Methylphenidate, a stimulant drug used to treat fatigue in cancer patients, has been shown to be of not much use, according to the results of a phase-III study published online on July 12 in the Journal of Clinical Oncology.

The researchers compared the benefits of methylphenidate, which is marketed as Ritalin, in 148 adults, with a variety of cancers and stages of cancer with a placebo over a period of four weeks.

Patients in the study group were given one 18 mg tablet a day for the first week; two tablets a day for the second week, and three tablets a day for the third and fourth weeks, so that they reached the goal dose of 54 mg/day by the final two weeks of the study.

When analysed after four weeks, the investigators found that methylphenidate, when compared to the placebo, did not significantly improve cancer-related fatigue in the selected patient population.

For those patients with the highest levels of ‘worst’ fatigue, the mean change in usual fatigue was 26 with methylphenidate, and 16 with the placebo; however, this difference was not statistically significant, report the authors.

Toxicities were also a concern with this drug as it caused increased levels of nervousness and appetite loss in the methylphenidate group.

"I cannot recommend methylphenidate. It caused toxicities and had no clear benefit. Having said this, I can understand how some physicians would decide to treat patients with this," Charles Loprinzi, MD, from the Mayo Clinic, the senior author of this new study, was quoted as saying.

Patients may require a combination of counselling, increased physical activity, correction of hormonal and metabolic abnormalities, and pharmacologic interventions aimed at body composition, inflammation and brain function, according to Eduardo Bruera, MD, and Sriram Yennurajalingam, MD, from the University of Texas’ M.D. Anderson Cancer Center in Houston.

"Fatigue is a complex multidimensional symptom, and it is therefore unlikely to be successfully managed with single pharmacologic or non-pharmacologic interventions," they write.