Reactions 1704, p229 - 2 Jun 2018 Various toxicities: case report An 11-year-old girl developed tolerance to methylphenidate [Concerta] and lisdexamfetamine. She experienced withdrawal symptoms, which included vomiting, headaches and marked sensitivity to bright lights after discontinuation of methylphenidate. She also developed migraines and malaise after dose reduction of lisdexamfetamine. Additionally, she experienced irritability and skin picking due to lisdexamfetamine [routes, indications, durations of treatments to reaction onsets not stated; not all dosages and outcomes stated]. The girl presented with marked irritability, excessive reactivity to frustration, prominent skin picking, persistent impairment due to inattention and social difficulties. She had autism spectrum disorder (ASD), attention- deficit/hyperactivity disorder (ADHD) and a learning disability, and was receiving lisdexamfetamine 50 mg/day along with guanfacine and fluoxetine. Her parents reported that she experienced severe episode of vomiting, headaches and marked sensitivity to bright lights after abrupt discontinuation of an osmotic controlled release preparation of methylphenidate 36mg, which lasted for several days. At the time of her initial consultation, her interactions with the examiner were somewhat elusive. She admitted that the eye contact with other persons was difficult; hence, she preferred to look away. She could effectively use the language for sharing thoughts, but she spoke very fast with a flat tone in prosody. Her thoughts were connected and coherent without delusional content or perceptual abnormalities. She reported discomfort with certain numbers but no clear obsessions or compulsions. There were no motor or vocal tics. She had an elevated heart rate of 122 bpm and a BP of 138/64mm Hg. An ECG showed a sinus tachycardia with a QTc of 442ms. In a concern of the girl’s heart rate and BP, and in a suspicion of lisdexamfetamine’s contribution in her irritability and skin picking, the dose lisdexamfetamine was reduced to 40 mg/day. Guanfacine and fluoxetine were continued at the same doses. Immediately after the dose reduction, she developed migraines and marked malaise lasting for few days. Her skin piking and irritability reduced with better handling of frustrations. Then, the lisdexamfetamine dose was reduced to 30 mg/day. Subsequently, she again experienced of migraines and general malaise for two days. Her irritability continued to improve with complete resolution of the skin picking. Within six months, lisdexamfetamine was gradually tapered and discontinued. With each dose reduction, she experienced minor episodes of withdrawal. Author comment: "We argue that tolerance to stimulants was conceivably developing in this young female, and consequently discontinuation of methylphenidate and dose reduction of lisdexamfetamine resulted in withdrawal symptoms." "[L]isdexamfetamine might be contributing to her irritability and skin picking". "Immediately after the dose of lisdexamfetamine. . .Her irritability continued to improve and she was no longer picking at her skin." Krakowski A, et al. Stimulant withdrawal in a child with autism spectrum disorder and ADHD - A case report. Journal of the Canadian Academy of Child and Adolescent Psychiatry 27: 148-151, No. 2, Apr 2018 - Canada 803322971 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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