Findings from a new Cochrane Review caution clinicians to weigh the benefits and risks more carefully when prescribing methylphenidate.

A team of Cochrane researchers conducted a comprehensive assessment on all available randomized trials data of methylphenidate used to treat attention deficit hyperactivity disorder (ADHD). Methylphenidate is marketed as the brand name Ritalin, Concerta, Medikinet, Equasym, and others. The Review included findings from 185 randomized-controlled trials involving over 12,000 children or adolescents aged 3–18 years. All studies compared methylphenidate with either a placebo or no intervention. 

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Combined data showed methylphenidate resulted in modest improvements in teacher-reported ADHD symptoms, teacher-reported general behavior, and parent-reported quality of life. In addition, children were more likely to have sleep problems and loss of appetite during treatment with methylphenidate. 

Researchers attributed their low level of confidence in the results to incomplete reporting of results for many of the trials and variation among the results. Also, they noted the possibility for people involved in the trials to have been aware of which treatment the children were taking. 

“This review highlights the need for long-term, large, better-quality randomized trials so that we can determine the average effect of this drug more reliably,” concluded Professor Ole Jakob Storebø, Clinical Psychologist from the Psychiatric Research Unit in Region Zealand, Denmark. Clinicians are urged to consider the poor quality of evidence, monitor outcomes carefully and weigh the benefits and adverse effects. Researchers also added that clinicians and families should not rush in stopping treatment with methylphenidate if the child has experienced clinical benefits without the adverse effects. 

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