Stimulant Comparisons

Total Page：16

File Type：pdf, Size：1020Kb

Stimulant Comparisons Methylphenidate • T1/2 4.5 hours • Duration of effect, adults, or IR form: 3-6 hours Methylphenidate Formulations Methylphenidate LA • 50% release immediately • 50% release 4 hours later • Exactly mimics 2 doses of methylphenidate IR • “Shortest-acting of longest-acting agents” Methylphenidate CD • 30% immediate release • 70% release 4 hours later • Good for kids who become more distractible later in the day Methylphenidate Transdermal system (Daytrana) • Patch, approved for age 6-12 • More potent, as it bypasses gut and first pass metabolism • You CAN cut patches to adjust dose • Apply hip, below underwear, rotate location to prevent local irritation o Fair-skinned kids get more irritation o Rotate patch around body “girdle” e.g. Hips/pelvis • Placement on other parts of the body (arm, leg) leads to absorption variability • Optimal absorption depends on hygiene, skin integrity • Approximate equivalence: o 10 mg patch = 15 mg IR o 15 mg patch = 22.5 mg IR o 20 mg patch = 30 mg IR o 30 mg patch = 45 mg IR • remove after 9 hours • Action stops 2 hours after removal Dexmethylphenidate (Focalin) • IR and XR versions • Isolated d-enantiomer of racemic d, l-MPH • Using only d-enantiomer allows doses to be halved but still be equally effective; they claim increased tolerability • XR: 50% of beads released at time 0, 50% released 4 hours later Dextroamphetamine/amphetamine • Tmax oral: 3 hours • Tmax oral, extended release: 7 hours • T1/2, adults: 10-13 hours • T1/2 adolescents: 11-14 hours Amphetamine Preparations Mixed amphetamine salts (Adderall, Adderall XR) • MAS ER comparable to MAS IR bid • 2-pulsed, micro-bead delivery system • 50:50 ratio of IR and ER beads (0 hr, 4 hr) • Duration 10-12 hours • Max concentration 7 hr (4 hour longer than IR) • Longer half-life than methylphenidate • XR is 2nd longest-acting long-acting o Longer appetite suppression, more likely to cause insomnia Lisdexamfetamine (Vyvanse) • Pharmacologically inactive • Pro-drug = l-lysine + dextroAMP • After ingestion, hydrolysis to d-AMP • Takes 2 hours before becoming active via metabolism • Half life 10 hr->once daily, efficacy persists to early pm • Decreases risk of toxicity, abuse, diversion • Approved ADHD ages 6-12 • Dose equivalents: o 30 mg = 10 mg mixed AMP o 50 mg = 20 mg mixed AMP o 70 mg = 30 mg mixed AMP Thanks to Mary Cook, MD for info .

Copy Link

Recommended publications

(19) United States (12) Patent Application Publication (10) Pub
US 20130289061A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2013/0289061 A1 Bhide et al. (43) Pub. Date: Oct. 31, 2013 (54) METHODS AND COMPOSITIONS TO Publication Classi?cation PREVENT ADDICTION (51) Int. Cl. (71) Applicant: The General Hospital Corporation, A61K 31/485 (2006-01) Boston’ MA (Us) A61K 31/4458 (2006.01) (52) U.S. Cl. (72) Inventors: Pradeep G. Bhide; Peabody, MA (US); CPC """"" " A61K31/485 (201301); ‘4161223011? Jmm‘“ Zhu’ Ansm’ MA. (Us); USPC ......... .. 514/282; 514/317; 514/654; 514/618; Thomas J. Spencer; Carhsle; MA (US); 514/279 Joseph Biederman; Brookline; MA (Us) (57) ABSTRACT Disclosed herein is a method of reducing or preventing the development of aversion to a CNS stimulant in a subject (21) App1_ NO_; 13/924,815 comprising; administering a therapeutic amount of the neu rological stimulant and administering an antagonist of the kappa opioid receptor; to thereby reduce or prevent the devel - . opment of aversion to the CNS stimulant in the subject. Also (22) Flled' Jun‘ 24’ 2013 disclosed is a method of reducing or preventing the develop ment of addiction to a CNS stimulant in a subj ect; comprising; _ _ administering the CNS stimulant and administering a mu Related U‘s‘ Apphcatlon Data opioid receptor antagonist to thereby reduce or prevent the (63) Continuation of application NO 13/389,959, ?led on development of addiction to the CNS stimulant in the subject. Apt 27’ 2012’ ?led as application NO_ PCT/US2010/ Also disclosed are pharmaceutical compositions comprising 045486 on Aug' 13 2010' a central nervous system stimulant and an opioid receptor ’ antagonist.
