Karaman 2010.

Methods	A patient report of a 15‐year old boy with ADHD who developed pulmonary arterial hypertension (PAH) during OROS methylphenidate treatment
Participants	Diagnosis of ADHD: DSM‐IV (subtype: not stated) Age: 15 years old IQ: intellectual capacity within normal limits Sex: male Ethnicity: not stated Country: Turkey Comorbidity: no Comedication: none MPH‐naïve: yes Sociodemographics: not stated
Interventions	Methylphenidate type: osmotic release oral system (OROS) Methylphenidate dosage: 54 mg/day Administration schedule: once daily, morning Duration of intervention: 18 months Treatment compliance: not stated
Outcomes	Non‐serious adverse events: On the 4th day of treatment: the patient began to experience occasional episodes of slight shortness of breath. Continued over several months. Not associated with either exercise or anxiety At the 18th month of treatment: fainting. Normal weight. No sign of allergy, hypersensitivity, or sleep apnea. Mean pulmonary arterial pressure of 40 mmHg at rest, otherwise no pathological findings from extensive testing (Examination: clear lungs, no murmurs, rubs, or gallops, and otherwise unremarkable. Laboratory tests, including C‐reactive protein, thyroid and liver function tests, electrolytes. Blood gases, antinuclear antibodies, D‐dimers, chest X‐ray, ventilation‐perfusion scintigraphy, electrocardiography, respiratory function tests. Echography. Transthoracic echocardiogram: normal except for the mean pulmonary arterial pressure) No use of any other drug. No history of alcohol and substance use and no symptoms or signs of methylphenidate misuse (intravenous (IV) injection). The personal and family histories were also negative for pulmonary or cardiovascular diseases Discontinuation of OROS‐methylphenidate, 1 month: free of symptoms. Mean pulmonary arterial pressure of 28 mmHg
Notes	Funding/vested interests/affiliations: no conflict of interests or financial ties to disclose. Key conclusions of study authors: this case shows that pulmonary arterial hypertension should be considered in patients who present with dyspnoea and a reduced exertion tolerance and who are known to use methylphenidate Comments from the study authors: using the Naranjo algorithm, the likelihood that OROS methylphenidate was responsible for precipitating pulmonary arterial hypertension in our patient was judged probable