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Methylphenidate
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| Systematic (IUPAC) name | |
| methyl 2-phenyl-2-(piperidin-2-yl) acetate | |
| Identifiers | |
| CAS number | |
| ATC code | N06 |
| PubChem | |
| DrugBank | |
| Chemical data | |
| Formula | C14H19NO2 |
| Mol. mass | 233. IUPAC Nomenclature is a system of naming Chemical compounds and of describing the science of Chemistry in general CAS registry numbers are unique numerical identifiers for Chemical compounds Polymers biological sequences mixtures and Alloys They are also referred to The Anatomical Therapeutic Chemical Classification System is used for the classification of drugs It is controlled by the WHO Collaborating Centre for Drug A section of the Anatomical Therapeutic Chemical Classification System containing Psychoanaleptics. PubChem is a Database of chemical Molecules The system is maintained by the National Center for Biotechnology Information (NCBI a component The DrugBank database available at the University of Alberta is a unique Bioinformatics and Cheminformatics resource that combines detailed drug (i A chemical formula is a way of expressing information about the Atoms that constitute a particular Chemical compound, and how the relationship between those atoms changes Carbon (kɑɹbən is a Chemical element with the symbol C and its Atomic number is 6 Hydrogen (ˈhaɪdrədʒən is the Chemical element with Atomic number 1 Nitrogen (ˈnaɪtɹəʤɪn is a Chemical element that has the symbol N and Atomic number 7 and Atomic weight 14 Oxygen (from the Greek roots ὀξύς (oxys (acid literally "sharp" from the taste of acids and -γενής (-genēs (producer literally begetteris the The molecular mass (abbreviated m of a substance, more commonly referred to as molecular weight and abbreviated as MW, is the Mass of one 31 g/mol |
| SMILES | & |
| Pharmacokinetic data | |
| Bioavailability | 11–52% |
| Protein binding | 30% |
| Metabolism | Liver |
| Half life | 2–4 hours |
| Excretion | Urine |
| Therapeutic considerations | |
| Pregnancy cat. |
C |
| Legal status |
Controlled (S8)(AU) Schedule III(CA) Class B(UK) Schedule II(US) |
| Routes | Oral, Transdermal, IV, Nasal |
| Indicated for: Other uses: |
Contraindications:
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| Side effects:[1][2]
Atypical sensations:
Eye:
Skin: Urogenital and reproductive: Miscellaneous:
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Methylphenidate (MPH) is a prescription stimulant commonly used to treat Attention-deficit hyperactivity disorder, or ADHD. An adverse drug reaction (abbreviated ADR) or adverse drug event (abbreviated ADE) is an expression that describes the unwanted negative consequences In Psychology, sensation is the first stage in the biochemical and neurologic events that begins with the impinging of a stimulus upon the receptor cells of a This is an article about the rock music band "Circulatory System" Dysrhythmia redirects here For the American band see Dysrhythmia (band. The ear is the sense organ that detects Sounds The Vertebrate ear shows a common biology from Fish to Humans with variations Anatomically a nose is a protuberance in Vertebrates that houses the Nostrils or nares which admit and expel air for respiration in conjunction with the In Anatomy, the throat is the anterior part of the Neck, in front of the vertebral column. The endocrine system is an integrated system of small organs that involve the release of extracellular signaling molecules known as Hormones The endocrine system is instrumental Eyes are organs that detect Light, and send signals along the Optic nerve to the visual areas of the brain Blood is a specialized Bodily fluid that delivers necessary substances to the body's cells such as nutrients and oxygen—and transports Waste products Muscle (from Latin musculus, diminutive of mus "mouse" is contractile tissue of the body and is derived from the In Biology, the skeleton is a strong and often a rigid framework that supports the body of an animal holding it upright and giving it shape and strength (Also skeletal Insomnia is a symptom of a sleeping disorder characterized by persistent difficulty falling asleep or staying asleep despite the opportunity Many different terms are often used to describe what is collectively known as dizziness. A headache ( cephalalgia in medical terminology is a condition of pain in the Head; sometimes Neck or upper back pain may also be interpreted Psychology (from Greek grc ψῡχή psȳkhē, "breath life soul" and grc -λογία -logia) is an Academic and Psychosis (from the Greek ψυχή "psyche" for mind or soul and -οσις "-osis" for abnormal condition with adjective psychotic Anxiety is a physiological and psychological state characterized by Cognitive, Somatic, Emotional and Behavioral