[Show full text]
Methamphetamine (Canadian Drug Summary)
www.ccsa.ca • www.ccdus.ca March 2020 Canadian Drug Summary Methamphetamine Key Points • The prevalence of methamphetamine use in the Canadian population is low (~0.2%). • Several jurisdictions report at least a three-fold increase in the use of methamphetamine over the past five years among individuals accessing treatment or harm reduction services. • Notable increases for rates of criminal violations involving methamphetamine have been observed in the last five years (2013–2018). Introduction Methamphetamine is a synthetic drug classified as a central nervous system (CNS) stimulant or psychostimulant. CNS stimulants cover a wide range of substances that act on the body by increasing the level of activity of the CNS and include caffeine, nicotine, amphetamine (e.g., Adderall®), methylphenidate (e.g., Ritalin®), MDMA (“ecstasy”), cocaine (including crack cocaine) and methamphetamine (including crystal meth).1,2 While both methamphetamine and amphetamine are psychostimulants and often grouped together, they are different drugs. A slight chemical modification of amphetamine produces methamphetamine, which has a different pharmacological profile that results in a larger release of certain neurochemicals in the brain and a stronger and more rapid physiological response. Some amphetamines are prescribed in Canada for attention-deficit hyperactivity disorder (ADHD) and narcolepsy (e.g., Adderall and Vyvanse®), but methamphetamine use is currently illegal. Methamphetamine is often made in illegal, clandestine laboratories with commonly available, inexpensive chemicals, such as ephedrine and pseudoephedrine, found in medications, among other sources. The use of these medications as precursor chemicals for methamphetamine led to stricter regulations introduced in Canada in 2006, limiting access to them by requiring they be kept behind the counter of pharmacies.3 Illegal production can be dangerous due to the toxicity of the chemicals used and the high risk of explosions.
[Show full text]
A Comparison of Ritalin and Adderall: Efficacy and Time-Course in Children with Attention-Deficit/Hyperactivity Disorder
A Comparison of Ritalin and Adderall: Efficacy and Time-course in Children With Attention-deficit/Hyperactivity Disorder William E. Pelham, PhD*; Helen R. Aronoff, MD‡; Jill K. Midlam, MA*; Cheri J. Shapiro, PhD*; Elizabeth M. Gnagy, BS*; Andrea M. Chronis, BS*; Adia N. Onyango, BS*; Gregory Forehand, BS*; Anh Nguyen, BS*; and James Waxmonsky, MD‡ ABSTRACT. Objective. Very little research has fo- ratings were also made for evening behavior to assess cused on the efficacy of Adderall (Shire-Richwood Inc, possible rebound, and side effects ratings were obtained Florence, KY) in the treatment of children with attention- from parents, counselors, and teachers. Parents, counsel- deficit/hyperactivity disorder (ADHD), and no studies ors, and teachers also rated their perceptions of medica- have compared it with standardized doses of Ritalin tion status and whether they recommended the contin- (Novartis Pharmaceuticals, East Hanover, NJ). It is ued use of the medication given that day. Finally, a thought that Adderall has a longer half-life than Ritalin clinical team made recommendations for treatment tak- and might minimize the loss of efficacy that occurs 4 or 5 ing into account each child’s individual response. hours after Ritalin ingestion. We compared two doses of Results. Both drugs were routinely superior to pla- Ritalin and Adderall in the treatment of ADHD in chil- cebo and produced dramatic improvements in rates of dren in an acute study and assessed the medications’ negative behavior, academic productivity, and staff/par- time courses. ent ratings of behavior. The doses of Adderall that were Design. Within-subject, double-blind, placebo-con- assessed produced greater improvement than did the as- trolled, crossover design lasting 6 weeks.
