Controlled trial of high doses of pemoline for adults with attention-deficit/hyperactivity disorder

Citation
Te. Wilens et al., Controlled trial of high doses of pemoline for adults with attention-deficit/hyperactivity disorder, J CL PSYCH, 19(3), 1999, pp. 257-264
Citations number
59
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Pharmacology,"Neurosciences & Behavoir
Journal title
JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY
ISSN journal
0271-0749 → ACNP
Volume
19
Issue
3
Year of publication
1999
Pages
257 - 264
Database
ISI
SICI code
0271-0749(199906)19:3<257:CTOHDO>2.0.ZU;2-B
Abstract
Despite the increasing awareness of attention-deficit/hyperactivity disorde r (ADHD) in adults, there are a limited number of controlled pharmacologic studies of this disorder. Because the stimulant medication magnesium pemoli ne (Cylert, Abbott Laboratories, Abbott Park, IL) has been found effective in treating ADHD in pediatric groups, me tested its efficacy in adults with ADHD using higher daily doses than those previously studied. We conducted a Id-week, double-blind, placebo-controlled, crossover design study of pemo line at a target daily dose of 3 mg/kg per day in 35 adult patients with DS M-III-R and -IV ADHD. We used standardized structured psychiatric instrumen ts for diagnosis. To measure improvement, we used separate assessments of A DHD, depressive, and anxiety symptoms at baseline and at each biweekly visi t. ADHD outcome was determined using the ADHD symptom checklist and Clinica l Global Impression scales of Severity and Improvement. Of the 35 adults wi th ADHD who mere randomized in the trial, 27 (77%) completed the protocol. Treatment with pemoline in the final week of the 4-week active phase was be st tolerated at doses substantially lower than the target dose of 3 mg/kg p er day (mean dose, 2.2 mg/kg per day; mean +/- SD, 148 +/- 95 mg). Pemoline was significantly better at reducing ADHD symptoms compared with placebo ( z = 2.4, p < 0.02). Using a predefined 30% reduction in symptoms as an indi cation of improvement, 50% of pemoline-treated subjects and 17% of subjects in the placebo group were considered positive responders (chi(2) = 7.1, p = 0.008). These results indicate that pemoline is moderately effective in t he treatment of ADHD in adults. Although robust doses were targeted, most a dults preferred more moderate dosing (120-160 mg/day). Given the Limited ef ficacy, tolerability, and concerns of hepatic dysfunction, pemoline should be considered as second-line medication for treating ADHD in adults.