藥學雜誌 124 109 ADHD 藥物副作用及處理方式 奇美醫院精神科醫師林健禾 奇美醫院藥劑部藥師王慧瑜 摘要 (ADHD) ADHD ADHD ADHD atomoxetine methylphenidate 壹 前言 (Attention deficit hyperactivity disorder, ADHD) 4%-8% ADHD (Dopamine) 臨床ADHD 藥物治療學 ADHD dextroamphetamine/amphetamine (Adderall) dextroamphetamine (Dexedrine) methylphenidate (Ritalin Ritalin LA Concerta ) Methylphenidate (MPH) Methylphenidate (striatum) 貳 選擇性正腎上腺素再回收抑制劑 Atomoxetine (Strattera) FDA 31 3
臨床藥Therapeutics of Clinical Drugs 物治療 學 1 參 副作用以及建議處理方式 ADHD ADHD ADHD 一 食慾不振 生長遲緩 ( 一 ) 副作用 MPH (meta-analysis) 30.3% 26.4% 2 MPH-OROS (Concerta) MPH-IR (Ritalin) 1 MPH-OROS 18% MPH-IR 24% 4% 3 Atomoxetine (ATX) 15.4% 4 5 110 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.3 MPH 1 6 ATX 2.5 2.7 7 Graham (2011) 8 ( 1.5 ) 二 心臟血管風險 ( 一 ) 風險 MPH ATX 1-4 mmhg 1-2 mmhg 1-2 9 EACG ( 100 ) ADHD
藥學雜誌 124 111 三 睡眠 ( 一 ) 副作用 ADHD Schachter (2001) 1 MPH MPH-IR 17% 6-8 ATX 1.9% 9.9% 4 ATX MPH ( ) ADHD ADHD 10 (ATX) ATX 11 臨床ADHD 藥物治療四 抽搐 (tics) 學( 一 ) 副作用 12 447 ADHD MPH ATX 13 ATX 8 3 ADHD (ADHD ) ADHD ATX ADHD 14 肆 結語 1955 FDA MPH ADHD 60 ADHD 31 3
臨床藥物治療學表一 ADHD 藥物常見的副作用追蹤與處置 BMI MPH-IR ATX ADHD ATX. Therapeutics of Clinical Drugs 112 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.3 ADHD Side Effects of Drugs for ADHD and Managements Chien-Ho Lin 1, Hue-Hu Wang 2 Department of Psychiatry, Chi Mei Medical Center 1 Department of Pharmacy, Chi Mei Medical Center 2 Abstract ADHD is one of the most common mental disorder in children. Currently, there are two categories for ADHD medications: stimulants and non-stimulants. Despite most adverse
藥學雜誌 124 113 effects during treating ADHD are mild, many parents still concern about drug safety and risk. The aim of this article is to provide overview about common ADHD drugs adverse effects during treatment: poor appetite, growth retardation, cardiac vascular risk, sleep, tic. 參考資料 : 1. ADHD 2010; 26: 14-19 2. Schachter HM, Pham B, King J, et al: How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis. Canadian Medical Association Journal 2001;165:1475-1488. 3. Pelham WE, Gnagy EM, Burrows-MacLean LW, et al: Once-a-day Concerta methylphenidate versus three-times daily methylphenidate in laboratory and natural settings. Pediatrics 2001;107:E105 4. Cheng JY, Chen RY, Ko JS, et al: Efficacy and safety of atomoxetine for attention-deficit/hyperactivity disorder in children and adolescents-meta-analysis and meta-regression analysis. Psychopharmacology (Berlin) 2007;194:197-209. 5. Faraone SV, Biederman J, Morley CP, et al: Effect of stimulants on height and weight: A review of the literature. Journal of the American Academy of Child and Adolescent Psychiatry 2008;47:994-1009. 6. Poulton A: Growth on stimulant medication; clarifying the confusion: A review. Archives of Diseases in Children 2005;90:801-806. 7. Kratochvil CJ, Wilens TE, Greenhill LL, et al: Effects of long-term atomoxetine treatment for young children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry 2006;45: 919-927. ADHD 臨床藥物治療學 31 3 8. Graham J, Banaschewski T, Buitelaar J, et al: European guidelines on managing adverse effects of medication for ADHD. European Child and Adolescent Psychiatry 2011;20:17-37. 9. Hammerness PG, Perrin JM, Shelley-Abrahamson R, et al: Cardiovascular risk of stimulant treatment in pediatric attention-deficit/hyperactivity disorder: Update and clinical recommendations. Journal of the American Academy of Child and Adolescent Psychiatry 2011;50:978-990. 10. Konofal E, Lecendreux M, Cortese S: Sleep and ADHD. Sleep Medicine 2010;11:652-658 11. Block SL, Kelsey D, Coury D, et al: Once-daily atomoxetine for treating pediatric attention-deficit/hyperactivity disorder: Comparison of morning and evening dosing. Clinical Pediatrics (Philadelphia) 2009;48:723-733. 12. Albin RL : Neurobiology of basal ganglia and Tourette syndrome: Striatal and dopamine function. Advences in Neurology 2006;99:99-106. 13. Pringsheim T, Steeves T: Pharmacological treatment for Attention Deficit Hyperactivity Disorder (ADHD) in children with comorbid tic disorders. Cochrane Database of Systematic Reviews 2011;4:CD007990 14. Cortese S, Holtmann M, Banaschewski T, et al: Practitioner review: current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents. Journal of Child Psychology and Psychiatry 2013;54:227-246.