Sarhill, N., Walsh, D., Nelson, K. A., Homsi, J., LeGrand, S., Davis, M. P. (2001). Methylphenidate for fatigue in advanced cancer: a prospective open-label pilot study. American Journal of Hospice and Palliative Care, 18, 187–192.

Methylphenidate immediate release was administered at 5 mg twice daily and was titrated to effect as much as 20 or 30 mg per day if no response occurred after three and five days, respectively. Doses were given in the morning and at noon to limit insomnia. Treatment was discontinued after one week if no improvement was reported.

• In total, 11 patients were included.    
• Age ranged from 50 to 79 years.
• Men and women were included.
• Patients had various advanced malignancies.
• Ethnicity was not reported.

• Inpatient and outpatient   
• Large university cancer center

Patients were undergoing the end of life phase of care.

The study used a prospective, case series, open-label design; no comparison group was used.

• No formal fatigue measures were used.
• Patients self-reported improvement in fatigue.

Of the 11 patients, two experienced no improvement in fatigue on methylphenidate and one required 30 mg to sustain improvements in fatigue. Eight patients experienced improvements in their self-reported levels of fatigue after treatment with 10 mg daily in a divided dose.

• The study was open-label, with no randomization or control or comparison group.
• The study was a small case series.
• Six patients experienced a side effect, including insomnia (n = 5), agitation (n = 1), anorexia (n = 1), nausea and vomiting (n = 1), and dry mouth (n = 1).

No special training is required to deliver the intervention. Costs are related to drug acquisition.