No

Stimulant

Treatment of ADHD; exogenous obesity (short-term adjunct)

C-II

C

Known hypersensitivity or idiosyncrasy to sympathomimetic amines; patients with advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension (stage II or III), hyperthyroidism, glaucoma, agitated states; patients with a history of drug abuse; use during or within 14 days following MAO inhibitor therapy; stimulant medications are contraindicated for use in children with attention deficit/hyperactivity disorders and concomitant Tourette's syndrome or tics

Use with caution in patients with bipolar disorder, diabetes mellitus, cardiovascular disease, seizure disorders, insomnia, porphyria, or mild hypertension (stage I). May exacerbate symptoms of behavior and thought disorder in psychotic patients. Potential for drug dependency exists - avoid abrupt discontinuation in patients who have received for prolonged periods. Use in weight reduction programs only when alternative therapy has been ineffective. Products may contain tartrazine - use with caution in potentially sensitive individuals. Stimulant use in children has been associated with growth suppression.

Cardiovascular: Hypertension, tachycardia, palpitations

Central nervous system: Restlessness, headache, exacerbation of motor and phonic tics and Tourette's syndrome, dizziness, psychosis, dysphoria, overstimulation, euphoria, insomnia

Dermatologic: Rash, urticaria

Endocrine & metabolic: Change in libido

Gastrointestinal: Diarrhea, nausea, vomiting, stomach cramps, constipation, anorexia, weight loss, xerostomia, unpleasant taste

Genitourinary: Impotence

Neuromuscular & skeletal: Tremor

Miscellaneous: Suppression of growth in children, tolerance and withdrawal with prolonged use

Symptoms of overdose include seizures, hyperactivity, coma, hypertension

There is no specific antidote for amphetamine intoxication and the bulk of the treatment is supportive. Hyperactivity and agitation usually respond to reduced sensory input, however with extreme agitation haloperidol (2-5 mg I.M. for adults) may be required. Hyperthermia is best treated with external cooling measures, or when severe or unresponsive, muscle paralysis with pancuronium may be needed. Hypertension is usually transient and generally does not require treatment unless severe. For diastolic blood pressures >110 mm Hg, a nitroprusside infusion should be initiated. Seizures usually respond to diazepam IVP and/or phenytoin maintenance regimens.

CYP2D6 enzyme substrate

Methamphetamine may decrease hypotensive effects of guanethidine

Methamphetamine is contraindicated with MAOIs

Antipsychotics may antagonize the CNS stimulant effect of methamphetamine

Concurrent use of methamphetamine and TCAs and indirect-acting sympathomimetic amines should be dosed carefully

A sympathomimetic amine related to ephedrine and amphetamine with CNS stimulant activity; peripheral actions include elevation of systolic and diastolic blood pressure and weak bronchodilator and respiratory stimulant action

Duration: 12-24 hours

Attention deficit disorder: Children >6 years: 2.5-5 mg 1-2 times/day, may increase by 5 mg increments weekly until optimum response is achieved, usually 20-25 mg/day

Exogenous obesity: Children >12 years and Adults: 5 mg, 30 minutes before each meal; long-acting formulation: 10-15 mg in morning; treatment duration should not exceed a few weeks

Should be administered 30 minutes before meals

Heart rate, respiratory rate, blood pressure, and CNS activity

Use vasoconstriction with caution in patients taking methamphetamine. Amphetamines enhance the sympathomimetic response of epinephrine and norepinephrine leading to potential hypertension and cardiotoxicity.

Up to 10% of patients taking dextroamphetamines may present with hypertension. The use of local anesthetic without vasoconstrictor is recommended in these patients.

Take exactly as directed (do not increase dose or frequency without consulting prescriber); may cause physical and/or psychological dependence. Do not crush extended release tablets. Take early in day to avoid sleep disturbance, 30 minutes before meals. Avoid alcohol, caffeine, or OTC medications that act as stimulants. You may experience restlessness, false sense of euphoria, or impaired judgment (use caution when driving or engaging in tasks requiring alertness until response to drug is known); dry mouth (frequent small meals, frequent mouth care, sucking lozenges, or chewing gum may help); nausea or vomiting (small frequent meals, frequent mouth care may help); constipation (increased exercise, dietary fiber, fruit, or fluid may help); diarrhea (buttermilk, boiled milk, or yogurt may help); or altered libido (reversible). Diabetics need to monitor serum glucose closely (may alter antidiabetic medication requirements). Report chest pain, palpitations, or irregular heartbeat; extreme fatigue or depression; CNS changes (aggressiveness, restlessness, euphoria, sleep disturbances); severe unremitting abdominal distress or cramping; blackened stool; changes in sexual activity; or blurred vision. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Do not breast-feed.

Dose should not be given in evening or at bedtime; do not crush extended release tablet

Tablet, as hydrochloride: 5 mg

Tablet, extended release, as hydrochloride (Gradumet®): 5 mg, 10 mg, 15 mg

Catanzarite VA and Stein DA, "'Crystal' and Pregnancy: Methamphetamine-Associated Maternal Death," West J Med, 1995, 162(5):454-7.

Gilbert RB, Peng PI,and Wong D, "A Labetalol Metabolite With Analytical Characteristics Resembling Amphetamines," J Anal Toxicol, 1995, 19(2):84-6.

Gospe SM Jr, "Transient Cortical Blindness in an Infant Exposed to Methamphetamine," Ann Emerg Med, 1995, 26(3):380-2.

McKinney PF, Tomaszewski C, Phillips S, et al, "Methamphetamine Toxicity Prevented by Activated Charcoal in a Mouse Model," Ann Emerg Med, 1994, 24(2):220-2.

Mendelson J, Jones RT, Upton R, et al, "Methamphetamine and Ethanol Interactions in Humans," Clin Pharmacol Ther, 1995, 57(5):559-68.

Mueller PD and Korey WS, "Death by Ecstasy - The Serotonin Syndrome?" Clin Toxicol, 1995, 33(5):550.

Nestor TA, Tamamoto WI, Kam TH, et al, "Acute Pulmonary Oedema Caused by Crystalline Methamphetamine," Lancet, 1989, 2(8674):1277-8.

Richards CF, Clark RF, Holbrook T, et al, "The Effect of Cocaine and Amphetamines on Vital Signs in Trauma Patients," J Emerg Med, 1995, 13(1):59-63.

Rothrock JF, Rubenstein R, and Lyden PD, "Ischemic Stroke Associated With Methamphetamine Inhalation," Neurology, 1988, 38(4):589-92.

Segar DL, "Substances of Abuse: Topics," Emerg Med, 1985, 7:18-30.

Sperling LS and Horowitz JL, "Methamphetamine-Induced Choreoathetosis and Rhabdomyolysis," Ann Intern Med, 1994, 121(12):986.