Lasheen Wael, Walsh Declan, Mahmoud Fade, Davis Mellar P, Rivera Nilo, Khoshknabi Dilara Seyidova
Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, OH 44195, USA.
Am J Hosp Palliat Care. 2010 Feb;27(1):16-23. doi: 10.1177/1049909109345145. Epub 2009 Sep 10.
Methylphenidate (MP) is often recommended for symptom control in advanced cancer. Little is known about its side effects in frail adults.
To evaluate MP-associated symptoms or side effects (S/E).
Data was collected from 2 published prospective cohort series and a phase 2 study of MP for symptom control in advanced cancer. All 3 reports had identical dosing schedules and symptom assessments. Initial MP doses were 10 mg/d (5 mg at 8 AM and at 12 noon) titrated up to a maximum of 30 mg/d. Depression, fatigue, and symptoms identified as possible MP S/E were evaluated for presence (prevalence) and for severity (using categorical scales) before MP (day 0) and on days 3, 5, and 7 thereafter. The categorical scale used was none, mild, moderate, and severe.
62 patients were enrolled. Fifty completed 7 days of MP with a median age of 69 (range 30-90) years. Thirty-five received MP 10 mg/day. Most (96%) had improvement in depression and/or fatigue. Among the 62 patients, new symptom prevalence throughout the study was agitation (16%), insomnia (16%), dry mouth (15%), nausea (10%), tremors (6%), anorexia (5%), headache (3%), palpitations (2%), and vomiting (2%). Patients could have more than 1 symptom simultaneously. Seven (11%) withdrew due to MP S/E. Some symptoms present before MP showed significant improvement during MP therapy.
(1) Treatment with MP (10-20 mg/d) in advanced cancer is well tolerated. (2) S/E symptoms with MP appeared to improve spontaneously despite continued MP therapy. (3) Depression and fatigue improved at doses lower than those recommended in other clinical conditions. (4) MP improved depression and fatigue, and some secondary symptoms associated with them. Methylphenidate (MP) appears safe when used in the treatment of depression and fatigue in advanced cancer.
哌醋甲酯（MP）常被推荐用于晚期癌症症状的控制。关于其在体弱成年人中的副作用知之甚少。
评估与MP相关的症状或副作用（S/E）。
数据收集自2个已发表的前瞻性队列研究系列以及一项关于MP用于晚期癌症症状控制的2期研究。所有3份报告都有相同的给药方案和症状评估。初始MP剂量为10毫克/天（上午8点和中午12点各5毫克），最高可滴定至30毫克/天。在服用MP前（第0天）以及之后的第3、5和7天，评估抑郁、疲劳以及被确定为可能的MP S/E的症状的存在情况（患病率）和严重程度（使用分类量表）。所使用的分类量表为无、轻度、中度和重度。
共纳入62例患者。50例完成了7天的MP治疗，中位年龄为69岁（范围30 - 90岁）。35例接受10毫克/天的MP治疗。大多数（96%）患者的抑郁和/或疲劳症状有所改善。在这62例患者中，整个研究期间新出现症状的患病率分别为：激动（16%）、失眠（16%）、口干（15%）、恶心（10%）、震颤（6%）、厌食（5%）、头痛（3%）、心悸（2%）和呕吐（2%）。患者可能同时出现不止一种症状。7例（11%）因MP S/E退出研究。一些在服用MP前就存在的症状在MP治疗期间有显著改善。
（1）晚期癌症患者使用MP（10 - 20毫克/天）治疗耐受性良好。（2）尽管持续进行MP治疗，但与MP相关的S/E症状似乎会自发改善。（3）在低于其他临床情况下推荐的剂量时，抑郁和疲劳症状得到改善。（4）MP改善了抑郁和疲劳以及与之相关的一些继发症状。哌醋甲酯（MP）用于治疗晚期癌症的抑郁和疲劳时似乎是安全的。
