Brand Name: |
Ritalin |
Dexedrine |
Adderall |
Generic/
Drug Name: |
Methylphenidate |
Dextroamphetamine |
Dextroamphetamine and amphetamine |
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Mechanism
of action: |
There is some evidence that the alteration of dopamine transport systems by methylphenidate may indirectly augment the action of serotonin
Mechanism is speculative and poorly understood. |
Data suggest that the modulation of serotonergic pathways by the amphetamines may contribute to the calming effects in the treatment of this disorder.
The exact mode of therapeutic action in ADHD is not known.
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Stimulate the release of norepinephrine from central adrenergic receptors
There is no conclusive evidence for the mechanism(s) of action.
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Prescribed for: |
ADHD
Narcolepsy |
ADHD
Narcolepsy |
ADHD
Narcolepsy |
Tablet sizes and dose regimen: |
5 M.G. (x2 daily)
10 M.G. (x2 daily)
20 M.G. (x2 daily)
Sustained release 20 M.G. (x1 daily) |
5 M.G. spinules (x1 daily)
10 M.G. spinules (x1 daily)
15 M.G. spinules (x1 daily)
5 M.G. (x2 daily)
5 M.G./5 ml (elixir)(x2 daily) |
5mg (x1 – x2 daily)
10mg (x1 daily)
15mg (x1 daily)
20mg (x1 daily)
25mg (x1 daily)
30mg (x1 daily)
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Dose range: |
2.5–85 M.G./day |
2.5–60 M.G./day |
2.5–40 M.G./day |
Effects: |
Almost immediate.
• Steady state reached at 7–8 days |
Within a few days. Full effects in 4 weeks. |
Within a few hours. Steady state reached at 7–8 days |
Drug interactions: |
Monoamine Oxidase Inhibitors (MA Os) (Contraindicated): serious, potentially fatal
Tricyclic antidepressants (Tachs) (moderate): may produce toxicity
Anticonvulsants (moderate): pattern of seizures may change
Anticoagulants (moderate): effects may be increased
Acetaminophen; Aspirin, ASA; Caffeine: (moderate). Excessive caffeine ingestion may contribute to side effects like nervousness, irritability, nausea, insomnia, or tremor. |
• Monoamine Oxidase Inhibitors (MA Os): serious, potentially fatal.
Tricyclic antidepressants (Tachs) (moderate): levels may be increased.
Chlorpromazine, lithium, haloperidol (moderate): effects of dextroamphetamine may be decreased.
Antihistamines (moderate): due to their sedative effect, the effect of dextroamphetamine may be counteracted.
Nimodipine (minor): Amphetamines increase both systolic and diastolic blood pressure and may counteract the activity of some antihypertensive agents
Balkanizing agents (acetazolamide) (moderate): increase absorption ofdetroamphetamine.
Acidifying agents (reserpine, guanethidine, fruit juices) (moderate): may decreasedextroamphetamine’sabsorption. |
Examples:
- Acarbose (moderate): Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
- Acetaminophen; Aspirin, ASA; Caffeine (moderate): Excessive caffeine ingestion may contribute to side effects like nervousness, irritability, nausea, insomnia, or tremor.
- Sodium Citrate; Citric Acid (moderate): Increasing urine pH may increase amphetamine exposure by reducing urinary excretion of amphetamine.
- Primidone (major): Patients who are taking anticonvulsants for epilepsy/seizure control should use amphetamines with caution. Amphetamines may decrease the seizure threshold and may increase the risk of seizures.
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Side effects: |
The incidence is unknown for many side effects. Below are a few examples of side effects:
Mild
- anorexia
- headache
- abdominal pain
- vomiting
- diarrhea
Moderate
- growth inhibition
- hallucinations
- blurred vision
- euphoria
- hypertension
Severe
- seizures
- stroke
- visual impairment
- suicidal ideation
- myocardial infarction
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The incidence is unknown for many side effects. Below are a few examples of side effects:
Mild
- anorexia
- headache
- tremor
- vomiting
- diarrhea
Moderate
- growth inhibition
- hallucinations
- blurred vision
- euphoria
- hostility
Severe
- Tourette's syndrome
- stroke
- visual impairment
- suicidal ideation
coma |
The incidence is unknown for many side effects. Below are a few examples of side effects:
Mild
- anorexia
- headache
- abdominal pain
- vomiting
- diarrhea
Moderate
- growth inhibition
- hallucinations
- blurred vision
- euphoria
- dysphoria
Severe
- Tourette's syndrome
- stroke
- visual impairment
- suicidal ideation
coma |
Habit-forming potential: |
High |
High |
High |
Effect of
long-term use: |
Chronic use of methylphenidate may lead to tolerance of side effects and psychological dependence, similar to other psychostimulants.
Increased risk of arrhythmia
Possible growth inhibition
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Chronic use of dextroamphetamine may lead to tolerance of side effects and psychological dependence, similar to other psychostimulants.
Increased risk of arrhythmia
Possible growth inhibition |
High potential for abuse
Several adverse reactions ranging from mild (e.g., headache), to moderate (e.g., depression) to severe (seizures) |