Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. 226-233 (doi:10.1542/peds.2008-1855)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Google Scholar
Right arrow Articles by Conklin, H. M.
Right arrow Articles by Khan, R. B.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Conklin, H. M.
Right arrow Articles by Khan, R. B.
Related Collections
Right arrow Tumors
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

ARTICLE

Side Effects of Methylphenidate in Childhood Cancer Survivors: A Randomized Placebo-Controlled Trial

Heather M. Conklin, PhDa, Joanne Lawford, PhDa, Bruce W. Jasper, PhDa, E. Brannon Morris, MDb, Scott C. Howard, MDc, Susan W. Ogg, RN, MSNa, Shengjie Wu, MSd, Xiaoping Xiong, PhDd and Raja B. Khan, MDe

a Divisions of Behavioral Medicine
b Neurology
c Departments of Oncology
d Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee
e Department of Neurology, University of Tennessee, Memphis, Tennessee

OBJECTIVES: To investigate the frequency and severity of side effects of methylphenidate among childhood survivors of acute lymphoblastic leukemia and brain tumors and identify predictors of higher adverse effect levels.

METHODS: Childhood cancer survivors (N = 103) identified as having attention and learning problems completed a randomized, double-blind, 3-week, home-crossover trial of placebo, low-dose methylphenidate (0.3 mg/kg; 10 mg twice daily maximum) and moderate-dose methylphenidate (0.6 mg/kg; 20 mg twice daily maximum). Caregivers completed the Barkley Side Effects Rating Scale (SERS) at baseline and each week during the medication trial. Siblings of cancer survivors (N = 49) were recruited as a healthy comparison group.

RESULTS: There was a significantly higher number and severity of symptoms endorsed on the SERS when patients were taking moderate dose compared with placebo or low dose, but not low dose compared with placebo. The number of side effects endorsed on the SERS was significantly lower during all 3 home-crossover weeks (placebo, low dose, moderate dose) when compared with baseline symptom scores. The severity of side effects was also significantly lower, compared with baseline screening, during placebo and low-dose weeks but not moderate-dose weeks. Both the number and severity of symptoms endorsed at baseline were significantly higher for patients compared with siblings. Female gender and lower IQ were associated with higher adverse effect levels.

CONCLUSIONS: Methylphenidate is generally well tolerated by childhood cancer survivors. There is a subgroup at increased risk for side effects that may need to be closely monitored or prescribed a lower medication dose. The seemingly paradoxical findings of increased "side effects" at baseline must be considered when monitoring side effects and designing clinical trials.

Key Words: leukemia • brain tumor • methylphenidate • stimulant • side effects

Abbreviations: ADHD—attention-deficit/hyperactivity disorder • ALL—acute lymphoblastic leukemia • BT—brain tumor • CNS—central nervous system • LD—low dose • MD—moderate dose • SERS—Barkley Side Effects Rating Scale

Accepted Nov 10, 2008.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?