NICE issues new guidelines on Ritalin
BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7269.1100 (Published 04 November 2000) Cite this as: BMJ 2000;321:1100
New guidelines from the National Institute for Clinical Excellence (NICE) for the use of methylphenidate in England and Wales advise that the drug should be used as part of a comprehensive treatment programme for children with a diagnosis of severe attention deficit hyperactivity disorder.
In its latest guidance, the institute said that an estimated 1% of school aged children—69 000 children aged 6 to 16 in England and 4200 in Wales—meet the diagnostic criteria for severe, “combined-type” attention deficit hyperactivity disorder. About 48 000 of those are not currently receiving methylphenidate (Ritalin and Equasym), and if all the children were to be prescribed it for a trial period, the cost of the drug would be an estimated £7m ($9.8m).
Andrew Dillon, NICE's chief executive, said, “The institute's guidance is based on a very careful consideration of the evidence presented to the appraisal committee. I hope that it will be welcomed both by the families of children with ADHD and by health professionals.”
The institute said that attention deficit hyperactivity disorder should be diagnosed by a child psychiatrist or a paediatrician with expertise in the disorder, with involvement of children, parents, carers, and the child's school.
It says that children taking methylphenidate should also receive regular monitoring, and when improvement has occurred and the child's condition is stable, treatment can be discontinued, under careful specialist supervision.
Current treatments for attention deficit hyperactivity disorder include a range of social, psychological, and behavioural interventions, which can involve the child, parents, or teachers. The only drugs that are currently licensed for treating the disorder in the United Kingdom are methylphenidate and dexamphetamine, although tricyclic and other antidepressants are sometimes prescribed.
On the same day that the institute issued its guidelines on methylphenidate, it also gave advice on the treatment of hepatitis C. It recommended that NHS specialists should use a combination of interferon alfa and ribavirin to treat most people aged over 18 years with moderate to severe hepatitis C.
Mr Dillon said, “Hepatitis C is a potentially life threatening disease, and the use of these drugs in combination to treat it varies considerably across the NHS in England and Wales.”
The institute estimates that there will be about 7000 patients in England and Wales who will be treated in the first instance. Assuming that treatment of these patients is spread over three years, the drug cost would total about £55m.