Ritalin lung (a.k.a. methylphenidate lung) describes pulmonary changes induced by the illicit injection of talc-containing methylphenidate, the most commonly known brand being Ritalin, although many brand names are used globally.
Methylphenidate is prescribed primarily for attention deficit hyperactivity disorder (ADHD) and narcolepsy, the latter being the only licensed indication in adults. It is in the piperidine class and is a structural analog of amphetamine. It is used globally and marketed under multiple different brands, a well-known one being Ritalin. Off-label use forms an increasingly large proportion of prescriptions 5.
It has not been fully elucidated why emphysematous changes develop with intravenous administration of talc-containing methylphenidate 6. It has been suggested that exposure to talc either results in alveolar destruction via talc granulomatosis or that there is a secondary infection relating to talc exposure resulting in production of elastases resulting in alveolar destruction 6. However, similar emphysematous changes are not noted in intravenous administration of other talc-containing drugs, suggesting that methylphenidate may inherently play a role in the pathogenesis of emphysema as well 6.
HRCT chest classically shows panlobular emphysematous change 1,4.
History and etymology
Methylphenidate was originally synthesized in 1944 by Leandro Pannizon, a Swiss chemist working in Basel, Switzerland. His wife Marguerite, who suffered from low blood pressure, used methylphenidate as a stimulant before she played a game of tennis. His wife's nickname was Rita, and Pannizon named the drug after her 7.
General imaging differential considerations include:
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- 2. Sherman CB, Hudson LD, Pierson DJ. Severe precocious emphysema in intravenous methylphenidate (Ritalin) abusers. Chest. 1987;92 (6): 1085-7. doi:10.1378/chest.92.6.1085 - Pubmed citation
- 3. Sharma N, Justaniah AM, Kanne JP et-al. Vanishing lung syndrome (giant bullous emphysema): CT findings in 7 patients and a literature review. J Thorac Imaging. 2009;24 (3): 227-30. doi:10.1097/RTI.0b013e31819b9f2a - Pubmed citation
- 4. Schmidt RA, Glenny RW, Godwin JD et-al. Panlobular emphysema in young intravenous Ritalin abusers. Am. Rev. Respir. Dis. 1991;143 (3): 649-56. - Pubmed citation
- 5. Trenque T, Herlem E, Abou Taam M, Drame M. Methylphenidate off-label use and safety. (2014) SpringerPlus. 3: 286. doi:10.1186/2193-1801-3-286 - Pubmed
- 6. Nguyen VT, Chan ES, Chou SH, Godwin JD, Fligner CL, Schmidt RA, Pipavath SN. Pulmonary effects of i.v. injection of crushed oral tablets: "excipient lung disease". (2014) AJR. American journal of roentgenology. 203 (5): W506-15. doi:10.2214/AJR.14.12582 - Pubmed
- 7. Richard Leroy Myers, Rusty L. Myers. The 100 Most Important Chemical Compounds. (2020) ISBN: 9780313337581