Editing Methylphenidate (section)

=== Attention deficit hyperactivity disorder ===
Methylphenidate is used for the treatment of [[attention deficit hyperactivity disorder]] (ADHD).<ref>{{cite journal | vauthors = Fone KC, Nutt DJ | title = Stimulants: use and abuse in the treatment of attention deficit hyperactivity disorder | journal = Current Opinion in Pharmacology | volume = 5 | issue = 1 | pages = 87–93 | date = February 2005 | pmid = 15661631 | doi = 10.1016/j.coph.2004.10.001 }}</ref> The dosage may vary and is [[dose titration|titrated]] to effect, with some guidelines recommending initial treatment with a low dose.<ref name="Huss Duhan Gandhi Chen 2021 p.">{{cite journal | vauthors = Huss M, Duhan P, Gandhi P, Chen CW, Spannhuth C, Kumar V | title = Methylphenidate dose optimization for ADHD treatment: review of safety, efficacy, and clinical necessity | journal = Neuropsychiatric Disease and Treatment | volume = 13 | pages = 1741–1751 | date = 2 June 2021 | pmid = 28740389 | pmc = 5505611 | doi = 10.2147/NDT.S130444 | doi-access = free }}</ref> Methylphenidate is available in both immediate-release and [[Modified-release dosage|modified-release]] formulations.<ref name="Management 2011 pp. 1007–1022">{{cite journal | vauthors = Wolraich M, Brown L, Brown RT, DuPaul G, Earls M, Feldman HM, Ganiats TG, Kaplanek B, Meyer B, Perrin J, Pierce K, Reiff M, Stein MT, Visser S | title = ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit / hyperactivity disorder in children and adolescents | journal = Pediatrics | volume = 128 | issue = 5 | pages = 1007–1022 | date = November 2011 | pmid = 22003063 | pmc = 4500647 | doi = 10.1542/peds.2011-2654 }}</ref><ref name="Neinstein-2009">{{cite book | vauthors = Neinstein L | year=2009 | title=Handbook of Adolescent Health Care | publisher=Wolters Kluwer Health / Lippincott Williams & Wilkins | location=Philadelphia, PA | isbn=978-0-7817-9020-8 | oclc=226304727 }}{{rp|722}}</ref> Methylphenidate is not approved for children under six years of age.<ref>{{cite journal | vauthors = Vitiello B | date = October 2001 | title = Psychopharmacology for young children: clinical needs and research opportunities | journal = Pediatrics | volume = 108 | issue = 4 | pages = 983–989 | pmid = 11581454 | doi = 10.1542/peds.108.4.983 | s2cid = 33417584 }}</ref><ref>{{cite journal | vauthors = Hermens DF, Rowe DL, Gordon E, Williams LM | date = May 2006 | title = Integrative neuroscience approach to predict ADHD stimulant response | journal = Expert Review of Neurotherapeutics | volume = 6 | issue = 5 | pages = 753–763 | pmid = 16734523 | doi = 10.1586/14737175.6.5.753 | s2cid = 15971025 }}</ref>

The International Consensus Statement on ADHD shows that the results from [[systematic review]]s, [[Meta-analysis|meta-analyses]] and large scale studies are clear: methylphenidate is safe and among the most efficacious drugs in all of medicine; treatment in the long-term substantially reduces accidental injuries, traumatic brain injury, substance abuse, cigarette smoking, educational underachievement, bone fractures, sexually transmitted infections, depression, suicide, criminal activity, teenage pregnancy, vehicle crashes, burn injuries and overall-cause mortality, and eliminates the increased risk for obesity.<ref name="Faraone_2021">{{cite journal |vauthors=Faraone SV, Banaschewski T, Coghill D, Zheng Y, Biederman J, Bellgrove MA, Newcorn JH, Gignac M, Al Saud NM, Manor I, Rohde LA, Yang L, Cortese S, Almagor D, Stein MA, Albatti TH, Aljoudi HF, Alqahtani MM, Asherson P, Atwoli L, Bölte S, Buitelaar JK, Crunelle CL, Daley D, Dalsgaard S, Döpfner M, Espinet S, Fitzgerald M, Franke B, Gerlach M, Haavik J, Hartman CA, Hartung CM, Hinshaw SP, Hoekstra PJ, Hollis C, Kollins SH, Sandra Kooij JJ, Kuntsi J, Larsson H, Li T, Liu J, Merzon E, Mattingly G, Mattos P, McCarthy S, Mikami AY, Molina BS, Nigg JT, Purper-Ouakil D, Omigbodun OO, Polanczyk GV, Pollak Y, Poulton AS, Rajkumar RP, Reding A, Reif A, Rubia K, Rucklidge J, Romanos M, Ramos-Quiroga JA, Schellekens A, Scheres A, Schoeman R, Schweitzer JB, Shah H, Solanto MV, Sonuga-Barke E, Soutullo C, Steinhausen HC, Swanson JM, Thapar A, Tripp G, van de Glind G, van den Brink W, Van der Oord S, Venter A, Vitiello B, Walitza S, Wang Y |date=September 2021 |title=The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder |journal=Neuroscience and Biobehavioral Reviews |volume=128 |pages=789–818 |doi=10.1016/j.neubiorev.2021.01.022 |pmc=8328933 |pmid=33549739}}</ref>

