Kids who have survived cancer can tolerate Ritalin

Despite previous studies suggesting that childhood cancer survivors with attention and learning problems have a lot of side effects while taking methylphenidate (marketed as Ritalin and other names), most such children do well on the drug, according to a new study.

However, some groups of children should be closely monitored for side effects while taking methylphenidate, a stimulant often prescribed for children with attention deficit-hyperactivity disorder (ADHD), write Dr. Heather M. Conklin from St. Jude Children’s Research Hospital, Memphis, Tennessee, and colleagues in their report in the journal Pediatrics.

In their study, Conklin’s team gave 103 childhood cancer survivors one of two different doses of methylphenidate or placebo. All of the children received all of the options at different phases in the trial.

During the phase of the trial in which they were receiving a moderate dose of methylphenidate, patients experienced more severe symptoms than they did during the low-dose and placebo phases.

Still, the researchers note, side effects were less severe, and less frequent, than they were before the trial started, no matter what phase of the trial the children were in at the time. The team suggests that this was because some of the “side effects” of methylphenidate usage are actually attention problems that improve with medication.

There were some groups that should be monitored more carefully, however: Parents of girls reported more side effects than did parents of boys across all dose levels, the investigators say, and lower IQ was associated with more side effects during the low-dose methylphenidate period relative to placebo.

The authors also found that brain tumor survivors were 3 times more likely than other childhood cancer survivors to stop methylphenidate treatment early because of side effects.

“Those groups at increased risk need to be closely monitored by prescribing clinicians,” the authors advise. “It may also be that lower doses of methylphenidate medication are advisable in the higher risk cancer survivors given previous findings that failed to reveal a behavioral advantage for a moderate dose of methylphenidate over a low dose of methylphenidate.”

SOURCE Pediatrics, July 2009.