dgreen@squid (Dan R. Greening) (10/06/89)
I have a friend who has been having emotional problems connected with
his AIDS diagnosis and his family. He recently saw a psychiatrist to sort
out some of the problems. To deal with his chronic fatigue, the psychiatrist
prescribed Ritalin.
My friend, when diagnosed with AIDS, had a helper T count of 180. After months
on AZT, his helper T count stabilized at 600. After starting the Ritalin
therapy, his helper T count jumped up to 750, where it has remained for the
last month.
My friend claims to feel much less tired, and is functioning better. He now
works a 9 to 5 job. I'm not sure the Ritalin helped him with the
psychological problems, but it appears to have helped with some physical
problems associated with AIDS.
Much to the dismay of my friend's psychiatrist, he has experimented with
the dosage level on his own (with the help of a Physician's Desk Reference,
I should add). He is taking a slightly higher dosage than his psychiatrist
recommended. I want to point out that my friend was very careful about
adjusting the dosage, and kept within the PDR recommended dosage levels.
He has had problems obtaining Ritalin, because it is not an approved drug for
AIDS and because it is on the controlled substance list (I believe it is a
member of the amphetamine family). He contacted a sales representative for
Ciba-Geigy to ask them what could be done about getting Ritalin on the
approved substance list for AIDS. The representative told him that Ciba-Geigy
was not willing to invest research energy in Ritalin because the patent had
expired, and much of the profits that would accrue from the new application
would go to generic manufacturers. The approval time for new applications
has been on the order of 6 years, he said. (Yes, I know this isn't true
for many AIDS drugs...but that's what he said).
The representative said that if a physician published research on
Ritalin showing it to be effective in raising T cell counts, that would
improve the willingness of other physicians to prescribe.
The evidence for Ritalin is extremely anecdotal. I've only heard of it
being used in a couple of cases. However, since my friend has had good
experiences with it, I thought it would be appropriate to report them.
Play safe.
--
Dan Greening dgreen@cs.ucla.edu NY 914-789-7620 | 308 Westwood Plaza, Box 117
CA 213-825-2266 | Los Angeles, CA 90024-1647dyer@ursa-major.SPDCC.COM (10/06/89)
Methylphenidate (Ritalin) is an amphetamine-like drug, and is placed in the
DEA's Schedule II along with the amphetamines. Strictly speaking, there
is nothing preventing a physician from prescribing Ritalin for AIDS-related
fatigue, but the paperwork and paranoia which surround most C-II prescriptions
might very well cause her to be less than enthusiastic to try it. There is
also the legitimate concern that such a stimulant might aggravate the anorexia
which often accompanies AIDS. Ritalin suppresses appetite somewhat less than
amphetamine or methamphetamine, but it may be enough to cause problems in
people with AIDS who are already losing weight. Finally, this class of drugs
frequently encourages increasing the dose, as some degree of tolerance kicks
in. You have to be a little careful with that.
An alternative drug which may be useful in combatting AIDS-related fatigue is
pemoline (Cylert). It is an amphetamine-like drug which like Ritalin is used
in attention-deficit disorder (was: "hyperactivity"). It is also a controlled
substance, but is in Schedule IV, indicating low abuse potential, at least
relative to those in Schedules II and III. Unlike those in C-II, C-IV drugs
can be prescribed over the phone and can be refilled up to five times in six
months. Thus, it may be more convenient for both the doctor and patient.
In addition, unlike Ritalin, it has a long half-life, requiring only once-a-
day administration.
---
Steve Dyer
dyer@ursa-major.spdcc.com aka {ima,harvard,rayssd,linus,m2c}!spdcc!dyer
dyer@arktouros.mit.edu, dyer@hstbme.mit.edugeb@cadre.dsl.pitt.edu (Gordon E. Banks) (10/06/89)
In article <27802@shemp.CS.UCLA.EDU> dgreen@squid (Dan R. Greening) writes: >out some of the problems. To deal with his chronic fatigue, the psychiatrist >prescribed Ritalin. > >He has had problems obtaining Ritalin, because it is not an approved drug for >AIDS and because it is on the controlled substance list (I believe it is a Your friend may want to suggest to his doctor that he try Cylert. I have used it successfully to treat fatigue in MS patients. Cylert is not nearly as hard to get as Ritalin, plus it is long acting, so one or two doses per day will do. I have found 18.75 mg daily usually adequate. More often makes the patient insomniac. Amantadine is another possibility, and isn't a controlled substance.