Medication and Dry Eyes
Is This The End Of Ritalin?
by MARTYN HALLE, Daily Mail
Doctors treating hyperactive children may soon have a new treatment in place of the controversial drug Ritalin, which has raised concerns amid fears of abuse and serious side-effects.
While it, and a number of similar drugs, can have a calming effect on children with attention deficit hyperactive disorder (ADHD) they are in the same class of drugs as amphetamines used by drug addicts. Chemically they are related to cocaine.
Now atomoxetine, designed to treat children with ADHD, is expected to become available later this year.
The treatment - which has already been approved by U.S. Health authorities - has the same calming effects as Ritalin but apparently with none of its side-effects or potentially addictive qualities.
ADHD has become a major cause for concern for parents and teachers, with as many as two children in every school class affected by the condition.
ADHD children are impulsive, tend to throw tantrums, have problems concentrating and can't stay still. Its cause is unknown, although scientists believe it may be connected to an over-stimulation of a gene linked to alertness.
Around 100,000 children in Britain are on Ritalin to deal with ADHD. But the drug is said to cause hallucinations, mood swings and even depression.
Although it calms down many children, it has been described as a 'chemical cosh', making children sleepy and unable to learn. There are also concerns that it might cause brain damage if used long term.
Experts say atomoxetine has very few side-effects and there have been no reports of the problems experienced by children taking Ritalin.
It is also longer lasting and some doctors report that it appears to be of benefit to more children.
The new drug has been developed by American pharmaceutical giant Eli Lilly. A small two-year UK trial - in Glasgow and Sheffield - has been completed and final trials that may lead to UK approval are just starting.
'For a long time we have only really had Ritalin as a treatment for ADHD,' says Dr Val Harpin, a paediatrician at Sheffield Children's Hospital. 'There is no doubt that it has benefited many children, but a significant number have run into problems.
'Children on Ritalin can have difficulty sleeping, have their growth slowed and suffer a loss of appetite. And with these children we have often been left without an effective treatment.'
Dr Harpin has been treating ADHD children with atomoxetine.
'We found that we got a good response from 75 per cent of the children on the trial and think we have discovered a good drug with no obvious side- effects,' she says.
ANDREA BILBOW, the founder of the Attention Deficit Disorder Information Service, says: 'Atomoxetine is not a controlled drug like Ritalin and it doesn't have the same stigma attached to it. Ritalin can be difficult to manage and anything new will be welcome.'
One of the 75 children involved in an ongoing trial with atomoxetine is 14-yearold Andrew Wainwright, from Dronfield, near Sheffield.
'Going on this drug was the best thing that happened to Andrew,' says his mother, Charmaine, a 45-year-old sales representative. 'For the past two years he has been virtually calm all the time.
'He still has occasional moments of hyperactivity, but nothing that presents a real problem for him at school. Before he was a real handful, although he has never had any violent outburst.
'He would be fidgety, prone to making inappropriate comments and had a complete lack of concentration for hours at a time.'
{"status":"error","code":"499","payload":"Asset id not found: readcomments comments with assetId=180565, assetTypeId=1"}Ritalin May Damage Brain
by PRAVIN CHAR, Metro
Children given Ritalin to control hyperactivity could be permanently brain damaged, it was claimed yesterday.
Research suggests the controversial 'chemical cosh' drug raises the risk of depression and anxiety in adulthood.
Ritalin alters the brain's chemical composition so that it has a lasting effect on mental health, US scientists believe. Because these changes take place while a child's brain is growing, they could cause irreversible damage.
The findings will alarm parents using the drug to control a child's attention deficit hyperactivity disorder (ADHD).
British GPs dispensed a record 254,000 Ritalin prescriptions last year, up from 208,500 in 2001. One in 20 children is said to have ADHD, which makes them boisterous and unfocused.
'It is vitally important we evaluate the long-term effects of these drugs,' said Dr Nora Volkow, director of the US National Institute on Drug Abuse.
Although American studies involved laboratory rats, the doses given were comparable to those used on children.
In one test, giving Ritalin to young, healthy rats increased the presence of certain chemicals linked to depression in adults. Asecond study found higher levels of stress hormones and anxietylike behaviours.
Last night, Shadow children's minister Tim Loughton urged the Government to investigate Ritalin use.
The Royal College of Paediatrics said: 'Ritalin has been used for 40 years. If there was a long-term side-effect, it would have been discovered by now.'
Novartis, the company which makes Ritalin, insisted there was no clinical link to depression or anxiety disorders.
Ritalin La
Abuse, Misuse, and Addiction
High potential for abuse, misuse, and addiction.
Assess the risk of abuse, misuse, and addiction prior to prescribing and monitor during therapy.
Risks to Patients with Serious Cardiac Disease
Sudden death has been reported in patients with structural cardiac abnormalities or other serious cardiac disease receiving CNS stimulants.
Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, or other serious cardiac disease.
Evaluate further if exertional chest pain, unexplained syncope, or arrhythmias develop during treatment.
Increased Blood Pressure and Heart Rate
Psychiatric Adverse Reactions
Exacerbation of pre-existing psychosis: May exacerbate symptoms of behavior disturbance and thought disorders in patients with pre-existing psychotic behavior.
Induction of a manic episode in patients with bipolar disorder: May induce a mixed/manic episode in patients with bipolar disorder. Screen for risk factors for developing a manic episode prior to treatment (eg, comorbid or history of depressive symptoms or a family history of suicide, bipolar disorder, and depression).
New psychotic or manic symptoms: May cause psychotic or manic symptoms in patients without a history of psychotic illness or mania. Consider discontinuing if symptoms occur.
Priapism
Prolonged and painful erections, sometimes requiring surgical intervention, have been reported.
Priapism has not been reported during drug initiation but developed after some time on the drug.
Seek immediate medical attention if priapism occurs.
Peripheral Vasculopathy, including Raynaud's Phenomenon
Signs and symptoms are usually intermittent and mild; very rare sequelae include digital ulceration and/or soft tissue breakdown.
These signs and symptoms generally improve after reduction in dose or discontinuation.
Observe carefully for digital changes during treatment. Evaluate further (eg, rheumatology referral) for certain patients.
Long-Term Suppression of Growth
In pediatric patients, closely monitor growth (weight and height).
May need to interrupt treatment in patients who are not growing or gaining height or weight as expected.
Acute Angle Closure Glaucoma
Increased Intraocular Pressure and Glaucoma
Motor and Verbal Tics, and Worsening of Tourette's Syndrome
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