components Euphoria is a medically recognized emotional state related to Pleasure and Happiness. In Animal physiology, respiration is the transport of Oxygen from the outside air to the cells within tissues and the transport of Carbon dioxide The skin is the outer covering of living tissue of an animal (or plant A sex organ, or primary sexual characteristic, as narrowly defined is any of the anatomical parts of the body which are involved in sexual reproduction and constitute Reproduction is the Biological process by which new individual Organisms are produced A prescription (℞ is a health-care program implemented by a Physician or other medical practitioner in the form of instructions that govern the plan of care for an individual Stimulant drugs are Drugs that temporarily increase alertness and awareness Attention-Deficit Hyperactivity Disorder (ADHD is a neurobehavioral developmental disorder affecting about 3-5% of the world's population It is also one of the primary drugs used to treat the daytime drowsiness symptoms of narcolepsy and chronic fatigue syndrome. A drug, broadly speaking is any chemical substance that when absorbed into the body Somnolence (or " drowsiness " is a state of near- Sleep, a strong desire for sleep or sleeping for unusually long periods (c Narcolepsy is a Neurological condition most characterized by Excessive Daytime Sleepiness (EDS in which a person falls asleep during the day at inappropriate Chronic fatigue syndrome ( CFS) is the most common name given to a poorly understood variably debilitating disorder or disorders of uncertain causation The drug is seeing early use to treat cancer-related fatigue. [3] Brand names of drugs that contain methylphenidate include Ritalin (Ritalina, Rilatine, Attenta, Methylin, Penid, Rubifen); and the sustained release tablets Concerta, Metadate CD, Methylin ER, Ritalin LA, and Ritalin-SR. Sustained-release ( SR) extended-release ( ER, XR, or XL) time-release or timed-release, controlled-release Focalin is a preparation containing only dextro-methylphenidate, rather than the usual racemic dextro- and levo-methylphenidate mixture of other formulations. Dexmethylphenidate (sold commercially by Novartis as Focalin also available generically in the US exclusively In Chemistry, a racemic mixture, or racemate, is one that has equal amounts of left- and right-handed enantiomers of a chiral A newer way of taking methylphenidate is by using a transdermal patch (under the brand name Daytrana), similar to those used for hormone replacement therapy, nicotine release and pain relief (fentanyl). A transdermal patch or skin patch is a Medicated Adhesive patch that is placed on the Skin to deliver a specific Dose of medication Daytrana (formerly known as MethyPatch is a medicinal patch marketed by Shire Pharmaceuticals and developed under contract by Noven Pharmaceuticals that Fentanyl is one of the most powerful Opioid Analgesics with a potency approximately 81 times that of Morphine.
Contents |
History
Methylphenidate(or ritalin) was patented in 1954 by the CIBA pharmaceutical company (now Novartis) as a potential cure for Mohr's disease. Novartis International AG is a multinational Pharmaceutical company based in Basel Switzerland that manufactures drugs such as Clozapine Beginning in the 1960s, it was used to treat children with ADHD, known at the time as hyperactivity or minimal brain dysfunction (MBD). Today methylphenidate is the most commonly prescribed medication to treat ADHD around the world. Production and prescription of methylphenidate rose significantly in the 1990s, especially in the United States, as the ADHD diagnosis came to be better understood and more generally accepted within the medical and mental health communities. [4]
Most brand-name Ritalin is produced in the United States, and methylphenidate is produced in the United States, Mexico, Argentina and Pakistan. The United States of America —commonly referred to as the The United Mexican States ( or commonly Mexico (ˈmɛksɪkoʊ () is a federal constitutional Republic in North America. For a topic outline on this subject see List of basic Argentina topics. Pakistan () officially the Islamic Republic of Pakistan, is a country located in South Asia, Southwest Asia, Middle East and Other generic forms, such as "methylin" are produced by several U. S. pharmaceutical companies. Ritalin is also sold in the United Kingdom, Germany and other European countries (although in much lower volumes than in the United States). The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located Germany, officially the Federal Republic of Germany ( ˈbʊndəsʁepuˌbliːk ˈdɔʏtʃlant is a Country in Central Europe. These generic versions of methylphenidate tend to outsell brand-name Ritalin four-to-one. In Belgium the product is sold under the name "Rilatine".
