Posted by zeugma on August 15, 2005, at 7:19:33
In reply to Re: Focalin XR » zeugma, posted by ed_uk on August 14, 2005, at 16:41:04
Hi Ed!
I'm sorry lofepramine did not affect your circadian rhythms. It might be relevant that NRI's have age-dependent pharmacodynamics, but it is more likely that an NRI would have positive effects on a narcoleptic's CR, because the hypnagogic hallucinations etc. were terribly disruptive of sleep and hence any attempt to maintain a normal sleep time. In fact I suffered from terrible insomnia as a result of these problems.
As regards Focalin, this is one of several studies
J Child Adolesc Psychopharmacol. 2004 Winter;14(4):542-54. Related Articles, Links
A double-blind, placebo-controlled withdrawal trial of dexmethylphenidate hydrochloride in children with attention deficit hyperactivity disorder.Arnold LE, Lindsay RL, Conners CK, Wigal SB, Levine AJ, Johnson DE, West SA, Sangal RB, Bohan TP, Zeldis JB.
Ohio State University, Columbus, Ohio 43210-1296, USA. arnold.6@osu.edu
OBJECTIVES: d,l-threo-methylphenidate HCl (D,L-MPH) is the most common treatment of attention deficit hyperactivity disorder (ADHD). A previous report showed placebo-controlled efficacy for the purified d-isomer (dexmethylphenidate hydrochloride, d-MPH, Focalin) with a 2:1 potency compared to dl, and suggested a 6-hour duration of action. This study complements that report by studying the effect of placebo-controlled discontinuation and retesting the duration of action. METHODS: A 6-week, open-label titration of d-MPH (2.5-10 mg twice-a-day) was followed by a double-blind, placebo-controlled, 2-week withdrawal study of responders. RESULTS: In the open titration, 82% of the 89 enrolled patients achieved a Clinical Global Impression-Improvement (CGI-I) rating of much or very much improved. Only 5 patients discontinued for adverse events. Seventy-five patients continued into the placebo-controlled discontinuation. For the randomly assigned d-MPH (n=35) and placebo (n=40) groups, mean ages, respectively, were 10.1 +/- 2.9 and 9.9 +/- 2.7 years, 86% and 78% were male, and 70.6% and 80.0% took the ceiling dose of 10 mg twice-daily, respectively. Each group had 80% combined type ADHD and 20% inattentive type. By the end of the 2-week, placebo-masked withdrawal, significantly more placebo patients (24 of 39) than d-MPH continuers (6 of 35) relapsed (61.5% versus 17.1%, p=0.001). Compared to d-MPH continuers, placebo patients deteriorated significantly more in the 2-week period on teacher ratings of the 18 ADHD symptoms rated 0-3 (p=0.028), the 3 p.m. and 6 p.m. parent ADHD symptom ratings (p=0.0026 and p=0.0381, respectively), and clinic (2-3 p.m.) and home (6 p.m.) Math Tests (p=0.024 and p<0.0001, respectively). The 6 p.m. scores replicated the significant effect at 6 hours reported in the previous study. CONCLUSIONS: d-MPH is safe, tolerable, and effective, with a 6-hour duration of effect suggested by the significant difference from placebo at 6 hours on a double-blind discontinuation.>>
that claims that Focalin has a 6-hour duration of action. This would be highly significant, as Ritalin LA has a 6-8 hour duration of action, and that is not sufficient to get me through a demanding workday (actually nothing is, but every bit helps LOL). The problems I have had with Rit have been directly related to the need to take increased amounts to maintain the effect. I know the theme of this thread is a reappraisal of marketing claims for 'improved efficacy' of new-generation products over older drugs that were dosed improperly (20 mg haloperidol? 48 mg perphenazine? Of course Zyprexa will look good compared to the effects of these dosages!) and I am as cynical as anyone when it comes to marketing claims. But the situation appears to be the reverse (of the relationship e.g. between haloperidol and olanzapine)with Rit and Focalin: higher dosages, hence more s/e, are required to get similar results. And specifically, since unlike Celexa/Lexapro, MPH has a short half-life and effects that are highly variable based on when the med is taken, the duration of effect difference would be of real use to me (and others).
Well, if I do try Focalin XR, you can be sure to get a report that is uninfluenced by corporate grants, however placebo effects cannot be completed excluded ;-)
-z
poster:zeugma
thread:535356
URL: http://www.dr-bob.org/babble/20050811/msgs/541854.html