Department of Psychiatry, University of California-San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA.
Expert Opin Pharmacother. 2011 Feb;12(2):315-24. doi: 10.1517/14656566.2011.546058.
Attention deficit/hyperactivity disorder (ADHD) is estimated to affect 4-5% of adults. Impairment across multiple domains of daily living can be mild to serious. OROS methylphenidate (MPH) was evaluated in two large adult clinical trials, and in 2008 it was approved in the USA to treat ADHD in adults aged up to 65 years.
Products approved for adult ADHD; chemistry, pharmacodynamics, pharmacokinetics, metabolism, efficacy, safety, tolerability, abuse liability, regulatory affairs, and relative merits and limitations associated with OROS MPH; and complexities associated with diagnosis and treatment of ADHD are discussed in this review. The reader will gain an introduction to the epidemiology, features and special issues regarding clinical management of ADHD in adults. Key features and development of OROS MPH are presented, and unique characteristics of the delivery system and their implications for clinical use of the drug are discussed.
The OROS system delivers MPH in a highly consistent manner using osmotic pressure at a controlled rate over a 12-h duration of effect. Compared with immediate-release MPH, it provides a smoother pharmacokinetic curve, and it may show greater patient compliance, fewer missed doses and reduced abuse liability.
注意力缺陷多动障碍(ADHD)估计影响 4-5%的成年人。日常生活中多个领域的障碍可能从轻度到严重。盐酸哌甲酯控释片(MPH)在两项大型成人临床试验中得到了评估,并于 2008 年在美国获得批准,用于治疗 65 岁以下的成人 ADHD。
本文讨论了用于成人 ADHD 的获批产品、化学、药效学、药代动力学、代谢、疗效、安全性、耐受性、滥用倾向、监管事务,以及与盐酸哌甲酯控释片相关的优缺点和局限性;并讨论了与 ADHD 的诊断和治疗相关的复杂性。读者将对成人 ADHD 的流行病学、特征以及临床管理的特殊问题有一个初步了解。本文介绍了盐酸哌甲酯控释片的特点和开发,并讨论了其给药系统的独特特征及其对药物临床应用的影响。
OROS 系统通过渗透压以受控速率在 12 小时的作用持续时间内输送 MPH,其方式非常稳定。与速释 MPH 相比,它提供了更平稳的药代动力学曲线,并且可能具有更高的患者依从性、更少的漏服剂量和降低的滥用倾向。