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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.
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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:
- alpha-1-antitrypsin deficiency: lung changes can be almost indistinguishable on imaging 1
- vanishing lung syndrome: tends to have more giant bullous spaces with paraseptal emphysema 3
- 1. Stern EJ, Frank MS, Schmutz JF et-al. Panlobular pulmonary emphysema caused by i.v. injection of methylphenidate (Ritalin): findings on chest radiographs and CT scans. AJR Am J Roentgenol. 1994;162 (3): 555-60. AJR Am J Roentgenol (abstract) - Pubmed citation
- 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