Stimulants
Stimulants
Stimulants are used to treat attention deficit hyperactivity disorder (ADHD), a condition characterized by inattention, impulsivity, and hyperactivity. They include:
- dextroamphetamine
- lisdexamfetamine
- methylphenidate
- mixed amphetamine salts
- modafinil.
Pharmacokinetics
Stimulants are well absorbed from the GI tract and are distributed widely in the body. Methylphenidate undergoes significant first pass effect.
Metabolism and excretion
Stimulants are metabolized in the liver and excreted primarily in urine.
Pharmacodynamics
These drugs are believed to work by increasing levels of dopa-mine and norepinephrine in one of three ways: by blocking the reuptake of dopamine and norepinephrine, by enhancing the presynaptic release, or by inhibiting MAO.
Pharmacotherapeutics
Stimulants are the treatment of choice for ADHD. They’re helpful in improving attention, leading to improved school or work performance, and decreasing impulsivity and hyperactivity, if present. Pemoline, however, is no longer a first line choice for treatment of ADHD because it can cause hepatotoxicity.
Dextroamphetamine and methylphenidate are also used in the treatment of narcolepsy.
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Warning!Adverse reactions to stimulants
Adverse reactions to stimulants are listed below.
Dextroamphetamine and lisdexamfetamine
- Restlessness
- Tremor
- Insomnia
- Tachycardia
- Palpitations
- Arrhythmias
- Dry mouth
- Unpleasant taste
- Diarrhea
Methylphenidate
- Dizziness
- Insomnia
- Seizures
- Palpitations
- Arrhythmias
- Abdominal pain
- Rash
- Thrombocytopenia
Mixed amphetamine salts
- Restlessness
- Insomnia
- Hyperexcitability
- Palpitations
- Arrhythmias
- Tremor
- Abdominal pain
- Dry mouth
- Unpleasant taste
Measure up
Stimulants may affect growth; children should be monitored closely for height and weight changes.
Take a holiday
Drug holidays are recommended every year to assess the continued need for a stimulant.
Drug interactions
- Methylphenidate may decrease the effect of guanethidine and may increase the effects of TCAs, warfarin, and some anticonvulsant drugs.
- Stimulants shouldn’t be used within 14 days of discontinuing therapy with an MAOI.
- Stimulants are highly abused substances, and close monitoring is required.
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