Use of methylphenidate in palliative care: clinical trial at the Grenoble University Hospital

According to studies, the asthenia concerns 12 to 98% of the patients with cancer in palliative care. If there many etiologies, for numerous patients, the physical and mental asthenia remains little accessible to an etiological treatment. Clinical studies on the methylphenidate (amphetamine) show an interest for the asthenia of the persons in palliative care with a relative safety. A preliminary study was so led to analyze in best its stimulating and unwanted effects. 22 patients received the methylphenidate during at least 7 days. The average daily posology of methylphenidate to J7 is of 20 milligrams. Intensity and characteristics of the physical and mental asthenia are estimated with the visual analogue scale (VAS). For the 22 persons included in the study, to J7, the physical asthenia is improved on average of 2.11 points in the VAS and the mental asthenia of -3.50 points. Among the 14 patients who pursue study beyond the 7-th day, the motives for exit of study during the follow-up are the escalation of the main pathology (3 patients), painful unwanted effects (2 patients), a difficulty of supply of the product and a follow-up become impossible. So, mental fatigue seems more improved than physical fatigue and this improvement concerns especially a decrease of the drowsiness. The quality of life is also improved, especially since the patient has better general state (indication of Karnofsky 50) at the time of the inclusion. The results of this study would need to be confirmed on a more important population in double-blind with placebo.