Risperidone-to-methylphenidate switch reaction in children: three cases

• Published in: Journal of psychopharmacology (Oxford) 2007-03, Vol.21 (2), p.216-219
• Main Author: Sabuncuoglu, Osman
• Format: Article
• Language: English
• Subjects: Adolescent; Agitation; Akathisia, Drug-Induced; Antipsychotic Agents - therapeutic use; Antipsychotics; Attention Deficit and Disruptive Behavior Disorders - drug therapy; Attention Deficit Disorder with Hyperactivity - drug therapy; Attention deficit hyperactivity disorder; Biological and medical sciences; Central Nervous System Stimulants - adverse effects; Central Nervous System Stimulants - therapeutic use; Child; Child, Preschool; Children; Children & youth; Cognitive ability; Complications and side effects; Conduct Disorder - chemically induced; Dopamine receptors; Drug Interactions; Drug therapy; Female; Health aspects; Humans; Hyperactivity; Intelligence; Irritable Mood - drug effects; Male; Medical sciences; Methylphenidate; Methylphenidate - adverse effects; Methylphenidate - therapeutic use; Methylphenidate hydrochloride; Neuropharmacology; Neurotransmission; Oppositional defiant disorder in children; Pharmacology. Drug treatments; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psycholeptics: tranquillizer, neuroleptic; Psychology. Psychoanalysis. Psychiatry; Psychomotor Agitation - etiology; Psychopharmacology; Psychotropic drugs; Risperidone; Risperidone - therapeutic use; Sensory Receptor Cells - drug effects; Sensory Receptor Cells - metabolism; Side effects; Stimulants
• ISSN: 0269-8811; 1461-7285
• DOI: 10.1177/0269881107069466

As atypical antipsychotics are increasingly used in the treatment of childhood behavioural disorders either as monotherapy or in combination with other medications, there is a need to know more about their safety, in particular during switching to and from methylphenidate treatment, as antipsychotics and methylphenidate have opposing effects on dopaminergic neurotransmission. This report is about three cases of children who developed severe adverse reactions during switching from risperidone to methylphenidate. The first patient was a 6-year-old boy, diagnosed with attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). He developed severe hyperactivity and agitation on taking methylphenidate after the discontinuation of risperidone treatment. The second patient was a girl of 6, already on risperidone for ADHD and borderline intellectual functioning when referred. She displayed severe hyperactivity, agitation and irritability upon switching to methylphenidate medication. The third patient was a 15-year-old female adolescent with a similar clinical course as the previous patients. In all the cases described here, it is only with the discontinuation of methylphenidate that the adverse reactions resolved and readministration of methylphenidate in two patients did not produce any adverse effect after a drug-free interval. Functional regulation of certain neuroreceptors during risperidone treatment may lead to altered behavioural responses upon switching to methylphenidate. Thus, a drug-free interval is recommended in order to prevent adverse reactions.