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pemoline; phenylisohydantoin (Cylert, PIO)

Tradename: Cylert. DEA-controlled substance: class 4. Risk of hepatic toxicity exceeds risk [3] Will be removed from market as supply is exhausted. Indications: 1) treatment of attention deficit hyperactivity disorder (ADDH) 2) narcolepsy Medi-Cal: for patients between ages 4-16 years with ADDH Contraindications: 1) liver disease 2) children < 6 years of age 3) Tourette's syndrome Caution: patient with renal insufficiency Dosage: 1) start 37.5 mg PO QD 2) increase by 18.75 mg/day at weekly intervals 3) usual effective dose: 56.25-75 mg/day 4) max 112.5 mg/day Tabs: 18.75, 37.5, 75 mg. Pharmacokinetics: - significant benefit may not be noted until 3rd to 4th week of therapy Monitor: - serum ALT or serum AST within 180 days Adverse effects: 1) common (> 10%) - insomnia, anorexia, weight loss 2) less common (1-10%) - dizziness, drowsiness, epigastric pain, rash, depression, nausea 3) uncommon (< 1%) - jaundice, seizures, precipitation of Tourette's syndrome, hallucination, headache, growth redardation, diarrhea, abnormal liver function tests (generally reversible), hepatitis, movement disorders Drug interactions: 1) decreased effect of insulin* 2) increased effect & toxicity with CNS depressants# 3) CNS stimulants# 4) sympathomimetics * insulin requirements may be increased # avoid caffeine & alcoholic beverages

Interactions

drug adverse effects (more general classes)

General

adrenergic neuron stimulant analeptic (CNS stimulant)

Properties

MISC-INFO: elimination route LIVER KIDNEY pregnancy-category B safety in lactation ?

Database Correlations

PUBCHEM correlations

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Kaiser Permanente Northern California Regional Drug Formulary, 1998 (deleted 12/99)
  3. Medwatch http://www.fda.gov/medwatch/safety/2005/safety05.htm#Cylert - Prescriber's Letter 12(12): 2005 Liver function test scheduling Detail-Document#: 211210 (subscription needed) http://www.prescribersletter.com