title: Methylphenidate side effects in advanced cancer: a retrospective analysis.
abstract: BACKGROUND
  Methylphenidate (MP) is often recommended for symptom control in advanced cancer. Little is known about its side effects in frail adults.
  
  
  OBJECTIVE
  To evaluate MP-associated symptoms or side effects (S/E).
  
  
  METHODS
  Data was collected from 2 published prospective cohort series and a phase 2 study of MP for symptom control in advanced cancer. All 3 reports had identical dosing schedules and symptom assessments. Initial MP doses were 10 mg/d (5 mg at 8 AM and at 12 noon) titrated up to a maximum of 30 mg/d. Depression, fatigue, and symptoms identified as possible MP S/E were evaluated for presence (prevalence) and for severity (using categorical scales) before MP (day 0) and on days 3, 5, and 7 thereafter. The categorical scale used was none, mild, moderate, and severe.
  
  
  RESULTS
  62 patients were enrolled. Fifty completed 7 days of MP with a median age of 69 (range 30-90) years. Thirty-five received MP 10 mg/day. Most (96%) had improvement in depression and/or fatigue. Among the 62 patients, new symptom prevalence throughout the study was agitation (16%), insomnia (16%), dry mouth (15%), nausea (10%), tremors (6%), anorexia (5%), headache (3%), palpitations (2%), and vomiting (2%). Patients could have more than 1 symptom simultaneously. Seven (11%) withdrew due to MP S/E. Some symptoms present before MP showed significant improvement during MP therapy.
  
  
  CONCLUSIONS
  (1) Treatment with MP (10-20 mg/d) in advanced cancer is well tolerated. (2) S/E symptoms with MP appeared to improve spontaneously despite continued MP therapy. (3) Depression and fatigue improved at doses lower than those recommended in other clinical conditions. (4) MP improved depression and fatigue, and some secondary symptoms associated with them. Methylphenidate (MP) appears safe when used in the treatment of depression and fatigue in advanced cancer.
authors.affiliation: Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, OH 44195, USA.
authors.forename: Wael
authors.initials: W
authors.lastname: Lasheen
authors.forename: Declan
authors.initials: D
authors.lastname: Walsh
authors.forename: Fade
authors.initials: F
authors.lastname: Mahmoud
authors.forename: Mellar P
authors.initials: MP
authors.lastname: Davis
authors.forename: Nilo
authors.initials: N
authors.lastname: Rivera
authors.forename: Dilara Seyidova
authors.initials: DS
authors.lastname: Khoshknabi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017109:Akathisia, Drug-Induced / Q000209:etiology; D000855:Anorexia / Q000139:chemically induced; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D003863:Depression / Q000188:drug therapy* / Q000209:etiology; D004244:Dizziness / Q000139:chemically induced; D004305:Dose-Response Relationship, Drug; D005221:Fatigue / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006261:Headache / Q000139:chemically induced; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000009:adverse effects*; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D009369:Neoplasms / Q000150:complications*; D012189:Retrospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000139:chemically induced; D014202:Tremor / Q000139:chemically induced; D014839:Vomiting / Q000139:chemically induced
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate