---------- Forwarded message ----------
Date: Wed, 28 Feb 1996 16:10:07 -0600 (CST)
From: Steven E. Mayer <[log in to unmask]>
To: [log in to unmask]
Subject: Ritalin in PD treatment
Dear Barbara: Below is the message I wrote (2-22-96) in response to RACHEL
and Marti EIERMAN'S discussion of the possible use of methylphenydate
(Ritalin) in PD and other CNS disorders. I have strong feelings about the
use of this dangerous drug. It should be used only by experts in very
restricted situations:
Comments on methylphenidate and PD. The bottom line is that no consistent
therapeutic effect of Ritalin has been established in PD patients, and the
danger of severe toxicity is ever present. (Q.v. The Pharmacologic Basis of
Therapeutics, ed. by Hardman et al., McGraw-Hill, 1996; chapter 10, p.224
and elsewhere). Methylphenidate is an amphetamine with cocaine-like efects.
The only uses that I belief are recognized are: maintenence of attention
span in children,and narcolepsy; both of these uses are controversial; it
has even been proposed to ban both uses. Methylphenidate is similar to
methamphetamine ("meth", "speed:) which is now banned in most states. This
is especially a problem in adults where the blood-pressure elevationin in
response to amphetamines and cocain may precipitate major strokes. This is
hardly worth the risk to arouse depressed PD patients.
The question of whether Ritalin might be used to inhibit dopamine
re-uptake which would elevate the concentration of the neurotransmitter in
the synaptic cleft analogous to that seen with amphetamines and cocaine is
intriguing. This might be as way of augmenting neurotransmitter supply for
the post-synaptic receptors in the niegrostriatal cells involved in PD.
However, no convincing data exist in the literature I have searched and in
texbook reviews (Goodman & Gilman). What is needed is a cocaine transport
inhbitior that does not produce sgnificant behavioral and blood pressure
effects. I don't know if anyone has found or is looking such a potentially
useful agent in PD.
With best regards and thanks. STEVEN
This is the text of the original submitted message with some improvment of
content and typography.
Steven E. Mayer, Ph.D.
