- Clinician reasons for methylphenidate dosing choices are so unsystematic that the authors of this meta-analysis of 49 studies could not tell if the selections were arbitrary or evidence-based.
- Clinical studies yield a range of maximum doses for treating ADHD for a drug that can cause insomnia, abdominal pain, headache, and anorexia.
Why this matters
- An accompanying editorial says that these authors have “done the pediatric field a great service” in asking and attempting to answer the question of why clinicians choose the doses they do.
- Maximum methylphenidate dose range: 0.8-1.8 mg/kg/day.
- Although studies described titration methods, rationales for the chosen range were not always provided.
- Adverse effects were as expected: insomnia, anorexia, abdominal pain, headache, all significantly more common with the drug.
- Adverse event risks were slightly higher in cohort studies vs randomized controlled trials.
- Meta-analysis of 11 randomized clinical trials (n=1304 on drug; 887 controls) and 38 cohort studies (n=5524).
- Outcomes: doses, justification for selected dose range, adverse effects when dose established by titration.
- Funding: None disclosed.
- Small sample sizes in most included studies.
- Drug formulation varied across studies.