Methylphenidate side effects in advanced cancer: a retrospective analysis.
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.
Lasheen
Wael
W
Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, OH 44195, USA.
Walsh
Declan
D
Mahmoud
Fade
F
Davis
Mellar P
MP
Rivera
Nilo
N
Khoshknabi
Dilara Seyidova
DS
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
D000697:Central Nervous System Stimulants; D008774:Methylphenidate