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Use of Methylphenidate in a Patient With Glaucoma and Attention-Deficit Hyperactivity Disorder: A Clinical Dilemma

Barbara Bartlik, MD; Gregory Harmon, MD; Peter Kaplan, MD
Arch Gen Psychiatry. 1997;54(2):188-189. doi:10.1001/archpsyc.1997.01830140100018.
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Methylphenidate hydrochloride (Ritalin), the drug of choice for attention-deficit hyperactivity disorder (ADHD), is contraindicated in patients with glaucoma on a theoretical, class-labeling basis. As methylphenidate had been, until recently, primarily prescribed to children, the consideration of prescribing it to patients with glaucoma rarely has arisen. However, as ADHD is being diagnosed and treated in more adults, this is becoming a treatment issue.

Moreover, stimulants are being used for the treatment of drug-induced and other sexual dysfunctions on an as-needed basis.1-3 When used cautiously in conjunction with glaucoma medications and regular ophthalmologic monitoring, methylphenidate and other psychostimulants may be safe in patients with well-controlled, open-angle glaucoma. The following is an example, as well as a practical solution, to this problem.

Report of a Case.  A 55-year-old male writer with primary open-angle glaucoma was receiving methylphenidate hydrochloride, 25 mg per day, for ADHD. Although his IQ placed him in the gifted


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