ADHD- Stimulants General Info Flashcards
First-line treatment in ADHD
Stimulants (for the most part unless there’s SUD)
Stimulants in ADHD
Methylphenidate (MPH) and amphetamine (AMP)
Which stimulant is more potent?
Amphetamines
What happens if you try one stimulant and it doesn’t work?
Just try a different one! Lack of response to one doesn’t mean lack of response to another
Features of IR formulations of stimulants: frequency
BID-TID due to their short half-lives
Features of IR formulations of stimulants: drug onset
15-30 minutes
Features of IR formulations of stimulants: duration
2-6 hours
Features of IR formulations of stimulants: advantages
Lower cost, less insomnia, fewer growth-related ADEs
Features of LA/ER formulations of stimulants: frequency
QD
Features of ER formulations of stimulants: duration of action
8-12 hours, may need another afternoon dose
Features of ER formulations of stimulants: advantage
Increases adherence!
Stimulant ADEs: psychiatric
psychosis/mania, aggression/violent behavior, severe anxiety/anxiety attacks –> decrease dose or cessation of stimulant, supportive treatment
Stimulant ADEs: cardiac
Increased HR by ~5 BPM, increased BP by 2-7mmHg, but not a cause of concern if there’s no underlying cardiac issues
Stimulant ADEs: growth
~1cm/year decreases over 3 years
~3kg weight deficit in 1st year, 1.2kg in 2nd year
Will the weight loss go away when taking a stimulant?
Yes! (But also attempt a drug-free trial every year)
Which stimulant is more likely to have DDIs?
MPH
Stimulant DDIs: combo with psychostimulants
Additive effects
Stimulant DDIs: MAOIs
Don’t use an MAOI within 14 days
Stimulant DDIs: MPH and TCA
MPH can increase TCA concentrations
Stimulant DDIs: MPH IR, MPH DR with antacids, PPIs, H2RAs
Antacids, PPIs, and H2RAs can increase absorption of the IR formulation and decrease it for DR
Stimulant DDIs: antacids and PPIs vs. AMP
Antacids decrease excretion of AMP
PPIs can increase rate of absorption of AMP
Stimulant DDIs: Acidic agents and AMP
Acidic agents can lower AMP absorption
Stimulant DDIs: 2D6 inhibitors and mixed AMP salts
2D6 inhibitors can increase mixed AMP salt exposure
Stimulant DDIs: concomitant use with alcohol
Can result in stimulant dumping