Another medicine is Concerta, a once-daily extended release form of methylphenidate, which was approved in April 2000. Studies have demonstrated that long-acting methylphenidate preparations such as Concerta are just as effective, if not more effective, than IR (instant release) formulas. [5][6][7][8] Time-release medications are also harder to misuse.
In April 2006, the FDA approved a transdermal patch for the treatment of ADHD, called Daytrana. Year 2006 ( MMVI) was a Common year starting on Sunday of the Gregorian calendar. Daytrana (formerly known as MethyPatch is a medicinal patch marketed by Shire Pharmaceuticals and developed under contract by Noven Pharmaceuticals that [9]
Indications
Methylphenidate is a central nervous system (CNS) stimulant,[10][11][12] reducing impulsive behavior, and facilitating concentration on work and other tasks. In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. Adults who have ADHD often report that methylphenidate increases their ability to focus on tasks and organize their lives.
Methylphenidate has been found to have a lower incidence of side effects than dextroamphetamine, a less commonly prescribed medication. Dextroamphetamine is a Psychostimulant which produces increased wakefulness energy and self-confidence in association with decreased fatigue and appetite [13] When prescribed at the correct dosage, methylphenidate is usually well tolerated by patients. [5]
A 2006 review assessing the safety of methylphenidate on the developing brain found that in animals with psychomotor impairments, structural and functional parameters of the dopamine system were improved with treatment. [14] This indicates that in subjects with ADHD, methylphenidate treatment may positively support brain development.
Pharmacology
Methylphenidate has binding affinity for both the dopamine transporter and norepinephrine transporter, with the D-isomer displaying a prominent affinity for the latter. The Dopamine transporter (also dopamine active transporter DAT SLC6A3 is a membrane-spanning protein that binds the Neurotransmitter Dopamine The Norepinephrine transporter or NET (or noradrenaline transporter (NAT is a Monoamine transporter that transports the Neurotransmitter Both the dextro- and levorotary isomers displayed receptor affinity for the serotonergic 5HT1A and 5HT2B subtypes, though direct binding to the serotonin transporter was not observed. Serotonergic means "related to the Neurotransmitter Serotonin " The Serotonin transporter (SERT is a Monoamine transporter Protein. [15]
The isomeric profiles and relative usefulness of dextro- and levo-methylphenidate is analogous to what is found in amphetamine, where dextro-amphetamine is considered to have a more beneficial effect than levo-amphetamine.
Mode of action
The means by which methylphenidate affects people diagnosed with ADHD are not well understood. Some researchers have theorized that ADHD is caused by a dopamine imbalance in the brains of those affected. Dopamine is a Hormone and Neurotransmitter occurring in a wide variety of animals including both vertebrates and invertebrates The brain is the center of the Nervous system in animals All Vertebrates and the majority of Invertebrates have a brain Methylphenidate is a norepinephrine and dopamine reuptake inhibitor, which means that it increases the level of the dopamine neurotransmitter in the brain by partially blocking the dopamine transporter (DAT) that removes dopamine from the synapses. Dopamine Reuptake Inhibitors ( DARI) Dopamine Uptake Inhibitors, Dopamine Transporter Inhibitors are compounds that inhibit the Reuptake of extracellular See Chemical synapse for an introduction to concepts and terminology used in this article Chemical synapses are specialized junctions through which Neurons signal to each other and to non-neuronal cells such as those in Muscles or Glands [16] This inhibition of DAT blocks the reuptake of dopamine and norepinephrine into the presynaptic neuron, increasing the amount of dopamine in the synapse. It also stimulates the release of dopamine and norepinephrine into the synapse. Finally, it increases the magnitude of dopamine release after a stimulus, increasing the salience of stimulus. The stimulants do not work paradoxically. They stimulate portions of the brain that are underactive by increasing dopamine and norepinephrine in the striatum and prefontal cortex. An alternate explanation which has been explored is that the methylphenidate affects the action of serotonin in the brain. Serotonin (ˌsɛrəˈtoʊnən ( 5-hydroxytryptamine, or 5-HT) is a Monoamine Neurotransmitter synthesized in serotonergic Neurons [17]
