Arnold L Eugene, Lindsay Ronald L, López Frank A, Jacob Sharon E, Biederman Joseph, Findling Robert L, Ramadan Yaser
Department of Psychiatry, Ohio State University, Columbus, Ohio, USA.
Pediatrics. 2007 Nov;120(5):1100-6. doi: 10.1542/peds.2007-0542.
Stimulant medications (amphetamine and methylphenidate) are the best-documented treatments for attention-deficit/hyperactivity disorder, but their short pharmacokinetic and behavioral half-lives have historically produced irksome time-course effects. New drug-delivery systems designed to eliminate the need for frequent dosing include the methylphenidate transdermal system, in which the matrix acts as both the drug reservoir and the skin adhesive. The methylphenidate transdermal system patch, in contrast to long-acting oral preparations, requires a paradigmatic shift in clinical thinking, as well as refinement of clinical management skills. For dosing with the methylphenidate transdermal system patch, clinicians must think in terms of a retrievable form of drug delivery (in milligrams per hour) rather than a fixed nonretrievable dose (in milligrams per dose or milligrams per day). Clinicians and patients can determine the optimal clinical dose by controlling 2 variables: (1) patch size (controlling milligrams per hour) and (2) duration of patch wear. The new paradigm is worth learning, because the patch offers several advantages over oral preparations for some patients, chiefly individualized control over effect duration (determined by when the patch is applied in the morning and removed in the afternoon/evening). Taking full advantage of this treatment option requires educating the patient and parents regarding practical elements of daily use. These elements include patch-site selection, application techniques, management of wear time to optimize the daily time course of clinical benefits, and skin hygiene. This article summarizes clinical principles that physicians may find useful in managing this new addition to the attention-deficit/hyperactivity disorder treatment armamentarium.
兴奋剂药物（苯丙胺和哌醋甲酯）是治疗注意力缺陷/多动障碍记录最完备的药物，但它们较短的药代动力学和行为半衰期在过去一直产生令人烦恼的时程效应。旨在消除频繁给药需求的新型给药系统包括哌醋甲酯透皮系统，其中基质既充当药物储库又充当皮肤黏附剂。与长效口服制剂相比，哌醋甲酯透皮系统贴片需要临床思维的范式转变以及临床管理技能的提升。对于使用哌醋甲酯透皮系统贴片给药，临床医生必须从可回收的给药形式（每小时毫克数）而非固定的不可回收剂量（每剂毫克数或每日毫克数）来考虑。临床医生和患者可以通过控制两个变量来确定最佳临床剂量：（1）贴片大小（控制每小时毫克数）和（2）贴片佩戴时长。这种新范式值得学习，因为对于一些患者而言，贴片相对于口服制剂具有若干优势，主要是对效应持续时间的个体化控制（由早晨贴片的粘贴时间和下午/晚上的移除时间决定）。要充分利用这种治疗选择，需要就日常使用的实际要素对患者和家长进行教育。这些要素包括贴片部位选择、应用技术、佩戴时间管理以优化临床获益的每日时程以及皮肤卫生。本文总结了医生在管理注意力缺陷/多动障碍治疗手段中的这一新增药物时可能会觉得有用的临床原则。
