title: Severe toxicity due to injected but not oral or nasal abuse of methylphenidate tablets.
abstract: BACKGROUND
  Non-medical use of methylphenidate is increasing. Little is known about potential acute medical complications associated with recreational use of methylphenidate.
  
  
  OBJECTIVE
  To identify medical problems associated with methylphenidate abuse.
  
  
  METHODS
  Retrospective case series of methylphenidate abuse cases presenting to an inner city emergency department.
  
  
  RESULTS
  We identified 14 cases of methylphenidate abuse between 2003 and 2010. Ten of these patients abused methylphenidate alone while four co-ingested other drugs, mainly alcohol. The route of ingestion was oral in nine patients, nasal in one and intravascular in four. Severe toxicity was exclusively observed in users who injected the drug. Two cases involved accidental intra-arterial injection and resulted in tissue necrosis leading to the amputation of a forearm and of fingertips, respectively. Clinical findings in the non-serious cases included mild to moderate symptoms and signs of sympathetic nervous stimulation such as agitation, tachycardia, hypertension, anxiety, hallucination, headache, tremor and dizziness. Nine of the fourteen patients were taking methylphenidate as a prescribed drug. Eight patients were former or current multiple substance abusers.
  
  
  CONCLUSIONS
  Methylphenidate misuse is not a significant burden for emergency departments in Switzerland. Oral and nasal administration of methylphenidate did not result in severe toxicity. However, injection of crushed methylphenidate pills lead to serious local toxicity. Most patients with methylphenidate abuse had a prescription for the drug indicating deviation from medical use. A history of multiple substance use may be a risk factor for non-medical use of methylphenidate.
authors: Division of Clinical Pharmacology & Toxicology, Department of Biomedicine and Department of Internal Medicine, University Hospital and University of Basel, Switzerland.
authors: Marcel
authors: M
authors: Bruggisser
authors: Michael
authors: M
authors: Bodmer
authors: Matthias E
authors: ME
authors: Liechti
mesh_terms: D000281:Administration, Intranasal; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000697:Central Nervous System Stimulants / Q000008:administration & dosage* / Q000506:poisoning*; D055030:Drug Users; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage* / Q000506:poisoning*; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000503:physiopathology* / Q000628:therapy; D013557:Switzerland; D055815:Young Adult
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate