Stimulant medication improves hyperactivity, inattention, and impulsivity in both pediatric and adult populations with
Attention Deficit Hyperactivity Disorder (
ADHD). However, data regarding the optimal dosage in adults is still limited.
CASE PRESENTATION: We report the case of a 38-year-old Caucasian patient who was diagnosed with
Attention Deficit Hyperactivity Disorder when he was nine years old. He then received up to 10 mg
methylphenidate (Ritalin®) and 20 mg sustained-release
methylphenidate (
Ritalin SR®) daily. When he was 13, his medication was changed to
desipramine (Norpramin®), and both Ritalin® and
Ritalin SR® were discontinued; and at age 18, when he developed obsessive-compulsive symptoms, his medication was changed to
clomipramine (Anafranil®) 75 mg daily. Still suffering from inattention and hyperactivity, the patient began college when he was 19, but did not receive stimulant medication until three years later, when Ritalin® 60 mg daily was re-established. During the 14 months that followed, he began to use Ritalin® excessively, both orally and rectally, in dosages from 4800-6000 mg daily. Four years ago, he was referred to our
outpatient service, where his
Attention Deficit Hyperactivity Disorder was re-evaluated. At that point, the patient's daily Ritalin® dosage was reduced to 200 mg daily orally, but he still experienced pronounced symptoms of,
Attention Deficit Hyperactivity Disorder so this dosage was raised again. The patient's plasma levels consistently remained between 60-187 nmol/l-within the recommended range-and signs of his obsessive-compulsive symptoms diminished with
fluoxetine 40 mg daily. Finally, on a dosage of 378 mg extended-release
methylphenidate (Concerta®), his symptoms of
Attention Deficit Hyperactivity Disorder have improved dramatically and no further use of
methylphenidate has been recorded during the 24 months preceding this report.
CONCLUSIONS: