PEBC: What You Need to Know: Stimulants

Examples: methylphenidate (IR<SR<ER<CR), dextroamphetamine (IR<SR), lisdexamfetamine, amphetamine

(immediate release - IR, sustained release - SR, extended release - ER, controlled release - CR)

Indication: attention deficit hyperactivity disorder

Dosing:

-long acting formulations are dosed once daily in the morning

-shorter acting formulations may be dosed up to twice daily

-dose may be started at a low dose for children and titrated up

-certain capsule formulations may be opened and given with food/water

Adverse Effects:

-Cardiovascular: increased heart rate and blood pressure

-Insomnia (hence dosed earlier in the day, preferably morning)

-Nausea, reduced appetite, anorexia (hence to give with a larger meal at breakfast)

-Growth restriction in children

-Headache, dry mouth

-Rare: sexual dysfunction, tics, psychosis, hyperthyroidism, seizures

Drug Interactions:

-MAOI inhibitors: hypertensive crisis; wait 14 days before starting stimulants

-Sympathomimetics: theophylline and ephedrine - increased cardiovascular stimulation