Side effects
Reported methylphenidate abuse side effects include psychosis (abnormal thinking or hallucinations), difficulty sleeping, mood swings, mood changes, stomach aches, diarrhea, headaches, increased sex drive, lack of hunger (leading to weight loss) and dry mouth. An adverse drug reaction (abbreviated ADR) or adverse drug event (abbreviated ADE) is an expression that describes the unwanted negative consequences Psychosis (from the Greek ψυχή "psyche" for mind or soul and -οσις "-osis" for abnormal condition with adjective psychotic [18]
Less common side effects include palpitations, high blood pressure and pulse changes. A palpitation (medical term ectopic heart beat) is an abnormal awareness of the beating of the Heart, whether it is too slow too fast irregular
Known or suspected risks to health
Researchers have also looked into the role of methylphenidate in affecting stature, with some studies finding slight decreases in height acceleration. [19] Other studies indicate height may normalize by adolescence. [20][21] In a 2005 study, only "minimal effects on growth in height and weight were observed" after 2 years of treatment. "No clinically significant effects on vital signs or laboratory test parameters were observed. "[22]
A 2003 study tested the effects of d-methylphenidate (Focalin), l-methylphenidate, and d, l-methylphenidate (Ritalin) on mice to search for any carcinogenic effects. Dexmethylphenidate (sold commercially by Novartis as Focalin also available generically in the US exclusively The researchers found that all three compounds were non-genotoxic and non-clastogenic; d-MPH, d, l-MPH, and l-MPH did not cause mutations or chromosomal aberrations. They concluded that none of the compounds present a carcinogenic risk to humans. [23]
In February 2005, a team of researchers from The University of Texas M. D. Anderson Cancer Center led by R. The University of Texas M D Anderson Cancer Center is one of the nation's original three comprehensive Cancer centers established by the National Cancer Act of 1971 A. El-Zein announced that a study of 12 children indicated that methylphenidate may be carcinogenic. In the study, 12 children were given standard therapeutic doses of methylphenidate. At the conclusion of the 3-month study, all 12 children displayed significant treatment-induced chromosomal aberrations. The researchers indicated that their study was relatively small and their results needed to be reproduced in a bigger population for a definitive conclusion about the genotoxicity of methylphenidate to be drawn. [24]
In response to the El-Zein study published in 2005, a team of six scientists from the Department of Child and Adolescent Psychiatry and Psychotherapy and the Department of Toxicology, University of Würzburg, Würzburg, Germany began a more in-depth study. The University of Würzburg is a university in Würzburg, Germany, founded in 1402 They sought to respond to the challenge noted above to attempt to replicate the results of El-Zein et al. in a larger study. Their paper was completed in 2006 and published in 2007 in Environmental Health Perspectives (EHP), the peer-reviewed journal of the United States' National Institute of Environmental Health Sciences. Environmental Health Perspectives (EHP is a peer-reviewed journal of the United States' National Institute of Environmental Health Sciences, published monthly The National Institute of Environmental Health Sciences (NIEHS is one of 27 Institutes and Centers of the National Institutes of Health (NIHwhich is a component of the Department This study used a larger cohort and a longer period of follow-up and included a small group of long-term users, but otherwise used what researchers believed to be an identical methodology to that used by El-Zein et al. (They note that El-Zein et al. published a short study report and did not publish detailed descriptions of methodology. ) After follow-ups at six months, the researchers found no evidence that methylphenidate might cause cancer, stating "the concern regarding a potential increase in the risk of developing cancer later in life after long-term MPH treatment is not supported". [25]
The effects of long-term methylphenidate treatment on the developing brains of children with ADHD is the subject of study and debate. [26][27] Although the safety profile of short-term methylphenidate therapy in clinical trials has been well established, repeated use of psychostimulants such as methylphenidate is less clear.
