Please check your internet connection and try again.
# ATTEMPTED DRUGS (Stimulants/ADHD Medications)
*Note: As "Att drugs" is interpreted as shorthand for ADHD/stimulant medications (specifically methylphenidate/amphetamine classes), the following pertains to central nervous system stimulants.*
## Overview
Stimulants increase extracellular levels of dopamine and norepinephrine by inhibiting reuptake and promoting release. They are classified as Schedule II controlled substances due to high potential for abuse and dependence.
## Primary Indications
* Attention-Deficit/Hyperactivity Disorder (ADHD)
* Narcolepsy (select agents)
* Binge Eating Disorder (Lisdexamfetamine only)
## Adult Dosing
* **Methylphenidate (Immediate Release):** Start 5 mg 2–3 times daily; titrate by 5–10 mg/week. Max: 60 mg/day.
* **Methylphenidate (Extended Release):** Start 18–36 mg once daily in the morning. Max: 72–108 mg/day (varies by formulation).
* **Lisdexamfetamine:** Start 30 mg once daily. Max: 70 mg/day.
* **Mixed Amphetamine Salts (XR):** Start 20 mg once daily. Max: 60 mg/day.
## Pediatric Dosing (Age 6+)
* **Methylphenidate (IR):** 0.3–0.7 mg/kg/dose 2–3 times daily. Max: 60 mg/day.
* **Methylphenidate (ER):** 0.3–0.7 mg/kg/day or starting at 18 mg once daily. Max: 54–72 mg/day based on formulation.
* **Lisdexamfetamine:** Start 30 mg once daily. Max: 70 mg/day.
* **Note:** Dosing varies significantly by specific brand/formulation. Local institutional protocols must be followed.
## Dose Adjustments
* **Renal Impairment:** Generally not required for common stimulants, but caution is advised in severe cases.
* **Hepatic Impairment:** May require dose reduction; monitor for increased sensitivity.
## Contraindications
* Known hypersensitivity to sympathomimetic amines.
* Current or recent (within 14 days) use of Monoamine Oxidase Inhibitors (MAOIs) due to risk of hypertensive crisis.
* Symptomatic cardiovascular disease, advanced arteriosclerosis, or moderate-to-severe hypertension.
* Hyperthyroidism or glaucoma.
* History of drug abuse.
## Adverse Effects
* **Common:** Insomnia, decreased appetite/weight loss, xerostomia (dry mouth), headache, tachycardia, palpitations.
* **Serious:** Sudden cardiac death (in patients with underlying cardiac abnormalities), worsening of pre-existing psychosis, peripheral vasculopathy (Raynaud’s phenomenon), serotonin syndrome.
## Key Drug Interactions
* **MAOIs:** Absolute contraindication; risk of hypertensive crisis.
* **Antihypertensives:** Stimulants may decrease the efficacy of blood pressure medications.
* **SSRIs/SNRIs:** Increased risk of serotonin syndrome.
* **Acidifying/Alkanizing Agents:** Alter urinary pH and can significantly affect the excretion rates of amphetamines.
## Monitoring
* **Blood Pressure and Heart Rate:** Baseline and at each dose adjustment.
* **Weight/Height:** Monitor growth patterns in children at each visit.
* **Psychiatric Status:** Monitor for emergence or worsening of tics, agitation, anxiety, or psychosis.
* **Abuse Potential:** Ensure compliance and screen for non-medical use.
## Clinical Pearls
* **Formulation Matters:** Do not assume interchangeability between brands (e.g., Concerta vs. Ritalin LA). Pharmacokinetics vary by delivery mechanism (e.g., OROS system vs. bead-filled capsules).
* **Administration:** Instruct patients to take long-acting doses in the morning to minimize insomnia.
* **Drug Holidays:** Consider periods of cessation (weekends/summer) to assess symptom control and mitigate growth suppression.
***
**Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Consult current prescribing information (FDA labels), clinical guidelines, or a board-certified clinical pharmacist before initiating or adjusting medication dosages.
