The safety of the use of methylphenidate is kept under careful review by the Medicines and Healthcare products Regulatory Agency (MHRA) in conjunction with other European regulatory authorities. In June 2007, at the request of the European Commission, a Europe wide review of the safety of methylphenidate products, including the risk of cardiovascular and cerebrovascular disorders, was initiated. As part of this review, the United Kingdom, on behalf of Europe, is in discussion with the pharmaceutical companies who manufacture methylphenidate products about the conduct of research to better characterise and further investigate the safety profile of methylphenidate. As new data emerge it will be carefully evaluated by the MHRA and where necessary current prescribing advice will be updated to reflect the new evidence.
We fully support the advice given by the National Institute of Clinical Excellence (NICE) in England on the use of drug therapy in treating children and young people with attention deficit hyperactivity disorder (ADHD) and expect the national health service to take this guidance into account when treating patients.
NICE have advised that drug therapy to treat ADHD, of which Ritalin is but one option, should only be part of a comprehensive treatment programme that includes a range of social, psychological and behavioural interventions. These are mainly aimed at the child, but sometimes involve the parents and/or teachers. NICE has recommended that drug therapy should only be initiated by an appropriately qualified healthcare professional with expertise in ADHD and should be based on a comprehensive assessment and diagnosis. Continued prescribing and monitoring of drug treatment may be performed by general practitioners, under shared care arrangements.
Psychological interventions that may be helpful include behavioural management, parent training, family and/or individual therapy, social skills training, cognitive behaviour therapy and problem solving techniques, among others. Careful, informed clinical decision-making, involving the parents and child should involve discussion of the benefits versus the risks of all interventions.
We have also asked NICE to develop a clinical guideline on both the pharmacological and psychological interventions to treat ADHD. The guideline will cover the care provided by primary, community and secondary healthcare professionals who have direct contact with, and make decisions concerning, the care of children, young people and adults with ADHD. The guideline will include:
care in general practice and NHS community care;
hospital out-patient and in-patient care;
primary/secondary interface of care; and
transition from childhood services to adult services.
Publication of the guideline is expected in July 2008.