In the United States, methylphenidate is classified as a Schedule II controlled substance, the designation used for substances that have a recognized medical value but present a high likelihood for abuse because of their addictive potential. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control A controlled substance is generally a drug or chemical whose manufacture possession and use are regulated by a government Internationally, methylphenidate is a Schedule II drug under the Convention on Psychotropic Substances. The Convention on Psychotropic Substances is a United Nations Treaty designed to control Psychoactive drugs such as Amphetamines Barbiturates [28] Methylphenidate has been used illegally by students for whom the drug has not been prescribed, to assist with coursework and examinations. [29] The use of ADHD medication in children under the age of 6 has not been studied. Severe hallucinations may occur. ADHD symptoms include hyperactivity and difficulty holding still and following directions; these are also characteristics of a typical child under the age of 6. For this reason it may be more difficult to diagnose young children, and caution should be used with this age group. [30]
On March 22, 2006 the FDA Pediatric Advisory Committee decided that medications using methylphenidate ingredients do not need black box warnings about their risks, noting that "for normal children, these drugs do not appear to pose an obvious cardiovascular risk. Events 238 - Gordian I and his son Gordian II are proclaimed Roman emperor. Year 2006 ( MMVI) was a Common year starting on Sunday of the Gregorian calendar. "[31] Previously, 19 possible cases had been reported of Cardiac arrest linked to children taking methylphenidate[32] and the Drug Safety and Risk Management Advisory Committee to the FDA recommend a "black-box" warning in 2006 for stimulant drugs used to treat attention deficit/hyperactivity disorder. A cardiac arrest, also known as cardiorespiratory arrest, cardiopulmonary arrest or circulatory arrest, is the abrupt cessation of normal circulation of In the United States, a black box warning (also sometimes called a black label warning or boxed warning) is a type of warning that appears on the Package [33]
Delivery
Ritalin: 5 mg, 10 mg, and 20 mg tablets;
Ritalin SR: 20 mg tablets;
Ritalin LA: 10 mg, 20 mg, 30 mg, and 40 mg capsules;
Attenta: 10mg tablets;
Methylin: 5 mg, 10 mg, and 20 mg tablets;
Methylin ER: 10 mg and 20 mg tablets;
Metadate ER: 10 mg and 20 mg tablets;
Metadate CD: 10 mg, 20 mg, 30 mg, 40 mg, and 60 mg capsules;
Concerta: 18 mg, 27 mg, 36 mg and 54 mg tablets;[34] (goes off patent in 2018)[35]
Equasym: 5 mg, 10 mg ,20 mg, and 30 mg tablets;
Rubifen: 5 mg, 10 mg, and 20 mg tablets;
Daytrana: 10 mg, 15 mg, 20 mg, and 30 mg patches
Criticism
Methylphenidate is frequently used in the treatment for ADHD, and as such criticism of the drug is typically related to the controversy about ADHD. Daytrana (formerly known as MethyPatch is a medicinal patch marketed by Shire Pharmaceuticals and developed under contract by Noven Pharmaceuticals that Attention-deficit hyperactivity disorder (ADHD is one of the most controversial psychiatric disorders despite being a well validated clinical diagnosis Attention-Deficit Hyperactivity Disorder (ADHD is a neurobehavioral developmental disorder affecting about 3-5% of the world's population
Generally criticism of methylphenidate revolves around the alleged or established side effects. Concerns about illicit use of the drug and the ethics of giving psychotropic drugs to children to reduce ADHD symptoms. A psychoactive drug or psychotropic substance is a Chemical substance that acts primarily upon the Central nervous system where it alters Brain [36] Others wonder if the medication is a gateway drug to substance abuse although this contention has been discredited. [37][38]
According to an article in the Los Angeles Times, "the uproar over Ritalin was triggered almost single-handedly by the Scientology movement. The Los Angeles Times (also known as the LA Times) is a daily Newspaper published in Los Angeles California and distributed Scientology is a body of beliefs and related practices initially created by American Science fiction author L "[39] The Citizens Commission on Human Rights, an antipsychiatry group associated with Scientology, conducted a major campaign against Ritalin in the 1980s and lobbied Congress for an investigation of Ritalin. See also Scientology and psychiatry The Citizens Commission on Human Rights (CCHR also sometimes known as the Citizens [39]
See also
- Ethylphenidate
- Psychoactive drug
- Stimulant
