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medication / psychostimulants / based on amphetamines

Amphetamine-based psychostimulants

Caution​

Amphetamines can lead to abuse, misuse, dependence, or diversion for non-therapeutic purposes which physicians should consider when prescribing this drug. increasing the doses to obtain the same effect and a great dependence sets in. In addition, its weaning is very difficult.

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Misuse of amphetamines can lead to serious cardiovascular adverse effects and sudden death.

Directions​

  • Attention deficit disorder with or without hyperactivity (ADHD)

  • Adjunctive therapy for narcolepsy (Dexedrine)

Contraindications​

  • Advanced arteriosclerosis

  • Symptomatic cardiovascular disease

  • Moderate to severe hypertension

  • Hyperthyroidism

  • Known hypersensitivity or special sensitivity to sympathomimetic amines

  • Allergy to amphetamines or other ingredients present in Vyvanse, Dexedrine, Adderall XR or its container

  • Glaucoma

  • States of agitation

  • History of medication or drug abuse

  • During treatment with monoamine oxidase inhibitors (MAOIs) or within 14 days of such treatment, may cause hypertensive crises

  • Anxiety (Dexedrine)

  • Blood Pressure (Dexedrine)

  • Presence of motor tics or family history of Tourette syndrome (verbal tics) (Dexedrine)

 

Pregnancy :  the safety of the product during pregnancy is not established

  • Breastfeeding: Amphetamines pass into breast milk, so breastfeeding is not recommended.

 

Children: It is not recommended to use amphetamines for the treatment of attention deficit disorder with or without hyperactivity in children under 6 years of age.

Drugs interactions​

Caution should be exercised in prescribing other drugs with amphetamines, as clinically significant interactions with several drugs have been reported. Potentiation of central nervous system and cardiac effects may, in some cases, be life threatening. Dosages should be closely monitored.

 

It is important to tell the doctor or pharmacist about all medicines you or your child are taking, including other medicines prescribed by a doctor, medicines you have bought without a prescription and any herbal remedies, in particular :

•   Medicines for high blood pressure

•   Antacids

•   Medicines for epileptic seizures

 

During treatment with Dexedrine, do not start taking any new medicine or herbal remedy unless you have checked with your doctor first.

 

The following agents have known interactions with amphetamines:

Synergistic interactions (they enhance the effect):

  • Tricyclic antidepressants

  • MAOI

  • Meperidine (Demerol)

  • Phenobarbital (barbiturate)

  • Phenytoin (Dilantin)

  • Propoxyphene (painkiller)

  • Acetazolamide (Diamox/glaucoma)

  • Thiazides (diuretic)

  • Urinary and gastrointestinal alkalizers (decreasing acidity)

 

Antagonistic interactions (they suppress or diminish the effect):

  • Adrenergic blockers (beta-blockers)

  • Antihistamines

  • Antihypertensives

  • Chlorpromazine (Largactil)

  • Ethosuximide (antiepileptic)

  • Guanethidine (painkiller)

  • Haloperidol (Haldol)

  • lithium carbonate

  • Methenamine (antibiotic)

  • Veratrum alkaloids (cardiovascular agent)

  • Urinary or gastrointestinal acidifiers (increased acidity)

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Side effects​

They depend on the dosage and duration of treatment, the metabolism of the individual and the context in which he lives.

 

Frequent

Head

  • Dizziness

  • Dry mouth

  • Headache

  • Vision problems

  • New mannerisms

 

Heart

  • Rise in blood pressure (high pressure)

  • Irregular heartbeats

 

Abdomen

  • Nausea

  • Vomiting

  • Pain in the upper abdomen

  • Diarrhea

  • Stomach ache

 

Members

  • Tremors (Dexedrine)

 

Others

  • Anorexia, decreased appetite

  • Irritability

  • Difficulty sleeping

  • Weightloss

  • Mood swings

  • Nervousness

  • Anxiety

  • Slowed growth (height and weight) in children

  • Epileptic seizures, mainly in people with

  • ever had epileptic seizures (Dexedrine)

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Uncommon and rare

  • Allergic reaction: skin rash, hives, swelling of the face, lips, tongue or throat, difficulty swallowing or breathing

  • Aggressive or hostile behavior

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Monitoring and medical supervision

Before treatment :

  • Check blood pressure (high pressure), possibilities of heart trouble.

  • Check family history of sudden death or cardiac death.

  • Check the kidneys.

  • Check history of epilepsy.

  • Check the history of motor tics and vocal tics.

  • Check for a history of Raynaud's phenomenon (tingling, numbness, discoloration of cold fingers and toes).

  • Indicate if you exercise intensely.

  • Indicate if you are taking other ADHD medications.

  • Indicate if you are allergic to aspirin.

  • Indicate if you have abused drugs, alcohol or medication.

 

During treatment :

  • Check blood pressure and heart.

  • Call your doctor right away if you or your child have any signs of heart problems such as chest pain, shortness of breath, or fainting during treatment.

  • Indicate the onset of mental health problems.

All people :

- Appearance or worsening of behavioral or thinking disorders.

- Appearance or aggravation of a “bipolar disorder”.

- Appearance or worsening of “aggressive or hostile behavior”.

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Children and adolescents :

- Appearance of psychotic symptoms (for example, hearing  

  voices, believing things that are not true or are suspicious)   or appearance of “manic symptoms”.

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Therapeutic effects ​

  • Helps increase attention span (including the ability to follow directions and complete a task) and reduce  the level of impulsivity and hyperactivity in people with ADHD.

  • Reduces fatigue, stimulates mental activity, improves mood and leads to an overall feeling  of well-being.

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Withdrawal symptoms

Psychotropic drugs act in the brain just as they do in the rest of the body; and as we have seen, each person reacts differently. It's the same with weaning; the person's metabolism, the type of drug, the dose as well as the duration of the intake and its half-life, explain that the withdrawal effects are varied. We have listed the potential and main withdrawal symptoms of each class of psychotropic drugs. This list is incomplete, as not all withdrawal effects are listed; moreover, knowledge is rapidly evolving in this field. A person may have no withdrawal symptoms or experience one, a few, or even many. The medication reduction journey is specific to each person, just as each process is unique. For example, a person can take the same medicine twice at the same dose and the effects will be different. Gradual reduction, like removing 10  % of dose per week/month, reduces the frequency or intensity of withdrawal symptoms and the incidence of rapid relapses. It is very important to undertake this process with the collaboration of your doctor. The pharmacist also plays a key role and can provide guidance to monitor withdrawal effects for each medication. Most people who will have withdrawal symptoms will tolerate them without problems for the short duration of these symptoms.

Common and frequent withdrawal symptoms for all classes: anxiety, nervousness, restlessness, sleep problems, greater need to rest, sleep, irritability, fatigue.

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Withdrawal symptoms for psychostimulants :

Withdrawal symptoms appear a few days after the dose is reduced. In the process of progressive reduction according to the method of 10  %, the last step can be particularly difficult. It can be lengthened or split to reduce withdrawal symptoms.

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Main psychological withdrawal symptoms: ​

  • Depressive syndrome

  • Hyperactivity

  • Return of original issues

  • suicidal tendencies

  • Irritability

  • Anxiety with agitation

  • Anger and aggression

 

Main physical withdrawal symptoms:

  • Lack of attention and concentration

  • Social withdrawal

  • Excessive need to sleep

  • Excessive need to eat

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