Comparison of the Effects and Side Effects of Different Doses of Propranolol in Combination with Methylphenidate in 6-12 y Children Affected by ADHD

Document Type : Original Article


Department of Psychiatry, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.


Background and Objective: Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common childhood psychiatric disorders. The low dose of propranolol is relatively effective in reducing ADHD symptoms. This study compares effect of different doses of propranolol in combination with methylphenidate among children with ADHD.
Subjects and Methods: Thirty children with ADHD were randomly categorized in two equal groups. All members of the first group received methylphenidate plus low dose propranolol (10-20mg/day) and all members of the second group received methylphenidate plus high dose propranolol (20-40mg/day). The symptoms were scored based on Conners scale at the beginning and at the end of the second and fourth weeks; and the therapeutic effects and side effects were determined.
Results: Conners scores decreased significantly in both groups at the end of the second and fourth weeks (P<0.05). The high dose propranolol group showed more decline in Conners scores than the first group at the end of the second and fourth weeks. The second group had 32% and 50% decline in average  Conners scores, compared to baseline, at the end of the second  and fourth weeks, respectively, and these results were 20 and 37% decline in Conners scores at the same time for first group, respectively (P=0.001). The blood pressure, pulse rate and prevalence of adverse effects showed no significant difference between two groups (P >0.05).
Conclusions: The results suggest thathigher dose of propranolol are more effective in reducing ADHD symptoms in comparison to the lower doses with no additional adverse effects.


