The Science of ADHD by Chris Chandler

Author:Chris Chandler
Language: eng
Format: epub
Publisher: Wiley
Published: 2010-12-10T05:00:00+00:00

A worrying study was published in 2007 which linked methylphenidate with DNA damage in the rat striatum, although this damage could be repaired [641]. Following this report and a similar one by El-Zein [831], a number of studies were conducted. Human studies have produced contradictory results with some finding an effect [831], but the majority do not find an adverse effect [642–643, 832–836]. Whilst this is good news it also demonstrates that one can influence DNA.

Pemoline

Pharmacology

Once marketed as Cylert, pemoline has been used to a lesser extent in the treatment of ADHD since 1975. Unlike methylphenidate and amphetamine, pemoline has no effect on noradrenergic systems (see [837]). Pemoline action is to increase DA release and block its reuptake [838–839]. The half-life of pemoline is 8.6 hours [840], with some finding effects still after 7 hours [841]. Therefore the advantage of pemoline is that a single dose can last a long time, thereby avoiding multiple dosing [837].

Clinical effects

There are comparatively few studies that have looked at pemoline in ADHD. Back in the days of minimal brain dysfunction, pemoline was seen to have a beneficial effect especially because of its duration of action [842–843]. In a study of ADHD children using a number of outcome measures, pemoline was seen as an effective treatment [844]. It was associated with an improvement in college students [845], in adolescents [846], and in adults it was better than placebo [847], but there appears to be a reduced effect of pemoline in adults because of adverse effects [848]. Whilst a benefit of pemoline over methylphenidate was seen in one study, adverse reactions to pemoline were greater and sufficient to prevent further use [849]. Another benefit with pemoline is its lack of abuse potential [850]. However, one paper does report a case study of pemoline abuse, but this was induced by prior amphetamine abuse [851].

Side-effects

One of the recurrent side-effects of pemoline that is reported is its hepatotoxicity. This can range from increases in liver enzymes through to full liver failure [852–854]. Such was the concern that the manufacturers stated it should not be a first-line medication for ADHD [837]. In contrast the effects of pemoline on growth appear to be transient [855]. Like methylphenidate, pemoline induces insomnia [841, 844] and is associated with abdominal pain and headaches [837].

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