McLaren 2010.
| Methods | A patient report of acute dystonia following withdrawal of methylphenidate treatment in the context of multiple high dose drug treatment | |
| Participants | Diagnosis of ADHD: DSM‐IV (subtype: not stated) Age: 11 years old IQ: no mental retardation Sex: male Ethnicity: not stated Country: USA Comorbidity: bipolar disorder Comedication: aripiprazole, 15 mg, twice daily. Lithium carbonate, 600 mg and 300 mg at night. Clonidine, 0.2 mg, twice daily Sociodemographics: not stated |
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| Interventions | Extended‐release OROS methylphenidate dosage: 108 mg daily Administration schedule: not stated Duration of treatment: 4 years prior to withdrawal in hospital. The last 6 months the dose had not been changed. Treatment compliance: not stated |
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| Outcomes |
Non‐serious adverse events Acute dystonia after discontinuation of OROS methylphenidate The patient experienced spasmodic muscular contractions of his jaw. The staff noticed a forceful jaw closure, contraction, and tension, and the patient had difficulties opening his mouth. Intramuscular diphenhydramine at 50 mg was administered intramuscularly, and the patient could open his mouth within 30 minutes and with no further dystonia |
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| Notes | Funding/vested interest/authors' affiliations: none declared Key conclusions of the study authors: need for vigilance regarding development of acute dystonic reactions when discontinuing methylphenidate whilst using concomitant antipsychotic drugs Comments from the review authors: the patient was on extremely high doses, not normally given to patients of this age, of all of the medication that he was on i.e. extended‐release OROS methylphenidate 108 mg (twice the recommended maximum dose), aripiprazole 15 mg twice daily (also in excess of double the normal maximum dose), lithium 900 mg daily (very high for a child of 11 years) and clonidine 0.2 mg (around double the maximum recommended dose) Supplemental information regarding patients diagnostic criteria and IQ received through personal email correspondence with the authors in October 2013 (McLaren 2013 [pers comm]) |
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