Ritalin Faces Competition

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Ritalin Faces Competition As More Adhd Children Are Diagnosed Diane Lore

c.2000 News Service

If Winnie-the-Pooh does indeed need drugs to treat attention deficit

hyperactivity disorder (ADHD), as recommended by a group of Canadian

pediatricians last week, the bear couldn't have been diagnosed at a better

time. He would join millions of children with ADHD - up to 15 percent

of all children, by some estimates - who now face an array of pharmaceutical

choices beyond Ritalin, once the only drug option. Several new drugs on the

market not only ease the symptoms of hyperactivity, inattentiveness and

impulsiveness but, in some cases, restore patients' privacy. Most of

the front-line drugs used to treat attention deficit are stimulants, which

change the balance of chemicals in the brain so that children with the

disorder can concentrate better. Traditionally the stimulants' effect has

been short-lived, requiring that patients take several pills a day in order

to remain focused. In recent years that has changed, with the development of

several new, longer-lasting drugs - and even a skin patch - that do not

require repeated doses. For example, Concerta, approved by the Food and

Drug Administration in August, is a new time-release version of

methylphenidate, the main ingredient in Ritalin. Unlike the older,

short-acting Ritalin tablets, which usually must be taken at four-hour

intervals, Concerta lasts 12 to 14 hours, which allows children to take their

medication at home before going to school and not need a second dose during

class. That helps eliminate the social stigma that some ADHD children might

face, from classmates or school employees, because of their medical

condition. ``There are kids who get too embarrassed to take their

medication at school,'' said Dr. Rubin, director of the Marcus Center

for Developmental Medicine and Emory University's Division of Developmental

Pediatrics. ``It's a very real issue.'' In addition, Noven

Pharmaceuticals plans on releasing Methypatch, a skin patch, within two

years. The patch, worn under the clothes, delivers methylphenidate directly

through the skin into the bloodstream. And because the medication doesn't go

through the digestive system, the company says, smaller doses will be needed.

But it's too early to tell whether these new entries will have a

lasting effect, doctors say. Although they beat more traditional medications

for convenience and privacy, they still must show over time that they work as

well as Ritalin, introduced in 1956. Ritalin, the prescription of

choice in almost 70 percent of children's ADHD cases, is often chosen because

it has a solid record of safety and doesn't linger in the body for long. And

it doesn't take weeks to find out whether a patient is responding to

treatment; doctors and parents often see improvement within an hour of a

child's taking the pill. But as more children are given Ritalin, more

parents and others have become concerned about its side effects and its

frequent social stigma. Some children on Ritalin become zombielike - although

doctors say that clearly means it's not working - and lose their appetite.

And, as children age, many become resistant to treatment, often because of

real or perceived stigmatization at school or elsewhere. The second

most popular ADHD drug, Adderall, introduced four years ago, is competing

well against Ritalin, mostly because it usually works well and a single dose

lasts seven to eight hours. Its main drawbacks are that it's expensive for

those without a pharmaceutical benefits plan and it's an amphetamine that can

be addictive. But the market for ADHD drugs continues to grow. Studies

show that between 3 percent and 6 percent of schoolchildren are taking some

kind of medication for attention deficit, and that number is likely to rise

as science becomes more sophisticated in identifying individuals with the

condition. Nationally, doctors recommended in 1999 that almost 7.7

million youngsters under 18 be placed on Ritalin or Adderall, almost a 23

percent increase from 1995, according to IMS Health, a pharmaceutical

tracking firm. For another 2.1 million children, doctors recommended

antidepressants known as selective serotonin reuptake inhibitors (SSRIs),

such as Prozac - a 73.9 percent jump since 1995. The rising demand

means that drug companies will keep looking for newer, better ways to treat

ADHD. ``We're going to see new medications in the future,'' Rubin predicted.

``The market is just too significant to ignore.'' But what did the

pediatricians whose diagnosis was published in the Canadian Medical

Association Journal recommend for the lovable, huggable bear? A low dose of

Ritalin. TREATMENT OPTIONS A glance at the three main drugs used

for treating ADHD, all of which are stimulants: Ritalin: Introduced in

1956. Main ingredient is methylphenidate, with a duration of four to six

hours. Notable advantage: Fast-acting, with doctors often able to monitor

behavioral changes within an hour. Common side effects: loss of appetite,

nervousness, trouble in sleeping, dizziness, drowsiness, headache, nausea and

stomach pain. Adderall: Approved by the Food and Drug Administration in

1996. A combination of four amphetamines, including Dexedrine, with a

duration of seven to eight hours. Notable advantage: Because of its longer

duration of action, it can replace Ritalin in some patients, ending the need

for a ``noon'' dose of medication. Common side effects: restlessness,

dizziness, insomnia, headache, dryness of the mouth, weight loss, diarrhea,

constipation and other gastrointestinal disturbances. Concerta:

Approved by the FDA this year. Main ingredient is methylphenidate. Notable

advantage: duration of 12 to 14 hours. Common side effects: headache, upper

respiratory tract infection, stomachache, vomiting, loss of appetite,

sleeplessness, increased cough, sore throat, sinusitis and dizziness.

(The Web site is at <A

HREF= " http://www.coxnews.com./ " >http://www.coxnews.com.</A>

Mike Savory

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