Coşkun 2009b.

Methods	2 patient reports of sexual side effects during methylphenidate treatment
Participants	Diagnosis of ADHD: DSM‐IV (subtype: 50% combined, 50% unknown) Age: 15 and 8 years old IQ: > 70 Sex: 2 males Ethnicity: Turkish Country: Turkey Comorbidity: borderline mental capacity: 50% Comedication: unknown Sociodemographics: unknown
Interventions	Case 1 Immediate release methylphenidate: 10‐30 mg/day in a divided dosage, 1 month. Treatment compliance: low Osmotic release oral system methylphenidate: 18 mg/day, 1 month. Treatment compliance: unknown Osmotic release oral system methylphenidate: 36 mg/day, 3 weeks. Treatment compliance: unknown Case 2 Osmotic release oral system methylphenidate: 18 mg/day, 10 days. Treatment compliance: unknown Immediate release methylphenidate: 10‐20 mg/day, 3 weeks. Treatment compliance: unknown Osmotic release oral system methylphenidate: 18 mg/day. Treatment compliance: unknown
Outcomes	Non‐serious adverse events: Case 1 Immediate release methylphenidate, 10‐30 mg/day: initial headache and nausea Osmotic release oral system methylphenidate, 18 mg/day: emotional side effects (sense of nervousness in the chest, occasional emotional numbing), multiple daily erections (unrelated to sexual stimuli, painless, without ejaculations, onset: a few hours after ingestion of methylphenidate, duration: 5‐10 minutes) Medication‐free period, 1 week: no erections unrelated to sexual stimuli Re‐administering of osmotic release oral system methylphenidate, 36 mg/day, 3 weeks: reemerging of erections, longer duration compared with osmotic release oral system‐methylphenidate 18 mg/day. Headache. Nausea. Same emotional side effects. Drug‐free days: no erections Discontinuation of medication: no erections Case 2 Osmotic release oral system methylphenidate, 18 mg/day: loss of appetite, headache, abdominal pain, sleep problems, and conjunctival injection. Headache and abdominal pain almost disappeared after 1 week. Hypersexual behaviours. Morning erections before ingestion of methylphenidate, duration: 1 hour. Weight loss: 1.5 kg within 2 months. Drug‐free days: almost no hypersexual behaviour during the day and no erection the following morning Immediate release methylphenidate, 10‐20 mg/day: morning erections and hypersexual behaviours decreased dramatically. Sleep and appetite problems improved mildly. No conjunctival injection (after 3 weeks). Possible withdrawal symptoms (increased irritability and hyperactivity, getting tearful easily), several hours after each dosage Osmotic release oral system methylphenidate, 18 mg/day: next‐morning erections, hypersexual behaviour during the day. Drug‐free days: almost no hypersexual behaviour Osmotic release oral system methylphenidate, 18 mg/day, 6:00 am: no morning erections, but still hypersexual behaviour. Sleep and appetite problems. Conjunctival injections. Sense of pins and needles in his legs after 10 days Discontinuation of osmotic release oral system methylphenidate: no morning erections or hypersexual behaviours
Notes	Funding: no financial ties or conflicts of interest Supplemental information was received through personal email correspondence with the authors in August 2013 (Coşkun 2013b [pers comm])