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# **ATTENTION DRUGS** ## Overview "Attention Drugs" is not a recognized pharmaceutical term. It is highly probable that this request refers to **stimulant medications** commonly used to treat Attention-Deficit/Hyperactivity Disorder (ADHD). This response will focus on common stimulants. ## Primary Indications * Attention-Deficit/Hyperactivity Disorder (ADHD) * Narcolepsy ## Adult Dosing Dosing varies significantly by agent, formulation (immediate-release vs. extended-release), and individual patient response. Titration is typically required. * **Methylphenidate (e.g., Ritalin, Concerta):** * Immediate-Release: Start with 5 mg BID to TID. Titrate up to 60 mg/day. * Extended-Release: Start with 18-20 mg once daily. Titrate up to 60 mg/day (Concerta) or 72 mg/day (other formulations). * **Amphetamine Salts (e.g., Adderall, Mydayis):** * Immediate-Release: Start with 5 mg BID. Titrate up to 40 mg/day. * Extended-Release: Start with 10-20 mg once daily. Titrate up to 40 mg/day (Adderall XR) or 50 mg/day (Mydayis). * **Lisdexamfetamine (Vyvanse):** * Start with 20-30 mg once daily. Titrate up to 70 mg/day. *Local protocols may dictate specific starting doses and titration schedules.* ## Pediatric Dosing Dosing is typically lower than in adults and requires careful titration. * **Methylphenidate:** * Children 6 years and older: * Immediate-Release: Start with 5 mg BID. Titrate up to 60 mg/day. * Extended-Release: Start with 18 mg once daily. Titrate up to 54 mg/day (Concerta) or 60 mg/day (other formulations). * **Amphetamine Salts:** * Children 3-5 years: Start with 2.5 mg once daily. Titrate up to 15 mg/day. * Children 6 years and older: * Immediate-Release: Start with 5 mg BID. Titrate up to 40 mg/day. * Extended-Release: Start with 5-10 mg once daily. Titrate up to 30 mg/day (Adderall XR). * **Lisdexamfetamine:** * Children 6 years and older: Start with 20-30 mg once daily. Titrate up to 50 mg/day. *Dosage recommendations for children under 3 years are less established and require extreme caution and specialized guidance.* ## Dose Adjustments * **Renal Impairment:** Use with caution. No specific dose adjustments are established for most agents, but reduced starting doses and slower titration may be prudent. * **Hepatic Impairment:** Use with caution. No specific dose adjustments are established for most agents, but reduced starting doses and slower titration may be prudent. ## Contraindications * Hypersensitivity to the drug or its components. * Concurrent use with or within 14 days of MAO inhibitors. * Severe cardiovascular disease. * Symptomatic cardiovascular abnormality. * Hyperthyroidism. * Glaucoma. * Agitated states. * History of drug abuse. ## Adverse Effects * **Common:** Insomnia, decreased appetite, weight loss, dry mouth, nausea, vomiting, abdominal pain, headache, dizziness, irritability, anxiety, increased blood pressure, increased heart rate. * **Serious:** Cardiovascular events (sudden death, MI, stroke), psychiatric events (new or worsening psychosis, mania), growth suppression in children, seizures, peripheral vasculopathy, priapism. ## Key Drug Interactions * **MAO Inhibitors:** Avoid concurrent use and within 14 days of discontinuation due to risk of hypertensive crisis. * **CYP2D6 Inhibitors:** May increase plasma concentrations of amphetamines (e.g., bupropion, fluoxetine, paroxetine, quinidine). * **Antihypertensives:** May decrease the efficacy of antihypertensive agents. * **Antacids/Urinary Alkalinizers:** May increase absorption and plasma concentration of amphetamines. * **Urinary Acidifiers:** May decrease absorption and plasma concentration of amphetamines. ## Monitoring * **Cardiovascular:** Baseline and periodic monitoring of blood pressure and heart rate. ECG may be indicated based on risk factors. * **Growth:** Monitor height and weight in pediatric patients at regular intervals. * **Psychiatric:** Assess for new or worsening psychiatric symptoms. * **Abuse/Dependence:** Screen for and monitor for signs of misuse or diversion. ## Clinical Pearls * Stimulants are controlled substances (Schedule II in the US) due to their potential for abuse and dependence. * Extended-release formulations offer convenience and potentially smoother symptom control. * Taking medication early in the day can help minimize insomnia. * Appetite suppression is common; encourage regular meals and snacks. * Careful titration based on patient response and tolerance is crucial. * Educate patients and caregivers about potential risks and side effects. *** *This information is intended for healthcare professionals and does not substitute for a comprehensive review of the current prescribing information or local institutional protocols. Always verify the most up-to-date drug information before making clinical decisions.*