- Amphetamine
- Methamphetamine
- Benzedrine
- Controversy about ADHD
- Pemoline
References
- ^ Methylphenidate - Oral (Ritalin) side effects, medical uses and drug interactions. Enantiomeric (dl- threo - Ethylphenidate is a potent psychostimulant that acts as both a Dopamine reuptake inhibitor and Norepinephrine A psychoactive drug or psychotropic substance is a Chemical substance that acts primarily upon the Central nervous system where it alters Brain Stimulant drugs are Drugs that temporarily increase alertness and awareness Amphetamine, and related drugs such as Methamphetamine are a group of drugs that act by increasing levels of Norepinephrine, Serotonin, and Dopamine Benzedrine is the trade name of the Racemic mixture of Amphetamine (dl-amphetamine Attention-deficit hyperactivity disorder (ADHD is one of the most controversial psychiatric disorders despite being a well validated clinical diagnosis Pemoline (sold as Cylert) is a medication used to treat Attention-deficit hyperactivity disorder (ADHD and Narcolepsy. Retrieved on 2007-11-02. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1570 - A Tidal wave in the North Sea devastates the coast from Holland to Jutland, killing more than 1000
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- ^ "An Old Drug May Give Cancer Patients a Lift", ACS News Center, American Cancer Society, 2002-01-24. See also 2002 (disambiguation Year 2002 ( MMII) was a Common year starting on Tuesday of the Gregorian calendar. Events 41 - Gaius Caesar (Caligula, known for his eccentricity and cruel Despotism, is Assassinated by his disgruntled Retrieved on 2008-02-24. 2008 ( MMVIII) is the current year in accordance with the Gregorian calendar, a Leap year that started on Tuesday of the Common Events 303 - Galerius, Roman Emperor, publishes his edict that begins the persecution of Christians in his portion of the
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- ^ Wilens, T. E. . , et al. (2003). "Does Stimulant Therapy of Attention-Deficit/Hyperactivity Disorder Beget Later Substance Abuse? A Meta-analytic Review of the Literature". PEDIATRICS. 2003 Vol. 111 No. 1:pp. 179-185
- ^ Russell A. Barkley, PhD,et al. (2003). "Does the Treatment of Attention-Deficit/Hyperactivity Disorder With Stimulants Contribute to Drug Use/Abuse? A 13-Year Prospective Study". PEDIATRICS. 2003 Vol. 111 No. 1: pp. 97-109
- ^ a b Sappell, Joel; Welkos, Robert W. . "Suits, Protests Fuel a Campaign Against Psychiatry", Los Angeles Times, 1990-06-29, p. The Los Angeles Times (also known as the LA Times) is a daily Newspaper published in Los Angeles California and distributed Year 1990 ( MCMXC) was a Common year starting on Monday (link displays the 1990 Gregorian calendar) Events 512 - A Solar eclipse is recorded by a monastic chronicler in Ireland. A48:1. Retrieved on 2006-11-29. Year 2006 ( MMVI) was a Common year starting on Sunday of the Gregorian calendar. Events 1777 - San Jose California, is founded as el Pueblo de San José de Guadalupe Backup copy link here
External links
- Department of Energy 1998 September 29 press release on Ritalin at Brookhaven National Laboratory
- www.Erowid.org Online library of psychoactive plants, chemicals and related topics from Erowid.org
- www.HarmReduction.org A coalition of harm reduction advocates with resources and insightful help for those dealing with drug issues as well as those trying to provide help. Events 522 BC - Darius I of Persia kills the Magian usurper Gaumâta securing his hold as king of the Persian Empire. Brookhaven National Laboratory ( BNL) is a United States national laboratory located in Upton New York on Long Island, and was formally established A psychoactive drug or psychotropic substance is a Chemical substance that acts primarily upon the Central nervous system where it alters Brain Erowidorg, also called The Vaults of Erowid, is an online Library of information about psychoactive plants and chemicals. Harm reduction is a Philosophy of Public health, intended to be a progressive alternative to the prohibition of certain potentially dangerous ]
- www.DanceSafe.org A community-driven information project from the rave culture.
- Ritalin Helps Doctor Beat His Cancer-Related Fatigue, 2002/06/13, from Cancer. org "Writing in the medical journal The Oncologist (Vol. 7: 96), Robert Wharton MD, a pediatrician, described his battle with cancer and the overwhelming fatigue he experienced. "
- Ritalin addiction resource from Myaddiction. com
Dictionary
methylphenidate
-noun
- (medicine) A stimulant used to treat attention-deficit hyperactivity disorder
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