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analeptic (CNS stimulant)

Indications: - attention-deficit hyperactivity disorder - may improve classroom behavior in children with ADHD [5] - cognitive impairment - drowsiness - fatigue - asthma, bronchospasm - chronic obstructive pulmonary disease - pulmomary emphysema - chronic bronchitis - headache - nasal congestion, sinusitis - urinary incontinence - respiratory depression - apnea - hypotension - head injury - weight reduction - obesity - depression - shift-work sleep disorder - narcolepsy - somnolence Contraindications: - not apppropriate for healthy children - 'inadvisable because of numerous social, developmental, & professional integrity issues' [3] (strength of evidence appears weak) Monitor: - consider ECG prior to prescribing [2] Adverse effects: - tachyarrhythmias, false sense of well being, nervousness, restlessness, insomnia - intoxication (overdose) - agitation, paranoia, tachycardia, hypertension, mydriasis * management of intoxication: - benzodiazepine Complications: - stimulant-associated mortality, although less than opioid-related mortality increased from 3 per 100,000 to 10 per 100,000 from 2010 to 2017 [4] Mechanism of action: - may interact with members of solute carrier family 6 SLC6A1, SLC6A3, SLC6A4

Interactions

drug adverse effects (more general classes)

Specific

8-chlorotheophylline amphetamine (Mydayis) benzphetamine; benzfetamine (Didrex) caffeine (NoDoz, Vivarin) cathinone; norephedrone; beta-ketoamphetamine chlorphentermine (Clorfentermina, Desopimon, Dezopimon, Lucofene) cocaine (Depsocaine, Eritroxilina) diethylpropion (Amfepramone, Frekentine, Moderatan, Dobesin) dimethylamylamine; methylhexaneamine; 1,3-dimethylpentylamine; Forthan, Forthane (DMAA) doxapram (Dopram) ephedrine fenethylline; amphetaminoethyltheophylline; amfetyline (Captagon, Biocapton, Fitton, INN) fenfluramine (Pondimin, Ponderil, Ponderex, Adipomin, Fintepla) mazindol (Sanorex) mephentermine (Wyamine) methylenedioxyamphetamine (Tenamfetamine) methylenedioxyethylamphetamine (MDEA) methylenedioxymethamphetamine (MDMA, Ecstasy, Molly) methylphenidate (Ritalin, Concerta, Daytrana, Metadate CD, Centedrine) modafinil (Provigil, Sparlon) p-methoxyamphetamine pemoline; phenylisohydantoin (Cylert, PIO) phendimetrazine (Mephenmetrazine) phenmetrazine (Oxazimedrine, Preludin, Mefolin) phentermine (Fastin, Ionamin, Adipex) theophylline (Slo-Phyllin, Elixophyllin, Uniphyl, Theo-24, Theo-Dur, Slo-bid, Theolair)

General

psychotropic agent

References

  1. Prescriber's Letter 12(1): 2005 Nonmedical Stimulant Use Detail-Document#: 210107 (subscription needed) http://www.prescribersletter.com
  2. Vetter VL et al. Cardiovascular monitoring of children and adolescents with heart disease receiving stimulant drugs: A scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing. Circulation 2008 Apr 21; [e-pub ahead of print] PMID: 18427125 http://dx.doi.org/10.1161/CIRCULATIONAHA.107.189473
  3. Graf WD et al Pediatric neuroenhancement: Ethical, legal, social, and neurodevelopmental implications. Neurology. March 13, 2013 PMID: 23486879 http://www.neurology.org/content/early/2013/03/13/WNL.0b013e318289703b.full.pdf+html
  4. Black JS, Bau GE, Iwanicki JL et al Association of Medical Stimulants With Mortality in the US From 2010 to 2017. JAMA Intern Med. Published online February 1, 2021 PMID: 33523100 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2775307
  5. Windle ML Rapid Rx Quiz: Stimulants Medscape.Oct 23, 2022 https://reference.medscape.com/viewarticle/981392