Stimulants Drugs for treatment Attention Deficit Hyperactivity Disorder
- Methylphenidate (Ritalin, Concerta, Metadate)
- Pemoline (Cylert)
- Dextroamphetamine (Dexedrine)
- Mixed amphetamines (Adderall)
HOW DO THESE DRUGS WORK?
Central nervous system stimulants help to balance the activity of neurotransmitters (chemical messengers) in the brain. Through this mechanism, they tend to increase attention span, improve focus, and decrease distractibility in people with ADHD.Although these medicines have a stimulating effect in most people, they tend to have a calming effect in children and adults with ADHD.
WHAT ARE THE BENEFITS?
Symptoms are improved in about 70 percent of people with ADHD. In children specifically, 75 to 80 percent improve after starting a stimulant medication.
POTENTIAL SIDE EFFECTS
Loss of appetite, difficulty sleeping, dry mouth, weight loss, stomachache, headache, overstimulation/anxiety, dizziness, tics, listlessness/lethargy, angina, and mood changes are the more common side effects associated with stimulants. In higher doses, paranoid psychotic reactions may be seen. In typical doses, clinically insignificant elevation of blood pressure and increased heart rate may occur.
MAJOR CAUTIONS
In February 2007, the United States Food and Drug Administration (FDA) ordered that all companies making stimulant drugs for ADHD add warning labels to their products. These new labeling regulations addressed two major concerns.
First, heart-related problems, including risk of sudden death in children with heart problems; risk of stroke, heart attacks; and sudden death in adults with a history of heart disease.
Second, psychiatric problems: these drugs may trigger or exacerbate negative behaviors and emotions, especially in those with any family history of mental illness. Suppression of growth is also a major concern with long-term use of stimulants in children. Psychological and/or physical dependence on stimulants can occur.
MEDICAL PRECAUTIONS
People with the following conditions or disorders should discuss their risks with their physician:
- Personal or family history of high blood pressure, heart problems, or sudden death
- Heart defects
- Heart rhythm irregularities or other heart problems
- Personal or family history of mental illness
- Hyperthyroidism
- Impaired hepatic function
- Glaucoma
- Anxiety
- History of drug abuse
- Pregnancy
- Breast-feeding
KNOWN DRUG INTERACTIONS
Stimulants should not be used concurrently with monoamine oxidase (MAO) inhibitors, or within two weeks before using them. Caution should be used when combining them with pressor agents (used to increase blood pressure). Methylphenidate may decrease the effectiveness of drugs used to treat hypertension, and it may inhibit the metabolism of coumarin anticoagulants, anticonvulsants (e.g., phenobarbital, phenytoin, primidone), and tricyclic drugs (e.g., imipramine, clomipramine, desipramine), so downward dose adjustments of these drugs may be required. Serious adverse events have been reported in concomitant use of Ritalin with clonidine.
Excessive serotonin activity may result when amphetamine is combined with SSRIs (selective serotonin reuptake inhibitors) such as fluoxetine, citalopram, and paroxetine. When amphetamine is combined with NRIs (norepinephrine reuptake inhibitors), such as Strattera, there may be a potentiation of its effects. Bupropion (Wellbutrin) has pro-convulsant properties that may be enhanced by amphetamine. Concomitant use of amphetamine and tricyclic antidepressants may increase serotonin-, dopamine-, and norepinephrinerelated drug effects.
FOOD OR SUPPLEMENT INTERACTIONS
Alcohol should be avoided with use of stimulants, and fruit juices may inhibit their absorption. Supplements of magnesium hydroxide are known to cause retention of amphetamines in the body, and may therefore increase blood levels of amphetamine.Vitamin C supplementation may decrease absorption of amphetamines. Tyrosine deficiency (usually seen with protein deficiency) may reduce amphetamine effectiveness because tyrosine is needed to produce the brain chemicals stimulated by amphetamines. Concurrent use of lithium with amphetamines may reduce amphetamine effectiveness. The use of amphetamines with stimulant herbs such as Ephedra sinica may cause excessive stimulation of the heart and nervous system. Vitamin B6 and L-tryptophan may have beneficial effects on some adverse symptoms associated with stimulant use.
NUTRIENT DEPLETION/IMBALANCE
Dextroamphetamine can enhance magnesium blood levels, causing a significant lowering of the calcium-to-magnesium ratio in the blood.
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