Efficacy and safety of methylphenidate and pemoline in children with attention deficit hyperactivity disorder

Objective: The aim of the study was to compare the efficacy and safety of methylphenidate and pemoline in the treatment of children with attention deficit hyperactivity disorder (ADHD). Background: Although methylphenidate, pemoline, and dextroamphetamine are all approved for the treatment of ADHD in children, in 1998 methylphenidate constituted similar to 70% of the market. To compare the efficacy of these 3 drugs in a large population of children and to assess adverse events associated with their administration, me conducted a retrospective descriptive study of 500 children treated for ADHD at a large teaching institution. Methods: The charts of 500 children aged 4 to 18 years treated for ADHD over a 12-month period at a university-affiliated pediatric neurology clinic were reviewed retrospectively. The author rated treatment success from 1 (poor) to 4 (excellent) and assessed adverse effects based on the children's records. Results: Methylphenidate was prescribed for 48% (n = 240) and pemoline for 49% (n = 245) of the patients, The mean treatment rating was higher for pemoline (3.5 vs 2.7). Discontinuation was higher in the methylphenidate group (32% [n = 77] vs 10% [n = 25]) for lack of efficacy but higher in the pemoline group (22% [n = 54] vs 5% [n = 12]) for adverse effects (primarily insomnia). No liver abnormalities were reported in either group. Conclusions: A higher percentage of pemoline- than methylphenidate-treated children had an excellent clinical response; however, they also had more adverse events.