naloxone and Attention-Deficit-Disorder-with-Hyperactivity

Attention-deficit hyperactivity disorder (ADHD) is a risk factor for the development of substance use disorders. Treatment of ADHD with psychostimulants in patients on opioid maintenance treatment (OMT) has been restricted in Norway. We examined the use of prescribed drugs for ADHD in OMT patients and assessed co-medication with other psychotropics.. Data were drawn from the nationwide Norwegian Prescription Database (NorPD), which includes all prescriptions filled at pharmacies. The study population included subjects ≥18 years on OMT during 2008-2010.. In 2010, 6,116 patients received OMT and 2.8% of these also received ADHD drugs. This percentage is seven times greater than that in the gender- and age-specific general population of Norway. The prevalence was higher in the youngest patients, while there was no gender difference. Methylphenidate was the most commonly used drug for ADHD in OMT patients, followed by atomoxetine. 60% of OMT patients filled at least one prescription for antidepressants, anxiolytics or hypnotics, and percentages were similar for users and non-users of ADHD drugs.. Treatment with ADHD drugs was higher in OMT patients than expected from the general population, but was relatively low compared to the prevalence of ADHD in patients with substance use disorders reported in the literature.

Topics: Adolescent; Adult; Analgesics, Opioid; Attention Deficit Disorder with Hyperactivity; Buprenorphine; Buprenorphine, Naloxone Drug Combination; Central Nervous System Stimulants; Databases, Factual; Female; Humans; Male; Methadone; Naloxone; Norway; Opiate Substitution Treatment; Opioid-Related Disorders; Prescription Drugs; Treatment Outcome; Young Adult

We describe a 4-year-old boy who presents to the emergency department with lethargy, bradycardia, and initial hypertension followed by hypotension due to guanfacine toxicity after ingestion of standard doses of the extended release formulation. This is the first case report to describe the use of naloxone to treat these symptoms and document improvements in level of consciousness, blood pressure, and heart rate associated with this therapy.

Topics: Antihypertensive Agents; Attention Deficit Disorder with Hyperactivity; Blood Pressure; Child, Preschool; Electrocardiography; Follow-Up Studies; Guanfacine; Humans; Hypotension; Male; Naloxone; Narcotic Antagonists

To highlight the increase in the number of cases of clonidine overdose admitted to a specialist paediatric hospital, with particular reference to the clinical features, clinical course and circumstances surrounding the incident.. Cases of clonidine overdose were identified by review of the emergency department attendance register, the intensive care unit database and inpatient statistics collection. Case notes were reviewed to determine the clinical features, history and clinical course in each case.. Fifteen patients experienced 16 overdoses during the period 1990-97 inclusive. Only one case occurred before 1994. Depressed level of consciousness and bradycardia were the most common clinical manifestations, and were observed in 75 and 88% of cases respectively. There were no fatalities. Five patients received naloxone. Other treatment modalities included gastrointestinal decontamination, atropine, ventilation and inotropic support. Fourteen cases occurred in association with medication prescribed for attention-deficit hyperactivity disorder (ADHD).. Clonidine overdose is a potentially serious condition, often requiring intensive care management. Our experience suggests that it is a growing problem, related in part to its increased use in the treatment of ADHD. Preventive strategies, including raising the level of awareness of risks, changes to packaging and appropriate selection of patients for treatment, need consideration if further overdoses are to be prevented.

Topics: Adrenergic alpha-Agonists; Attention Deficit Disorder with Hyperactivity; Bradycardia; Child; Child, Preschool; Clonidine; Drug Overdose; Drug Therapy, Combination; Drug Utilization; Female; Humans; Hypertension; Infant; Male; Naloxone; Narcotic Antagonists; Sleep Stages; Sympatholytics