Today a large part of the population knows or has heard of attention-deficit hyperactivity disorder or ADHD, a neurodevelopmental disorder characterized by problems maintaining attention and the presence of hyperactivity and impulsivity.

However, what is not so well known is that deep down these problems (certainly involuntary and beyond the control of the child, not being something voluntary) are linked to slower development of the front end, which governs executive functions including capabilities such as behavioral inhibition.

Although psycho-educational and psychological approaches are or should always be prioritized, sometimes drugs are prescribed that activate the frontal areas, facilitating better control of the situation in cases where it is deemed necessary. One of these drugs is Rubifen, which we will discuss throughout this article .

What is Rubifen?

Rubifen is the name of a psychoactive drug, a substance with moderate stimulant properties, which is used primarily in the treatment of attention deficit hyperactivity disorder.

This is one of the drugs synthesized based on methylphenidate, its active ingredient, which in turn is a product related to amphetamines . It acts by causing the activation of areas of the brain which, in those people who are prescribed it, are usually hypoactive. That is why, although it is stimulating in people with certain neurodevelopmental disorders, it usually causes them to be calmer.

Although it is often used in children, it is generally not reached unless other types of (non-pharmacological) therapy fail, and regular monitoring of cardiovascular health and growth must be done because of the possible side effects and problems that can arise through its use. However, in some cases it may be necessary and facilitate better psychosocial development, particularly in the most extreme cases and where functionality is very limited.

Also, the use of drugs of this type is subject to strong controversy due to the overdiagnosis of the disorders that justify their use, sometimes being applied to people who would not really have needed them. It is therefore essential to make an exhaustive assessment before deciding on the use of Rubifen and similar drugs, especially when we are talking about children, in the growth stage.

Rubifen can be found in different presentations, mainly capsules and tablets either immediate or extended release . It generally lasts between two and four hours and is mostly eliminated through the kidney, although to a lesser extent through the faeces.

Unfortunately, Rubifen is also known to be used as a stimulant drug, easily leading to situations of abuse and dependency despite being marketed only by prescription. In fact, it is sometimes called “the cocaine of the poor”, and this can have severe repercussions on health when used recreationally.

Main indications

Rubifen is a drug whose main therapeutic indication is attention deficit hyperactivity disorder, although as we have indicated it is only used if other strategies fail. However, it should be taken into account that cannot be used by all children with this problem , since if certain symptoms are present the use of this drug could worsen them (for example, tics and mannerisms). It is used in children over six years of age, and is not indicated for minors or adults with ADHD.

It may be surprising that a disorder known for impulsivity and hyperactivity has as a drug an activating and stimulating substance, but this is because in ADHD some areas of the brain are hypoactive (especially the prefrontal) and functions such as inhibiting behaviour, planning or even attention and concentration have not yet developed in a neurotypical way. Thus, Rubifen activates these areas, facilitating impulse control.

Although not an approved indication, this drug has also been used on occasion to treat cases of narcolepsy, even in adult subjects.

Mechanism of action

Rubifen, and methylphenidate in general, exerts its activity through an activating action mechanism that has effects on the brain stem and cortex.

This mechanism of action is not fully understood, but it is based on inhibiting the reuptake of dopamine and noradrenaline and stimulating their synthesis. That is, by preventing these monoamines from being recaptured by the presynaptic neuron, they cause dopamine and noradrenaline to remain in the synaptic space and thus to be used. The levels of these two neurotransmitters increase, which also causes the brain activity to increase. This drug seems to be especially relevant in its effects on the prefrontal, something that contributes to improving the functioning of executive functions and attention .

In addition, it also has a minor effect on serotonin, increasing it slightly, something that can be used for better control of the symptoms of disorders such as narcolepsy.

Side effects

Although Rubifen is an effective drug for treating ADHD symptoms, its use can carry a number of unpleasant side effects and even risks.

Among the various side effects we can find decreased appetite, insomnia, headache, weight loss, nausea and eritemic vomiting, decreased growth or tics. It can also generate emotional lability or even in some cases mania. In addition, uncontrolled speech and movement, confusion, spasms, speech problems, blurred vision, increased irritability or constipation may occur.

Other, less common, side effects may include agitation, tachycardia, dryness, priapism or erectile dysfunction, confusion, cardiovascular problems, dyskinesia and seizures, although these are more serious and may require medical attention. Finally, it can reduce the number of blood cells, cause arterial inflammation, liver problems and impaired thinking. Very rarely, it can cause heart attacks and strokes. For all these reasons, it is necessary that if it is used, a medical control of the subject must be carried out.

Contraindications

Rubifen can be effective, but it can’t be taken by just anyone: there are sectors of the population that have it contraindicated because it could be dangerous for them .

People with an allergy or hypersensitivity to methylphenidate, those with narrow-angle glaucoma, or people with a history of cardiovascular or cerebrovascular problems should avoid consumption. It should also be avoided in the case of Tourette’s or tic disorders, since as a possible side effect tics and stereotyped movements may be enhanced. Those who suffer from thyroid problems or anorexia nervosa (since the drug reduces the feeling of hunger). Likewise is contraindicated in psychotic disorders, bipolarity or in subjects with suicidal thoughts . It should also be avoided by patients with kidney or liver problems, high blood pressure or swallowing difficulties.

Pregnant and lactating women also have it contraindicated, since transmissions of the drug in milk have been seen as well as cases of respiratory toxicity in babies and fetuses. It is also recommended to avoid its consumption during puberty, since it can cause growth problems, and also under six years old.

Bibliographic references:

  • Spanish Agency for Medicines and Healthcare Products (2017). Leaflet: Rubifen 20 mg tablets. [Online]. Available at: https://cima.aemps.es/cima/dochtml/p/65153/Prospecto_65153.html#2-qu-necesita-saber-antes-de-que-usted-o-su-hijo-empiecen-a-tomar-rubifen

  • Soutullo Esperón, C. and Álvarez Gómez, M. J. (2014). Evidence-based pharmacological treatment of ADHD. Pediatrics, XVIII 9: 634-642.