One committee from the [[World Health Organization]] (WHO) responsible for the [[World Health Organization Essential Medicines List]] rejected an application in 2019, and a second application endorsed by 51 professional medical groups in 2021, for methylphenidate's inclusion due to uncertainty about its efficacy and safety.<ref>{{cite web |title=eEML - Electronic Essential Medicines List |url=https://list.essentialmeds.org/recommendations/1200 |publisher=World Health Organization |access-date=26 March 2020 |archive-date=26 March 2020 |archive-url=https://web.archive.org/web/20200326025659/https://list.essentialmeds.org/recommendations/1200 |url-status=live }}</ref><ref>{{Cite web |title=A.21 Methylphenidate – attention-deficit hyperactivity disorder – EML and EMLc |url=https://www.who.int/groups/expert-committee-on-selection-and-use-of-essential-medicines/23rd-expert-committee/a21-methylphenidate |access-date=1 May 2024 |publisher=World Health Organization}}</ref> However, in November 2023, the WHO Mental Health Gap Action Programme Guidelines for mental, neurological, and substance use disorders recommended that methylphenidate should be considered for children aged 6 years and older who have ADHD, noting specifically that, "methylphenidate treatment shows substantial effects on symptom reduction",<ref>{{Cite web |title=Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders |url=https://www.who.int/publications-detail-redirect/9789240084278  |access-date=1 May 2024 |publisher=World Health Organization |date=20 November 2023 |edition=Third}}</ref> in addition to other WHO publications.<ref>{{cite web |url=https://applications.emro.who.int/docs/EMRPUB_leaflet_2019_mnh_214_en.pdf |title=Attention Deficit Hyperactivity Disorder (ADHD) |publisher=World Health Organization |date=2019 |access-date=13 January 2025}}</ref> In 2024, the [[European Child & Adolescent Psychiatry|European Society for Child and Adolescent Psychiatry]] (ESCAP) and the [[American Academy of Pediatrics|American Academy of Paediatrics]] (AAP) endorsed the inclusion of methylphenidate in the WHO EML.<ref>{{cite journal | vauthors = Cortese S, Coghill D, Fegert JM, Mattingly GW, Rohde LA, Wong IC, Faraone SV | title = ESCAP endorses the inclusion of methylphenidate in the WHO model lists of essential medicines and in the Union list of critical medicines | journal = European Child & Adolescent Psychiatry | volume = 33 | issue = 5 | pages = 1605–1608 | date = May 2024 | pmid = 38662057 | doi = 10.1007/s00787-024-02443-5 }}</ref><ref>{{cite journal | vauthors = Cortese S, Coghill D, Mattingly GW, Rohde LA, Thom RP, Wilens TE, Wong IC, Faraone SV | title = AACAP Endorses the Inclusion of Methylphenidate in the WHO Model Lists of Essential Medicines | journal = Journal of the American Academy of Child and Adolescent Psychiatry | volume = 63 | issue = 7 | pages = 663–665 | date = July 2024 | pmid = 38428579 | doi = 10.1016/j.jaac.2024.02.008 | url = https://eprints.soton.ac.uk/492445/1/AACAP_endorses.docx }}</ref> A new application for methylphenidate's inclusion is currently pending review,<ref>{{Cite web |title=A.19 Methylphenidate - attention deficit hyperactivity disorder |url=https://www.who.int/groups/expert-committee-on-selection-and-use-of-essential-medicines/25th-expert-committee-on-selection-and-use-of-essential-medicines/a.19-methylphenidate-attention-deficit-hyperactivity-disorder |access-date=2025-03-22 |website=www.who.int |language=en}}</ref> having sparked debate in the comment process among researchers engaged in the evaluation of the evidence-base.<ref>{{Cite web |last=Storebø |first=Ole Jakob |title=Correspondence with the 2025 WHO Expert Committee: A.19 Methylphenidate – attention deficit hyperactivity disorder |url=https://cdn.who.int/media/docs/default-source/2025-eml-expert-committee/comments/a.19_comments-storeb.pdf?sfvrsn=db66ddce_1}}</ref><ref>{{Cite web |last=Bleazard |first=Ryan |title=Correspondence with the 2025 WHO Expert Committee: A.19 Methylphenidate – attention deficit hyperactivity disorder |url=https://cdn.who.int/media/docs/default-source/2025-eml-expert-committee/comments/a.19_comments_bleazard.pdf?sfvrsn=a7894ebc_1}}</ref><ref>{{Cite web |last=Manor |first=Iris |title=Correspondence with the 2025 WHO Expert Committee: A.19 Methylphenidate – attention deficit hyperactivity disorder |url=https://cdn.who.int/media/docs/default-source/2025-eml-expert-committee/comments/a.19_comments-manor74645dfb-3b22-4640-a7d3-d632e6d1a84f.pdf?sfvrsn=c34bd1e2_1}}</ref>

