Ritalin lung

Changed by Daniel J Bell, 25 Mar 2020

Updates to Article Attributes

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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.

Epidemiology

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 analogue 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.

Pathology

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.

Radiographic features

CT

HRCT chest classically shows panlobular emphysematous change 1,4.

History and etymology

Methylphenidate was originally synthesised 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.

Differential diagnosis

General imaging differential considerations include:

History and etymology

Methylphenidate was originally synthesised in 1944 by a Swiss chemist working in Basel, Switzerland. 

  • -<p><strong>Ritalin lung</strong> (a.k.a. <strong>methylphenidate lung</strong>) 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.</p><h4>Epidemiology</h4><p>Methylphenidate is prescribed primarily for <a href="/articles/attention-deficit-hyperactivity-disorder">attention deficit hyperactivity disorder (ADHD)</a> and <a href="/articles/narcolepsy">narcolepsy</a>, the latter being the only licensed indication in adults. It is in the piperidine class and is a structural analogue 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 <sup>5</sup>.</p><h4>Pathology</h4><p>It has not been fully elucidated why emphysematous changes develop with intravenous administration of talc-containing methylphenidate <sup>6</sup>. 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 <sup>6</sup>. However, similar emphysematous changes are not noted in <a href="/articles/excipient-lung-disease">intravenous administration of other talc-containing drugs</a>, suggesting that methylphenidate may inherently play a role in the pathogenesis of emphysema as well <sup>6</sup>.</p><h4>Radiographic features</h4><h5>CT</h5><p>HRCT chest classically shows <a href="/articles/pan-lobular-emphysematous-change">panlobular emphysematous change</a> <sup>1,4</sup>.</p><h4>Differential diagnosis</h4><p>General imaging differential considerations include:</p><ul>
  • +<p><strong>Ritalin lung</strong> (a.k.a. <strong>methylphenidate lung</strong>) 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.</p><h4>Epidemiology</h4><p>Methylphenidate is prescribed primarily for <a href="/articles/attention-deficit-hyperactivity-disorder">attention deficit hyperactivity disorder (ADHD)</a> and <a href="/articles/narcolepsy">narcolepsy</a>, the latter being the only licensed indication in adults. It is in the piperidine class and is a structural analogue 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 <sup>5</sup>.</p><h4>Pathology</h4><p>It has not been fully elucidated why emphysematous changes develop with intravenous administration of talc-containing methylphenidate <sup>6</sup>. 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 <sup>6</sup>. However, similar emphysematous changes are not noted in <a href="/articles/excipient-lung-disease">intravenous administration of other talc-containing drugs</a>, suggesting that methylphenidate may inherently play a role in the pathogenesis of emphysema as well <sup>6</sup>.</p><h4>Radiographic features</h4><h5>CT</h5><p>HRCT chest classically shows <a href="/articles/pan-lobular-emphysematous-change">panlobular emphysematous change</a> <sup>1,4</sup>.</p><h4>History and etymology</h4><p>Methylphenidate was originally synthesised 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 <sup>7</sup>.</p><h4>Differential diagnosis</h4><p>General imaging differential considerations include:</p><ul>
  • -</ul><h4>History and etymology</h4><p>Methylphenidate was originally synthesised in 1944 by a Swiss chemist working in Basel, Switzerland. </p>
  • +</ul>

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