Original article
Use of methylphenidate as an adjuvant to narcotic analgesics in patients with advanced cancer

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Abstract

Between October 1984 and July 1987, 50 patients were treated with methylphenidate (MP) for narcotic-induced sedation. All patients had pain due to advanced cancer and were receiving a mean daily equivalent dose of morphine of 165 ± 30 mg/day. Methylphenidate was started at a dose of 15 mg/day. Two patients (4%) had acute toxicity (hallucinations and paranoid-aggressive reaction, respectively) and required discontinuation of the drug. Forty-four of the 48 (91 %) remaining cases reported improvement after 48 hr of treatment and continued on MP for 39 ± 20 days. No other patient needed to discontinue MP because of toxicity. The mean maximal daily dose of MP and narcotics was 42 ± 6 mg and 237 ± 62 mg, respectively. The main reason for discontinuation of MP was a decrease in the dose of narcotics (18 cases); 12 patients continued to take MP until time of death. We conclude that: (1) MP can be administered to carefully selected advanced cancer patients with good tolerance; (2) toxicity occurs very early in the treatment, and late toxicity is infrequent; (3) significant tolerance develops to MP over the period of a month.

Keywords

Methylphenidate
amphetamine
pain
cancer
somnolence
sedation
narcotics

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