Prommer Eric
Division of Hematology/Oncology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA.
Am J Hosp Palliat Care. 2012 Sep;29(6):483-90. doi: 10.1177/1049909111427029. Epub 2011 Dec 4.
Methylphenidate is a psychostimulant originally used for the treatment of attention-deficit disorder. Methylphenidate inhibits neuronal neurotransmitter transporters involved in the uptake of dopamine and norepinephrine at the level of the synapse. Inhibition of these transmitter transporters leads to increased concentrations of dopamine and norepinephrine in the synapse, which results in increasing alertness. The stimulant effect of methylphenidate has been used for the treatment of major depression, poststroke depression, cognitive enhancement in patients with brain tumors, neurodegenerative disorders, HIV disease, fatigue, and as a treatment for delirium and sedation associated with opioid use. Other areas where methylphenidate has been evaluated include gait disorders in the elderly individuals and the treatment of apathy in dementia. Analgesic effects have been demonstrated in preclinical models but true analgesic effects remain to be proven in humans. This article reviews the current use of methylphenidate for symptom management with a critical look at the evidence base for its efficacy in the conditions described.
哌醋甲酯是一种精神振奋药，最初用于治疗注意力缺陷障碍。哌醋甲酯在突触水平抑制参与多巴胺和去甲肾上腺素摄取的神经元神经递质转运体。这些递质转运体的抑制导致突触中多巴胺和去甲肾上腺素浓度增加，从而提高警觉性。哌醋甲酯的兴奋作用已被用于治疗重度抑郁症、中风后抑郁症、脑肿瘤患者的认知增强、神经退行性疾病、HIV疾病、疲劳，以及作为与阿片类药物使用相关的谵妄和镇静的治疗方法。哌醋甲酯已被评估的其他领域包括老年人的步态障碍和痴呆症中冷漠的治疗。在临床前模型中已证明有镇痛作用，但真正的镇痛作用在人类中仍有待证实。本文回顾了哌醋甲酯目前在症状管理中的应用，并批判性地审视了其在所描述病症中疗效的证据基础。
