1043-3155 Pediatr Neurol Briefs pedneurbriefs Pediatr Neurol Briefs Pediatric Neurology Briefs Pediatr Neurol Briefs 2166-6482 1043-3155 2166-3155 Pediatric Neurology Briefs Publishers Chicago, IL, USA PNB-13-15-b 10.15844/pedneurbriefs-13-2-11 Antiepileptic Drugs Neurology Pediatrics Nervous System Diseases Child Development Brain Diseases Neurosurgery Child Infant Carbamazepine and Methylphenidate Levels in ADHD http://orcid.org/0000-0002-0173-7931 Millichap J. Gordon MD 1 2 * Division of Neurology, Children's Memorial Hospital, Chicago, IL Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL Correspondence: Dr. J. Gordon Millichap, E-mail: jgmillichap@northwestern.edu 02 1999 01 05 2016 13 2 15 16 Copyright: © 1999 The Author(s) 1999 This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Carbamazepine and methylphenidate in ADHD

A carbamazepine (CBZ)-induced lowering of methylphenidate (MPH) serum levels in a 13-year-old female treated for ADHD and aggressive behavior, is reported from the Eastern Pennsylvania Psychiatric Institute, Philadelphia.

 Carbamazepine Methylphenidate Pennsylvania

A carbamazepine (CBZ)-induced lowering of methylphenidate (MPH) serum levels in a 13-year-old female treated for ADHD and aggressive behavior, is reported from the Eastern Pennsylvania Psychiatric Institute, Philadelphia. ADHD symptoms that had responded to MPH became worse when CBZ was introduced and the dose increased to 800 mg/day (serum level 8.9 mcg/mL). Peak morning serum levels of MPH and ritalinic acid were 5.3 ng/mL on 20 mg MPH 3 times a day (standard range of MPH level is 5-20 ng/mL). After 6 weeks on CBZ, the MPH levels decreased to 4.2, and later to 2.4, when the dose of CBZ was increased to 1000 mg/day. ADHD symptoms worsened despite an increase in MPH dose to 35 mg 3x daily. The beneficial effects of MPH were regained only at doses of 60 mg 3x daily. [1]

COMMENT. When MPH and CBZ are used together, a worsening of ADHD symptoms may occur that correlates with lowered blood levels of MPH. This observation, not previously reported, is important in patients with ADHD complicated by seizures or abnormal EEGs, when MPH is added after first introducing the AED. Larger doses of MPH may be required to effect a response.

Schaller JL Behar D Carbamazepine and methylphenidate in ADHD J Am Acad Child Adolesc Psychiatry 1999 Feb 38 2 112 3 10.1097/00004583-199902000-00006 9951206