[Show full text]
(Adhd) Quantity Limitation Utilization Management Criteria
ATTENTION- DEFICIT HYPERACTIVITY DISORDER (ADHD) QUANTITY LIMITATION UTILIZATION MANAGEMENT CRITERIA DRUG CLASS: Stimulants and Non-Stimulants BRAND (generic) NAMES: Adderall® (amphetamine/dextroamphetamine) Adderall XR® (amphetamine/ dextroamphetamine ER) Adzenys XR-ODTTM (amphetamine ER dispersible) Aptensio XR® (methylphenidate ER) Concerta® (methylphenidate ER) Daytrana® (methylphenidate transdermal patch) Dextroampthetamine (DextroStat®) Dexedrine® (dextroamphetamine ER) DyanavelTM XR (amphetamine ER) Focalin XR® (dexmethylphenidate ER) Focalin® (dexmethylphenidate) Intuniv® (guanfacine ER) Kapvay® (clonidine ER) Metadate CD® (methylphenidate ER) Metadate ER® (methylphenidate ER) Methylin® (methylphenidate) Procentra® (dextroamphetamine) QuillichewTM (methylphenidate ER) Quillivant XR® (methylphenidate ER) Ritalin® (methylphenidate) Ritalin® LA (methylphenidate ER) Ritalin® SR (methylphenidate ER) Strattera® (atomoxetine) Vyvanse® (lisdexamphetamine) Zenzedi® (dextroamphetamine) COVERAGE AUTHORIZATION CRITERIA Non-formulary medications - Medications included in this criterion that are not part of ASO Net Results or Essential Formularies are subject to a trial and failure of up to TWO formulary alternatives that are clinically appropriate, to treat the same condition, prior to approval (see Non-formulary Exception Criteria for detailed limitations). Quantities above the program set limit (see pgs 2-4) for ADHD agents will be approved when the following is met: 1. The quantity (dose) requested is for documented titration purposes at the initiation of therapy (authorization for a 90 day titration period); AND 2. The prescribed dose cannot be achieved using a lesser quantity of a higher strength; AND 3. The quantity (dose) requested does not exceed the maximum FDA labeled dose, when specified, or to the safest studied dose per the manufacturer’s product insert; OR BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.
[Show full text]
Stimulant and Related Medications: US Food and Drug
Stimulant and Related Medications: U.S. Food and Drug Administration-Approved Indications and Dosages for Use in Adults The therapeutic dosing recommendations for stimulant and related medications are based on U.S. Food and Drug Administration (FDA)-approved product labeling. Nevertheless, the dosing regimen is adjusted according to a patient’s individual response to pharmacotherapy. The FDA-approved dosages and indications for the use of stimulant and related medications in adults are provided in this table. All medication doses listed are for oral administration. Information on the generic availability of the stimulant and related medications can be found by searching the Electronic Orange Book at https://www.accessdata.fda.gov/scripts/cder/ob/default.cfm on the FDA website. Generic Medication Indication Dosing Information Other Information Availability amphetamine/dextroamphetamine ADHD Initial dose: May increase daily dose by 5 mg at Yes mixed salts[1] 5 mg once or twice a day; weekly intervals until optimal response Maximum dose: 40 mg per day is achieved. Only in rare cases will it be necessary to exceed a total of 40 mg per day. amphetamine/dextroamphetamine narcolepsy Initial dose: 10 mg per day; May increase daily dose by 10 mg at Yes mixed salts Usual dose: weekly intervals until optimal response 5 mg to 60 mg per day is achieved. Take first dose in divided doses upon awakening. amphetamine/dextroamphetamine ADHD Recommended dose: Patients switching from regular-release Yes mixed salts ER*[2] 20 mg once a day amphetamine/dextroamphetamine mixed salts may take the same total daily dose once a day. armodafinil[3] narcolepsy Recommended dose: Take as a single dose in the morning.
[Show full text]
What Every Clinician Should Know Before Starting a Patient on Meds
CARING FOR CHILDREN WITH ADHD: A RESOURCE TOOLKIT FOR CLINICIANS, 2ND EDITION Basic Facts: What Every Clinician Should Know Before Starting a Patient on Medication Studies have shown that treatment for attention-deficit/ • If you reach the maximum recommended dose without • hyperactivity disorder (ADHD) with medication is effective in noticeable improvement in symptoms, try a different stimulant treating the symptoms of ADHD alone or in combination with medication class. Approximately 80% of children will respond to behavioral interventions. at least 1 of the 2 stimulant classes tried. • Stimulant medications also improve academic productivity but • When changing medications, be careful about the dose not cognitive abilities or academic skills. equivalence of different stimulant medication classes; in general, equivalent doses for dexmethylphenidate and Stimulants can help reduce oppositional, aggressive, impulsive, • amphetamine-based stimulants are approximately half of a and delinquent behaviors in some children. methylphenidate dose. Several types of medications are Food and Drug Administration Non-stimulant medications may require 2 or more weeks to see • (FDA)-approved for the treatment of ADHD. • effects, so you should titrate up more slowly than you would • Stimulant medications: methylphenidate, dexmethylphenidate, for stimulant medications. Obtaining follow-up rating scales is dextroamphetamine, mixed amphetamine salts, even more important than for stimulant medications because lisdexamfetamine changes are more gradual. • Non-stimulant medications: atomoxetine, and extended-release • Managing side effects effectively can improve adherence to and guanfacine and clonidine satisfaction with stimulant medications. When choosing which stimulant and dose to start first, consider • Common side effects to discuss with families include • stomachache, headache, decreased appetite, sleep problems, Family preference and experience with the medication, including • and behavioral rebound.
[Show full text]
Alcohol Mixed with Other Drugs
Alcohol Mixed with Other Drugs Stimulants Stimulants or “uppers”: Drugs that temporarily +increase alertness and energy Examples: Adderall, Ritalin, cocaine, methamphetamine FOCUS: Alcohol + Adderall Adderall: Used to treat ADHD and narcolepsy. Some students misuse Adderall in hopes it will help them study. “Misuse” is deﬁned as taking a medication that was not prescribed to you, taking more Alcohol than what was prescribed to you or taking it for a dierent purpose than prescribed. Eects: Because alcohol is a depressant Use CUPS to remember the and Adderall is a stimulant, Adderall will symptoms of alcohol poisoning: mask alcohol’s eects. Mixing alcohol with • Cold, clammy, pale or bluish skin. a stimulant makes you less aware of alcohol's • Unconscious or unable to be roused. intoxicating eects, which can result in an • Puking repeatedly or uncontrollably. overdose or death. Additionally, mixing alcohol with Adderall (or any other stimulant) • Slow or irregular breathing. can cause an irregular heartbeat and cause cardiovascular complications. Stat: 4.3 percent of UC Davis undergraduates reported using a prescription stimulant in the last 12 months that was not prescribed to them. Sedative Depressants or “downers”: Sedating drugs +that reduce stimulation Examples: opiates, Xanax, Valium FOCUS: Alcohol + Opiates/Opioids Opiates: A group of drugs that are used for treating pain -examples: heroin, morphine, codeine, oxycontin, vicodin, fentanyl Alcohol Eects: When alcohol and opioids are Symptoms: taken at the same time, the sedative • Slow or irregular breathing eects of both drugs will magnify. This • Lowered pulse and can depress or even stop involuntary blood pressure functions, such as breathing, and will • Unconscious or unable increase the risk of overdose and death.
[Show full text]
Phenylmorpholines and Analogues Thereof Phenylmorpholine Und Analoge Davon Phenylmorpholines Et Analogues De Celles-Ci
(19) TZZ __T (11) EP 2 571 858 B1 (12) EUROPEAN PATENT SPECIFICATION (45) Date of publication and mention (51) Int Cl.: of the grant of the patent: C07D 265/30 (2006.01) A61K 31/5375 (2006.01) 20.06.2018 Bulletin 2018/25 A61P 25/24 (2006.01) A61P 25/16 (2006.01) A61P 25/18 (2006.01) (21) Application number: 11723158.9 (86) International application number: (22) Date of filing: 20.05.2011 PCT/US2011/037361 (87) International publication number: WO 2011/146850 (24.11.2011 Gazette 2011/47) (54) PHENYLMORPHOLINES AND ANALOGUES THEREOF PHENYLMORPHOLINE UND ANALOGE DAVON PHENYLMORPHOLINES ET ANALOGUES DE CELLES-CI (84) Designated Contracting States: • DECKER, Ann Marie AL AT BE BG CH CY CZ DE DK EE ES FI FR GB Durham, North Carolina 27713 (US) GR HR HU IE IS IT LI LT LU LV MC MK MT NL NO PL PT RO RS SE SI SK SM TR (74) Representative: Hoeger, Stellrecht & Partner Patentanwälte mbB (30) Priority: 21.05.2010 US 347259 P Uhlandstrasse 14c 70182 Stuttgart (DE) (43) Date of publication of application: 27.03.2013 Bulletin 2013/13 (56) References cited: WO-A1-2004/052372 WO-A1-2008/026046 (73) Proprietors: WO-A1-2008/087512 DE-B- 1 135 464 • Research Triangle Institute FR-A- 1 397 563 GB-A- 883 220 Research Triangle Park, North Carolina 27709 GB-A- 899 386 US-A1- 2005 267 096 (US) • United States of America, as represented by • R.A. GLENNON ET AL.: "Beta-Oxygenated The Secretary, Department of Health and Human Analogues of the 5-HT2A Serotonin Receptor Services Agonist Bethesda, Maryland 20892-7660 (US) 1-(4-Bromo-2,5-dimethoxyphenyl)-2-aminopro pane", JOURNAL OF MEDICINAL CHEMISTRY, (72) Inventors: vol.
[Show full text]
Chronic Amphetamine Exposure Causes Long Term Effects on Dopamine Uptake in Cultured Cells Nafisa Ferdous
University of North Dakota UND Scholarly Commons Theses and Dissertations Theses, Dissertations, and Senior Projects January 2016 Chronic Amphetamine Exposure Causes Long Term Effects On Dopamine Uptake In Cultured Cells Nafisa Ferdous Follow this and additional works at: https://commons.und.edu/theses Recommended Citation Ferdous, Nafisa, "Chronic Amphetamine Exposure Causes Long Term Effects On Dopamine Uptake In Cultured Cells" (2016). Theses and Dissertations. 2016. https://commons.und.edu/theses/2016 This Thesis is brought to you for free and open access by the Theses, Dissertations, and Senior Projects at UND Scholarly Commons. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of UND Scholarly Commons. For more information, please contact [email protected]. CHRONIC AMPHETAMINE EXPOSURE CAUSES LONG TERM EFFECTS ON DOPAMINE UPTAKE IN CULTURED CELLS By Nafisa Ferdous Bachelor of Science, North South University, Bangladesh 2012 A Thesis submitted to the Graduate Faculty of the University of North Dakota in partial fulfillment of the requirements for the degree of Master of Science Grand Forks, North Dakota December 2016 ii PERMISSION Title Chronic amphetamine exposure causes long term effects on dopamine uptake in cultured cells Department Biomedical Sciences Degree Master of Science In presenting this thesis in partial fulfillment of the requirements for a graduate degree from the University of North Dakota, I agree that the library of this University shall make it freely available for inspection. I further agree that permission for extensive copying for scholarly purposes may be granted by the professor who supervised my thesis work or, in his absence, by the Chairperson of the department or the Dean of the School of Graduate Studies.
[Show full text]
Established Aggregate Production Quotas for Schedule I and II
59980 Federal Register / Vol. 77, No. 190 / Monday, October 1, 2012 / Notices DEPARTMENT OF JUSTICE for Schedule I and II Controlled information, DEA has determined that Substances and Proposed Assessment of adjustments to the proposed aggregate Drug Enforcement Administration Annual Needs for the List I Chemicals production quotas and assessment of [Docket No. DEA–365] Ephedrine, Pseudoephedrine, and annual needs for 3,4-methylenedioxy-N- Phenylpropanolamine for 2013,’’ was methylcathinone (methylone), Established Aggregate Production published in the Federal Register (77 3,4,methylenedioxypyrovalerone Quotas for Schedule I and II Controlled FR 46519). That notice proposed the (MDPV), 4-methyl-N-methylcathinone Substances and Established 2013 aggregate production quotas for (mephedrone), N-benzylpiperazine, Assessment of Annual Needs for the each basic class of controlled substance amphetamine (for conversion), List I Chemicals Ephedrine, listed in schedules I and II and the 2013 amphetamine (for sale), hydrocodone Pseudoephedrine, and assessment of annual needs for the list (for sale), hydromorphone, Phenylpropanolamine for 2013 I chemicals ephedrine, lisdexamfetamine, methylphenidate, pseudoephedrine, and morphine (for sale), oxycodone (for AGENCY: Drug Enforcement phenylpropanolamine. All interested sale), oxymorphone (for conversion), Administration (DEA), Department of persons were invited to comment on or remifentanil, sufentanil, tapentadol, Justice. object to the proposed aggregate ephedrine (for conversion), ephedrine ACTION:
[Show full text]
A Dose-Escalating, Phase-2 Study of Oral Lisdexamfetamine
Ezard et al. BMC Psychiatry (2016) 16:428 DOI 10.1186/s12888-016-1141-x STUDY PROTOCOL Open Access Study protocol: a dose-escalating, phase-2 study of oral lisdexamfetamine in adults with methamphetamine dependence Nadine Ezard1,2, Adrian Dunlop3, Brendan Clifford1* , Raimondo Bruno4, Andrew Carr5, Alexandra Bissaker1 and Nicholas Lintzeris6,7 Abstract Background: The treatment of methamphetamine dependence is a continuing global health problem. Agonist type pharmacotherapies have been used successfully to treat opioid and nicotine dependence and are being studied for the treatment of methamphetamine dependence. One potential candidate is lisdexamfetamine, a pro-drug for dexamphetamine, which has a longer lasting therapeutic action with a lowered abuse potential. The purpose of this study is to determine the safety of lisdexamfetamine in this population at doses higher than those currently approved for attention deficit hyperactivity disorder or binge eating disorder. Methods/design: This is a phase 2 dose escalation study of lisdexamfetamine for the treatment of methamphetamine dependence. Twenty individuals seeking treatment for methamphetamine dependence will be recruited at two Australian drug and alcohol services. All participants will undergo a single-blinded ascending-descending dose regime of 100 to 250 mg lisdexamfetamine, dispensed daily on site, over an 8-week period. Participants will be offered counselling as standard care. For the primary objectives the outcome variables will be adverse events monitoring, drug tolerability and regimen completion. Secondary outcomes will be changes in methamphetamine use, craving, withdrawal, severity of dependence, risk behaviour and other substance use. Medication acceptability, potential for non-prescription use, adherence and changes in neurocognition will also be measured.
[Show full text]
Product Monograph
PRODUCT MONOGRAPH VYVANSE®* lisdexamfetamine dimesylate Capsules: 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg and 70 mg Chewable Tablets: 10 mg, 20 mg, 30 mg, 40 mg, 50 mg and 60 mg Central Nervous System Stimulant Takeda Canada Inc. Date of Preparation: 22 Adelaide Street West, Suite 3800 19 February 2009 Toronto, Ontario M5H 4E3 Date of Revision: July 21, 2020 Submission Control No.: 240669 *VYVANSE® and the VYVANSE Logo are registered trademarks of Shire LLC, a Takeda company. Takeda and the Takeda Logo are trademarks of Takeda Pharmaceutical Company Limited, used under license. © 2020 Takeda Pharmaceutical Company Limited. All rights reserved. Pa ge 1 of 60 TABLE OF CONTENTS PART I: HEALTH PROFESSIONAL INFORMATION .................................................... 3 SUMMARY PRODUCT INFORMATION ................................................................... 3 INDICATIONS AND CLINICAL USE ........................................................................ 3 CONTRAINDICATIONS ............................................................................................ 5 WARNINGS AND PRECAUTIONS ............................................................................ 6 ADVERSE REACTIONS........................................................................................... 12 DRUG INTERACTIONS ........................................................................................... 23 DOSAGE AND ADMINISTRATION ........................................................................ 25 OVERDOSAGE .......................................................................................................
[Show full text]