Indications : התוויות

4.1. Therapeutic indications
Attention deficit hyperactivity disorder (ADHD):
Ritalin 10 mg tablets
Ritalin LA modified-release capsules (10mg, 20mg, 30mg, 40mg)
Narcolepsy:
Ritalin 10 mg tablets only
General

Attention-Deficit/Hyperactivity Disorder (ADHD, DSM-IV)
ADHD was previously known as attention-deficit disorder or minimal brain dysfunction.
Other terms used to describe this behavioural syndrome include: hyperkinetic disorder, minimal brain damage, minimal cerebral dysfunction, minor cerebral dysfunction and psycho- organic syndrome of patients. Ritalin is indicated as part of a comprehensive treatment programme which typically includes psychological, educational, and social measures and is aimed at stabilising patients with a behavioural syndrome characterised by moderate to severe distractibility, short attention span, hyperactivity, emotional lability, and impulsivity. The diagnosis should be made according to DSM-IV criteria or the guidelines in ICD-10. Non- localising (soft) neurological signs, learning disability, and abnormal EEG may or may not be present, and a diagnosis of central nervous system dysfunction may or may not be warranted.

Special Diagnostic Considerations for ADHD in children
The specific aetiology of this syndrome is unknown, and there is no single diagnostic test.
Proper diagnosis requires medical and neuropsychological, educational, and social investigation. Characteristics commonly reported include: history of short attention span, distractibility, emotional lability, impulsivity, and moderate-to-severe hyperactivity, minor neurological signs, and abnormal EEG. Learning may or may not be impaired. The diagnosis must be based upon a complete history and evaluation of the child and not solely on the presence of one or more of these characteristics. Drug treatment is not indicated in all children with this syndrome. Stimulants are not indicated in children with symptoms secondary to environmental factors (child abuse in particular) and/or primary psychiatric disorder, including psychosis. Appropriate educational placement is essential, and psychosocial intervention is generally necessary. Where remedial measures alone prove insufficient, the decision to prescribe a stimulant must be based on rigorous assessment of the severity of the child's symptoms.
RIT API 11APR24 V14           Page 2 of 23           reference: New Zealand Data Sheet Jan.2024 Special Diagnostic Considerations for ADHD in adults
Adults with ADHD have symptom patterns characterised by shifting activities, being bored easily, restlessness, impatience, and inattentiveness. Symptoms such as hyperactivity tend to diminish with increasing age possibly due to adaptation, neurodevelopment and self- medication. Inattentive symptoms are more prominent and have a greater impact on adults with ADHD. Diagnosis in adults should include a structured patient interview to determine current symptoms. The pre-existence of childhood ADHD is to be determined retrospectively.
Diagnosis should not be made solely on the presence of one or more symptoms. The decision to use a stimulant in adults must be based on a very thorough assessment of the severity and chronicity of the symptoms and their impact on the daily life of the patient.
Narcolepsy (Ritalin 10 mg tablets only)
Symptoms include daytime sleepiness, inappropriate sleep episodes, and sudden loss of voluntary muscle tone.