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10mg nolvadex a day in 12 weeks with little or no effect." Severity of ADHD symptoms was greater than 5% at the endpoint of all 4 trials. The trials did not have a standardized description by treatment group, as stated the authors, so severity grading was not specified. However, a recent publication by Hernan and colleagues (2009) found that a 3-point scale was sufficient to estimate ADHD severity. Two of the trials reported outcomes by age, and one duration of exposure to nolvadex. In both the 5- to 18-year-old groups, a significant effect on ADHD symptoms was found (RR, 0.28; 95% CI, 0.15–0.49; Q=2.6×10−4). The 6-year-old group saw a similarly but non-significant improvement (RR, 0.22; 95% CI, −0.06–0.65; Q=8.3×10−4). However, no significant treatment effects were seen in the groups over 12 months. The 2 trials of 18-year-olds did not find treatment effects for either group (RR, 0.90; 95% CI, 0.47–1.66; Q=4.9×10−4). The difference between 2 trials was not statistically significant, but the lack of an effect was surprising given there a considerable reduction in the number of adverse events in nolvadex for the 18-year-olds as compared with their counterparts in the 3- mg nolvadex arms of the other trials. use suboptimal dosing was an explanation for most, but not all (6), of the adverse events reported in 18-year-olds. Clinical Take Home Points The efficacy of nolvadex to improve attention and social function in children with ADHD is unquestioned. Adults in both the nolvadex and placebo groups reported greater improvement in attention the placebo arm (6-year-olds: RR, 0.38; 95% CI, 0.13–0.72; 18-year-olds: RR, 0.22; 95% CI, −0.06–0.65) and social functioning in the placebo arm (6-year-olds: RR, 0.21; 95% CI, −0.02–0.38; 18-year-olds: RR, 0.23; 95% CI, −0.05–0.37). There was no evidence for differences in any of the treatment effects with respect to adverse events. Clinical Implications The results of 2 clinical trials (5 mg vs. 12 weeks) are consistent with a finding by the authors of "conclusions" section. They wrote: "In view of the positive effect on ADHD symptoms and the absence of significant adverse event effect, the efficacy of naltrexone in children with ADHD seems justified." The use of nolvadex in children Over the counter equivalent to prozac with ADHD is supported by the results of large (1.25-year) placebo-controlled observational study. A recent update on that study, conducted by Kripke and colleagues (2010a), confirms the results of older study by saying that "no significant drug store in honolulu treatment effects were found with the 5 mg dose." In an accompanying editorial, Siegel and colleagues say that they appreciate this study and its findings. They also add that the "results could not be drawn from"

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