Safety and efficacy data have been reviewed extensively by medical regulators (e.g., the US [[Food and Drug Administration]] and the [[European Medicines Agency]]), the developers of evidence-based national guidelines (e.g., the UK [[National Institute for Health and Care Excellence]] and the [[American Academy of Pediatrics]]), and government agencies who have endorsed these guidelines (e.g., the Australian [[National Health and Medical Research Council]]). These professional groups unanimously conclude, based on the scientific evidence, that methylphenidate is safe and effective and should be considered as a first-line treatment for ADHD.<ref name="Faraone_2021" />

Since ADHD diagnosis has increased around the world, methylphenidate may be misused as a "study drug" by some populations, which may be harmful.<ref name="Abelman 68">{{cite journal | vauthors = Abelman DD | title = Mitigating risks of students use of study drugs through understanding motivations for use and applying harm reduction theory: a literature review | journal = Harm Reduction Journal | volume = 14 | issue = 1 | page = 68 | date = October 2017 | pmid = 28985738 | pmc = 5639593 | doi = 10.1186/s12954-017-0194-6 | doi-access = free }}</ref> This also applies to people who may be experiencing a different issue and are [[Medical error|misdiagnosed]] with ADHD.<ref name="Abelman 68" /> People in this category are prone to experience the negative side-effects of the drug, which can worsen their condition.<ref name="Abelman 68" />

Long-term meta-analyses and systematic reviews show that the medications used to treat ADHD are not associated with observed deficits in brain structure, but with improved brain development and functioning, most prominently in inferior frontal and striatal regions.<ref name="Faraone_2021" /> The most comprehensive meta-analysis available (19 studies with over 3.9 million participants) found "no statistically significant association between ADHD medications [including methylphenidate] and the risk of cardiovascular event among children and adolescents, young and middle-aged adults, or older adults";<ref>{{cite journal | vauthors = Zhang L, Yao H, Li L, Du Rietz E, Andell P, Garcia-Argibay M, D'Onofrio BM, Cortese S, Larsson H, Chang Z | title = Risk of Cardiovascular Diseases Associated With Medications Used in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis | journal = JAMA Network Open | volume = 5 | issue = 11 | pages = e2243597 | date = November 2022 | pmid = 36416824 | pmc = 9685490 | doi = 10.1001/jamanetworkopen.2022.43597 }}</ref> as do other systematic reviews and meta-analyses.<ref>{{cite journal | vauthors = Liang EF, Lim SZ, Tam WW, Ho CS, Zhang MW, McIntyre RS, Ho RC | title = The Effect of Methylphenidate and Atomoxetine on Heart Rate and Systolic Blood Pressure in Young People and Adults with Attention-Deficit Hyperactivity Disorder (ADHD): Systematic Review, Meta-Analysis, and Meta-Regression | journal = International Journal of Environmental Research and Public Health | volume = 15 | issue = 8 | pages = 1789 | date = August 2018 | pmid = 30127314 | pmc = 6121294 | doi = 10.3390/ijerph15081789 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Liu H, Feng W, Zhang D | title = Association of ADHD medications with the risk of cardiovascular diseases: a meta-analysis | journal = European Child & Adolescent Psychiatry | volume = 28 | issue = 10 | pages = 1283–1293 | date = October 2019 | pmid = 30143889 | doi = 10.1007/s00787-018-1217-x }}</ref><ref>{{cite journal | vauthors = Habel LA, Cooper WO, Sox CM, Chan KA, Fireman BH, Arbogast PG, Cheetham TC, Quinn VP, Dublin S, Boudreau DM, Andrade SE, Pawloski PA, Raebel MA, Smith DH, Achacoso N, Uratsu C, Go AS, Sidney S, Nguyen-Huynh MN, Ray WA, Selby JV | title = ADHD medications and risk of serious cardiovascular events in young and middle-aged adults | journal = JAMA | volume = 306 | issue = 24 | pages = 2673–2683 | date = December 2011 | pmid = 22161946 | pmc = 3350308 | doi = 10.1001/jama.2011.1830 }}</ref>