title: Methylphenidate for Treating ADHD: A Naturalistic Clinical Study of Methylphenidate Blood Concentrations in Children and Adults With Optimized Dosage.
abstract: BACKGROUND
  Methylphenidate (MPH), along with behavioral and psychosocial interventions, is the first-line medication to treat attention-deficit hyperactivity disorder (ADHD) in Sweden. The dose of MPH for good symptom control differs between patients. However, studies of MPH concentration measurement in ADHD treatment are limited.
  
  
  OBJECTIVE
  To describe blood and oral fluid (OF) concentrations of MPH after administration of medication in patients with well-adjusted MPH treatment for ADHD, and to identify the most suitable matrix for accurate MPH concentration during treatment.
  
  
  METHODS
  Patients were recruited from Child and Adolescent Psychiatry (CAP), General Psychiatry (GP), and the Department of Dependency (DD). Blood and OF samples were collected in the morning before MPH administration as well as 1 and 6 h after administration of the prescribed morning dose of MPH.
  
  
  RESULTS
  Fifty-nine patients aged between 9 and 69 years, 76 % males. The daily dose of MPH varied from 18 to 180 mg, but the median daily dose per body weight was similar, approximately 1.0 mg/kg body weight. The median MPH concentration in blood 1 and 6 h after the morning dose was 5.4 and 9.3 ng/mL, respectively. Highly variable OF-to-blood ratios for MPH were found at all time points for all three groups.
  
  
  CONCLUSIONS
  Weight is a reliable clinical parameter for optimal dose titration. Otherwise, MPH blood concentration might be used for individual dose optimization and for monitoring of the prescribed dose. Relying only on the outcome in OF cannot be recommended for evaluation of accurate MPH concentrations for treatment monitoring.
authors.affiliation: Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden. maria.dolores.cherma.yeste@regionostergotland.se.|Department of Clinical Pharmacology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. maria.dolores.cherma.yeste@regionostergotland.se.
authors.forename: Maria D
authors.initials: MD
authors.lastname: Chermá
authors.affiliation: Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.|Department of Physics, Chemistry and Biology, Linköping University, Linköping, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Josefsson
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Irene
authors.initials: I
authors.lastname: Rydberg
authors.affiliation: Department of Dependency, Linköping University Hospital, Linköping, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Woxler
authors.affiliation: Department of Dependency, Linköping University Hospital, Linköping, Sweden.
authors.forename: Tomas
authors.initials: T
authors.lastname: Trygg
authors.affiliation: Department of General Psychiatry, Västervik Hospital, Västervik, Sweden.
authors.forename: Olle
authors.initials: O
authors.lastname: Hollertz
authors.affiliation: Center for Social and Affective Neuroscience Department of Clinical and Experimental Medicine and Department of Child and Adolescent Psychiatry, Linköping University, Linköping, Sweden.
authors.forename: Per A
authors.initials: PA
authors.lastname: Gustafsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D001835:Body Weight; D000697:Central Nervous System Stimulants / Q000008:administration & dosage* / Q000493:pharmacokinetics; D002648:Child; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage* / Q000493:pharmacokinetics; D008875:Middle Aged; D013548:Sweden; D013997:Time Factors; D055815:Young Adult
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate