Abstract
Methylphenidate is a central nervous system stimulant with more prominent effects on mental activity than in motor activity. The mode of action is not fully known, but a key action seems to be the inhibition of dopamine transport. It is indicated as part of a comprehensive program of treatment of attention deficit disorder and hyperactivity (ADHD), which should include psychological, educational and social measures, in adults and children above 6 years of age. This review assessed the efficacy and safety of methylphenidate in the treatment of children and adolescents diagnosed with ADHD. Search of bibliographic resources was carried out in December 2012 in the database Center for Reviews and Dissemination (CRD), in order to identify releases of Health Technology Assessment. From 54 entries, three were selected for analysis. After analysis of these documents was held search for randomized controlled trials in EMBASE and PubMed databases, published 1 June 2010 to 22 February 2013, but none were selected for analysis. Evidence points behavioral therapies as first choice in the treatment of ADHD in children up to 6 years old. Above this age methylphenidate is indicated as drug of choice and should be considered an association with behavioral therapies, especially for children up to twelve years.
References
2. Aagaard L, Hansen EH. The occurrence of adverse drug reactions reported for attention deficit hyperactivity disorder (ADHD) medications in the pediatric population: a qualitative review of empirical studies. Neuropsychiatr Dis Treat [periódico na internet ]. 2011 [acesso em 25 mar 2013 ];7:729-44. Disponível em: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256000/pdf/ndt-7-729.pdf [ Links ]
3.American Academy of Pediatrics. Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics [periódico na internet ]. 2011 [acesso em 25 fev 2012 ];128(5):1007-22. Disponível em: http://pediatrics.aappublications.org/content/early/2011/10/14/peds.2011-2654.full.pdf+html [ Links ]
4. American Psychiatric Association. Manual diagnóstico e estatístico de transtornos mentais. Dornelles C, tradutor. 4. ed. Porto Alegre: Artmed; 2003. [ Links ]
5. ANVISA- Agência Nacional de Vigilância Sanitária. Prescrição e consumo de metilfenidato no Brasil: identificando riscos para o monitoramento e controle sanitário. Boletim de Farmacoepidemiologia [periódico na internet ]. 2012 [acesso em 20 fev 2013 ];2(2):1-14. Disponível em: http://portal.anvisa.gov.br/wps/wcm/connect/c4038b004e996487ada1af8a610f4177/boletim_sngpc_2_2012+corrigido+2.pdf?MOD=AJPERES [ Links ]
6. CADDRA - Canadian Attention Deficit Hyperactivity Disorder Resource Alliance. Canadian ADHD Practice Guidelines (CAP-Guidelines) [monografia na internet ]. 3.ed. Ontário; 2011. [acesso em 25 fev 2012 ]. Disponível em: http://www.caddra.ca/cms4/pdfs/caddraGuidelines2011.pdf [ Links ]
7.Charach A, Dashti B, Carson P, Booker L, Lim CG, Lillie E, et al. Attention Deficit Hyperactivity Disorder: effectiveness of treatment in at-risk preschoolers; long-term effectiveness in all ages; and variability in prevalence, Diagnosis, and Treatment [monografia na internet ]. Rockville, MD: Agency for Health Care Research and Quality; 2011. (Comparative Effectiveness Review, 44). [acesso em 15 dez 2012 ]. Disponível em: http://www.effectivehealthcare.ahrq.gov/reports/final.cfm. [ Links ]
8. Dobie C, Donald WB, Hanson M, Heim C, Huxsahl J, Karasov R, et al. Diagnosis and management of attention deficit hyperactivity disorder in primary care for school-age children and adolescents [monografia na internet ]. Bloomington (MN): Institute for Clinical Systems Improvement; 2012. 79 p. [acesso em 25 fev 2012 ]. Disponível em: http://guideline.gov/content.aspx?id=36812&search=attention-deficit%2fhyperactivity+disorder+and+attention-deficit%2fhyperactivity+disorder [ Links ]
9. King S, Griffin S, Hodges Z, Weatherly H, Asseburg C, Richardson G, et al. A systematic review and economic model of the effectiveness and cost-effectiveness of methylphenidate, dexamfetamine and atomoxetine for the treatment of attention deficit hyperactivity disorder in children and adolescents. Health Technol Assess [periódico na internet ]. 2006 [acesso em 15 dez 2012 ];10(23). Disponível em: http://www.hta.ac.uk/fullmono/mon1023.pdf [ Links ]
10. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Ciência e Tecnologia. Diretrizes metodológicas: elaboração de pareceres técnico-científicos [monografia na internet ]. 3. ed. rev.atual. Brasília (DF); 2011. 80 p. (Série A. Normas e manuais técnicos). [acesso em 23 jan 2012 ]. Disponível em:http://portal.saude.gov.br/portal/arquivos/pdf/DiretrizesPTC.pdf
11. NICE. National Institute for Health and Clinical Excellence. Attention deficit hyperactivity disorder. Diagnosis and management of ADHD in children, young people and adults [monografia na internet ]. London (UK); 2008. 59 p. (Clinical guideline, n. 72). [acesso em 25 fev 2012 ]. Disponível em: http://guideline.gov/content.aspx?id=14325&search=attention-deficit%2fhyperactivity+disorder+and+attention-deficit%2fhyperactivity+disorder [ Links ]
12. NICE. National Institute for Health and Clinical Excellence. Methylphenidate, atomoxetine and dexamfetamine for attention deficit hyperactivity disorder (ADHD) in children and adolescents [monografia na internet ]. London (UK); 2006. 34p. (Review of Technology Appraisal, 13). [acesso em 15 dez 2012 ]. Disponível em: http://guidance.nice.org.uk/TA98/Guidance/pdf/English [ Links ]
13. Organização Mundial de Saúde. Classificação de transtornos mentais e de comportamentos da CID-10: descrições clínicas e diretrizes diagnósticas. Porto Alegre: Artmed; 1993. [ Links ]
14. Ortega F, Barros D, Caliman L, Itaborahy C, Junqueira L, Ferreira CP. Ritalin in Brazil: production, discourse and practices. Interface: Comum Saude Educ [periódico na internet ]. 2010 [acesso em 15 dez 2012 ];14(34):499-512. Disponível em: http://www.scielo.br/pdf/icse/v14n34/aop1510.pdf [ Links ]
15. Pastura G, Mattos P, Araujo APQC. Prevalência do transtorno do déficit de atenção e hiperatividade e suas comorbidades em uma amostra de escolares. Arq Neuropsiquiatr [periódico na internet ]. 2007 [acesso em 15 dez 2012 ];65:1078-83. Disponível em: http://www.scielo.br/pdf/anp/v65n4a/a33v654a.pdf [ Links ]
16. Santos LF, Vasconcelos LA. Transtorno do Déficit de Atenção e Hiperatividade em Crianças: Uma Revisão Interdisciplinar. Psicologia: Teoria e Pesquisa [periódico na internet ]. 2010 [acesso em 15 dez 2012 ];26(4):717-72. Disponível em: http://www.scielo.br/pdf/ptp/v26n4/15.pdf [ Links ]
17. SIGN. Scottish Intercollegiate Guidelines Network . Management of attention deficit and hyperkinetic disorders in children and young people: a national clinical guideline [monografia na internet ]. Edinburgh (Scotland); 2009. 52p. (SIGN publication, 112). [acesso em 25 fev 2012 ]. Disponível em: http://guideline.gov/content.aspx?id=15540&search=attention-deficit%2fhyperactivity+disorder+and+attention-deficit%2fhyperactivity+disorder+and+%22attention-deficit%2fhyperactivity+disorder%22+and+%22attention-deficit%2fhyperactivity+disorder%22 [ Links ]
18. Silva EJC. Transtornos do déficit de atenção com hiperatividade em adolescentes. Adolesc Saúde [periódico na internet ]. 2005 [acesso em 15 dez 2012 ];2(2):25-9. Disponível em: http://www.adolescenciaesaude.com/detalhe_artigo.asp?id=171 [ Links ]
19. Venancio SI, Paiva R, Toma TS. Uso do metilfenidato no tratamento do Transtorno do Déficit de Atenção e Hiperatividade (TDHA) em crianças e adolescentes: parecer técnico-científico [monografia na internet ]. São Paulo: Instituto de Saúde, 2013. 30p. [acesso em 25 mar 2013 ]. Disponível em:http://www.saude.sp.gov.br/resources/instituto-de-saude/homepage/pdfs/pdfs-em-geral/ptc_metilfenidato.pdf [ Links ]
I Bula de Ritalina (cloridrato de metilfenidato, Novartis). [acesso em 15 de dezembro de 2012. Disponível em http://www4.anvisa.gov.br/base/visadoc/BM/BM%5B26162-1-0%5D.PDF
II National Guideline Clearinghouse é uma iniciativa da Agency for Healthcare Research and Quality, dos Estados Unidos; http://guideline.gov/index.aspx
III O sistema GRADE (Grading of Recommendations Assessment, Development and Evolution) classifica as recomendaçoes como fortes ou fracas e é utilizado como referência por diversas agências de regulação de saúde (www.gradingworkinggroup.org). A qualidade das provas é apresentada pelas letras A (alta qualidade), B (moderada), C (baixa) e D (muito baixa). A força da recomendação é de 1 (forte) a 2 (fraca).
IV Informação obtida da Lista de fármacos para solicitação de elaboração de parecer técnico científico, da CCTIES/SES-SP.21/11/2012
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2013 Sonia Isoyama Venancio, Rui de Paiva, Tereza Setsuko Toma, José Ruben de Alcântara Bonfim