.

So I tore apart and rebuilt the adverse events section. I feel like the previous one was complete garbage, potentially approaching the level of propaganda (the list was really really really bad). I used Wikipedia:WikiProject_Pharmacology/Style_guide and a number of major drug articles in order to determine how to best handle the adverse event data. It's a bit rough and scattered, especially with the last three paragraphs just getting thrown there from the previous text, but I think that I managed to communicate side effects in a way that is much more useful and accurate. I spent a lot of time reviewing data from multiple sources in order to ensure accuracy. (edit: I don't think basing things solely off of monographs is a good idea, multiple sources were invaluable here. Garzfoth (talk) 15:08, 23 June 2015 (UTC))

I may have accidentally screwed up with a few side effects that commonly appear at similar rates in both methylphenidate and placebo groups. Trying to handle that with multiple data sources was obviously a nightmare. Headache is the primary example -- you see a lot of headaches in the active drug groups, but the placebo groups are also getting lots of headaches. In general, most trials seem to have nowhere near statistically significant differences in headache rate between the two groups. The part I'm not sure how to handle is if you can seriously say "headache is a commonly observed potential adverse event" when it's no different from a sugar pill. Even if we say headache rate alone is significant, we're comparing against placebo, what's the headache rate in a population receiving no treatment? The end conclusion I reached is that because we can't show an increase, we can't assume that the headache rate is a unique medication-specific adverse event at all irregardless of how frequently it occurs. If it's a universal placebo effect, then it will happen with all meds, so who cares! What's the headache rate in ADHD patients anyways? Anyways, I just want to double check that my logic is sound here. It actually puts some insignificant side effects in a different light when you realize that they aren't driven by the med... I think the end result is sound, but it could be flawed.

I'm not quite sure how to deal with the "Uses" section, I'm not quite ready to start tearing that apart like I did with the adverse events section, but it seems to really...suck. It's scattered, packed with information that may be better placed elsewhere (or even not on the page at all), "Aggression and criminality" is inexplicably a separate subsection when it belongs under the ADHD subsection, the "Narcolepsy" subsection really sucks, "Other" is unclear and scattered, and I'm not sure that "Performance-enhancing" should have been laid out like that. I may end up changing some limited stuff and improving the "Narcolepsy" subsection, but I'm not sure what to do about the rest. Thoughts? Garzfoth (talk) 15:04, 23 June 2015 (UTC)

If there's any reason to doubt a side effect is caused by a medication (based upon clinical trial data and/or reasonable justification), it's generally okay to remove something like that. Monographs are a good place to start because they're sets of aggregated data; however, I agree that there's a need to "fine-tune" this information with higher quality sources like current medical reviews, when available.
Several statements and/or sections were imported from the amphetamine article a while back. Some related content seems to have been added around the imported sections since then. In general, if something seems completely tangential to methylphenidate or too technical, removing it should be fine.
I'll look through the article again a little later though; I didn't have enough time to go through the whole thing yesterday. Fixing the overdose section, removing the excessive number of references to the term "abuse", and adequately covering its involvement in an addiction were the main issues I was focused on addressing. Seppi333 (Insert ) 22:50, 23 June 2015 (UTC)
Forgot to add: anything that isn't cited by a WP:MEDRS-quality source – i.e., a fairly recent (~5-10 years) medical literature review or academic/professional medical textbook – can and usually should be deleted if it cites a medical claim, although sometimes it's worth looking for a better source to use to cite a statement. Bolding is covered by the manual of style under MOS:BOLD. Seppi333 (Insert ) 23:16, 23 June 2015 (UTC)
Thanks! The bold info is good to know, I was unhappy about how horrible it looked but didn't think I could touch it. Fine-tuning information and sticking to literature reviews can be difficult for some subjects, actually it can be difficult for a lot of them. I understand and support the intent behind it, but I feel it doesn't really apply universally, and is quite situational. It just worries me a bit not to know if I've stepped over that line. I'm a bit perfectionistic, so things like this are annoying to deal with. Did I overstep with my rewrite? Am I being misleading in some way? Did I leave out too much, or put too much in? Are my sources actually good enough? What benefit does this list serve, and is it addressing it better now? It can just be unclear where to go with Wikipedia's rules on content being complex and varied, especially when existing content can be so horrible (previous adverse effects list for example!), but persist so long... In general I'm finding myself very frustrated with articles like this, this is a huge site, we need to be providing neutral, accurate, detailed, and clear information... But we're falling short of that, and nobody steps up to fix it because it's "good enough". I'm getting off track here. Thanks again! Garzfoth (talk) 09:26, 25 June 2015 (UTC)

Section references[edit]

References

  1. ^ Noven Pharmaceuticals, Inc. (17 April 2015). "Daytrana Prescribing Information" (PDF). United States Food and Drug Administration. pp. 1–33. Retrieved 23 June 2015. 
  2. ^ Heedes G, Ailakis J. "Methylphenidate hydrochloride (PIM 344)". INCHEM. International Programme on Chemical Safety. Retrieved 23 June 2015. 

On the issue of capitalizing "pms"[edit]

This refers to the following edits:

The issue at hand is that Unforgettableid believes that the drug name should be "PMS-Methylphenidate ER" instead of the "pms-Methylphenidate ER" previously used.

The term pms stands for Pharmascience, a major generic drug manufacturer in Canada. Across a wide variety of mediums, drugs from Pharmascience have been consistently stylized as "pms-drugname" rather than "Pms-drugname" or "PMS-drugname". A wide number of generic drugs across numerous manfacturers in Canada use the naming system of "shortname-drugname", with the "shortname" conforming to a certain consistent style of capitalization that is rarely formatted in all-caps. Apotex uses "Apo", Novopharm uses "Novo", Pharmel uses "phl", Pharmascience uses "pms", Mylan uses "Mylan" or sometimes "Myl", NT Pharma uses "NTP", Teva uses "Teva", JAMP Pharma uses "Jamp", Pro Doc uses "Pro" or omits the "shortname-" part entirely, Riva uses "Riva", Ratiopharm uses "ratio", Ranbaxy uses "Ran", GenMed uses "GD", and there are a ton more examples not covered here. There are exceptions, but not enough to claim that this is not the universally accepted method in widespread use (and the most common exception is just replacing the dash with a space).

My point with this list is to illustrate that the capitalization is something that each generic company defines as they wish, and that this capitalization standard is adhered to across a broad variety of uses irregardless of generic or context, with the exception of certain places that capitalize everything (as in PMS-METHYLPHENIDATE, not PMS-Methylphenidate, and even then this may still be somewhat improper usage). This demonstrates that "this is a style already in widespread use" or "is done universally by sources", which means that MOS:TMRULES says this is the proper way to use the names (as far as I am aware the entire "Trademarks that begin with a lowercase letter" section should not apply here given that these are shorthand names used to identify and differentiate between different company-specific generics and not normal english usage).

So, in short, following those guidelines, we should adhere to the correct naming stylization standards defined by the manufacturer. For most Canadian drugs, these naming stylization standards can be easily found in the list of pharmaceuticals published by the RAMQ, and can be easily verified elsewhere if necessary. Garzfoth (talk) 22:44, 30 July 2015 (UTC)