1-Sadock BG, Sadock VA. Kaplan and Sadock's Synopsis of psychiatry, behavioral clinical psychiatry.10th ed. Philadelphia (PA): Lippincott, Williams & Wilkins; 2007: P. 1206-17.
2-Greenhill LL, Hechtman LI. Attention-Deficit/Hyperactivity Disorder. In: Sadock BJ, Sadock VA, Ruiz P. (eds).  Comprehensive Text Book of Psychiatry. 9th ed. Philadelphia: Lippincott, Williams & Wilkins 2009: 3560-72.
3-Faraone SV, Sergeant J, Gillbery C. ‘et al’. The worldwide Prevalence of ADHD: Is it an American condition?  World Psychiatry 2003 Jun; 2(2): 104-13.
4-Skounti M, Philalithis A, Galanakis E. Variations in prevalence of attention deficit hyperactivity disorder worldwide. Eur J pediatr  2007 Feb; 166(2): 117-23.
5-Tashakori A, Afkandeh R. prevalence of ADHD symptoms among male preschoolers based on different informants in Ahvaz city in Iran. ISRN Pediatrics 2011 july. Hindawi Publishing Corporation.‘ Available at;. Accessed Sep 28, 2014.
6-Anderson GM, Martin A. Neurochemistry Pharmacodynamic and biological psychiatry Spetie L, Arnold LE. Attention-Deficit/Hyperactivity Disorder. In: Martin A, Volkmar FR. Lewis's Child and Adolescent Psychiatry: A Comprehensive Textbook, 4th ed. Philadelphia: Lippincott, Williams & Wilkins; 2007: 240-3, 430-49.
7-Greydaus DE, Pratt HD, Patel DR. Attention Deficit- Hyperactivity Disorder across lifespan: the child, adolescent, and adult. Dis Mon 2007; 53: 70-131.
8-Berridge CW, Waterhouse BD. The locus coeruleus-noradrenergic system: modulation of behavioral state and state-dependent cognitive processes. Brain Research reviews 2003; 33-84.
9-Ramos BP, Arnsten AF. Adrenergic pharmacological cognition: Focus on the prefrontal cortex pharmacology & Therapeutics 2007; 113: 523-536.[PMID=17303246]
10-Mefford IN, Potter WZ. A neuroanatomical & biochemical basis for Attention Deficit Disorder with hyperactivity in children: a defect in tonic adrenaline mediated inhibition of locus coeruleus stimulation. Med hypotheses 1989; 29(1):33-42. [PMID=2546021] 
 11-PLiszka SR, McCracken JT, Maas JW. Catecholamines in Attention Deficit- Hyperactivity Disorder: current perspectives. J AM Acad child adolesc psychiatry 1996; 35(3):264-72. [PMID=8714313]
12-Riahi F, Tashakori A, Izadi-Mazidi S, Salehi-Veisi M. Effectiveness of reboxetine in treatment of outpatient children and adolescents with attention deficit/ hyperactivity disorder with comorbid anxiety disorders. Iran J Psychiatry 2013; 8(4): 195-200.
13- Gualtieri CT, Golden RN, Fash JJ. New development in pediatric psychopharmacology. J Dev Bhav pediatr 1983: 202-9. [PMID=6355189]
14-Ford RE, Greenhill LL, Posner K. stimulants. In: Martin A, Scahill L, Charney DS, Leckman JF. Pediatric psychopharmacology . Newyork, oxford university press; 2003: P. 225-63.
15-Katzung BG, Masters SB, Trevor AJ. Basic and clinical pharmacology. Translated by Fatullahi AR, Sobhanian Kh. Tehran: Arjmand publication Co 2010: P. 177-204.
16-Buitelaar JK, Van der Gaag RJ, Swaab-Barneveld H, Kuiper M. Pindolol and methylphenidate in children with attention deficit- hyperactivity disorder. Clinical efficacy and side-effects. J child psycho psychiatry 1996 Jul; 37(5): 587-95. [PMID=8807439]
17-Green WH. Child and adolescent clinical psychopharmacology. 4th ed. Philadelphia: Lippincott, Williams & Wilkins 2007: P. 319-22.
18-Spencer TJ,  Wilens T, Biederman J, Weisler RH, Read SC, Pratt R. Efficacy and safety of mixed amphetamine salts extended release (Adderall XR) in management of attention deficit/ hyperactivity disorder in adolescent patients: a 4 weeks, randomized, double-blind, placebo-controlled, parallel-group study. Clin Ther 2006 Feb; 28(2): 266-79. [PMID=16678648]
19-Kuperman K, Stewart MA. Use of propranolol to decrease aggressive outbursts in younger patients. Open study reveals potentially favorable outcome. Psychosomatics 1987 Jun; 28(6): 315-9. [PMID=3432546]
20-Tashakori A, Ghaderi H, Riahi F, Ghaffari M, Sepandi M. Assessment of methylphenidate and propranolol combination treatment in comparison with methylphenidate and placebo  among children with Attention Deficit- Hhyperactivity Disorder. SMJ 2011; 10(1): 45-57.
21-Weiss M, Weiss G. Attention Deficit- Hyperactivity Disorder. In: Martin A, Volkmar FR. Lewis's Child and Adolescent Psychiatry: A Comprehensive Textbook, 3rd ed. Philadelphia (PA): Lippincott, Williams & Wilkins; 2002, P: 645-51.
22-Brock SE, Clinton A. Diagnosis of attention deficit/ hyperactivity disorder (AD/HD) in childhood: A review of the literaturee. The california school psychologist. J child Dev 2007; (12): 73-91.
23-Shhayyan A,؛ Shahim TV, Beaming Laya, Yousefi Farida. Normalization Factor analysis and reliability of the short form of special Conners Parent Rating Scale for children 6 to 11 years in Shiraz city. Journal of Psychological Studies 2007 Fall; 3(3): 97-120.
24-Mattes JA. propranolol for adult with temper outburst & residual ADHD. J clin psychopharmacology 1986 Oct; 6(5): 299-302.
25-Mattes JA. Comparative effectiveness of carbamazepine and propranolol for rage outbursts. Neuropsychiatry clin neurosci 1990; 2(2): 159-164.[PMID=2136070]هنجاریابی و ویژگی های روان سنجی مقیاس درجه بندی کانرز - فرم