Case Study: Taking dextroamphetamine for  the treatment of ADHD

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Case Study: Taking dextroamphetamine for  the treatment of ADHD

Case Study: Taking dextroamphetamine for  the treatment of ADHD

A 15-year-old boy who has been taking dextroamphetamine for the treatment of ADHD has been experiencing a depressed mood and a sense of hopelessness. He confides in the school nurse that he has begun taking his stepfather’s antidepressant to improve his mood. After immediately phoning the boy’s stepfather, the nurse learns that the drug in question is phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI). The nurse should recognize that this combination of drugs creates a serious risk of what health problem?

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Amphetamines are noncatecholamine, sympathomimetic amines with CNS stimulant activity. Peripheral
actions include elevations of systolic and diastolic blood pressures and weak bronchodilator and respiratory
stimulant action.
There is neither specific evidence that clearly establishes the mechanism whereby amphetamines produce
mental and behavioral effects in children, nor conclusive evidence regarding how these effects relate to the
condition of the central nervous system.
DEXEDRINE SPANSULE capsules are formulated to release the active drug substance in vivo in a more
gradual fashion than the standard formulation, as demonstrated by blood levels. The formulation has not been
shown superior in effectiveness over the same dosage of the standard, noncontrolled-release formulations given
in divided doses.
Pharmacokinetics: The pharmacokinetics of the tablet and sustained-release capsule were compared in 12
healthy subjects. The extent of bioavailability of the sustained-release capsule was similar compared to the
immediate-release tablet. Following administration of three 5-mg tablets, average maximal dextroamphetamine
plasma concentrations (Cmax) of 36.6 ng/mL were achieved at approximately 3 hours. Following administration
of one 15-mg sustained-release capsule, maximal dextroamphetamine plasma concentrations were obtained
approximately 8 hours after dosing. The average Cmax was 23.5 ng/mL. The average plasma T½ was similar for
both the tablet and sustained-release capsule and was approximately 12 hours.
In 12 healthy subjects, the rate and extent of dextroamphetamine absorption were similar following
administration of the sustained-release capsule formulation in the fed (58 to 75 gm fat) and fasted state.
INDICATIONS AND USAGE
DEXEDRINE is indicated in:
Narcolepsy
Attention Deficit Disorder with Hyperactivity: As an integral part of a total treatment program that
typically includes other remedial measures (psychological, educational, social) for a stabilizing effect in
pediatric patients (ages 3 years to 16 years) with a behavioral syndrome characterized by the following group of
developmentally inappropriate symptoms: Moderate to severe distractibility, short attention span, hyperactivity,
emotional lability, and impulsivity. The diagnosis of this syndrome should not be made with finality when these
symptoms are only of comparatively recent origin. Nonlocalizing (soft) neurological signs, learning disability,
and abnormal EEG may or may not be present, and a diagnosis of central nervous system dysfunction may or
may not be warranted.
CONTRAINDICATIONS

Case Study: Taking dextroamphetamine for  the treatment of ADHD
Advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension,
hyperthyroidism, known hypersensitivity or idiosyncrasy to the sympathomimetic amines, glaucoma.
Agitated states.
Patients with a history of drug abuse.
During or within 14 days following the administration of monoamine oxidase inhibitors (hypertensive crises
may result).

Case Study: Taking dextroamphetamine for the treatment of ADHD

Case Study: Taking dextroamphetamine for the treatment of ADHD

WARNINGS
Serious Cardiovascular Events
Sudden Death in Patients with Pre-existing Structural Cardiac Abnormalities or Other Serious
Heart Problems: Children and Adolescents: Sudden death has been reported in association with CNS
stimulant treatment at usual doses in children and adolescents with structural cardiac abnormalities or other
serious heart problems. Although some serious heart problems alone carry an increased risk of sudden death,
stimulant products generally should not be used in children or adolescents with known serious structural cardiac
abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or other serious cardiac problems that may
place them at increased vulnerability to the sympathomimetic effects of a stimulant drug.
Adults: Sudden deaths, stroke, and myocardial infarction have been reported in adults taking stimulant
drugs at usual doses for ADHD. Although the role of stimulants in these adult cases is also unknown, adults
have a greater likelihood than children of having serious structural cardiac abnormalities, cardiomyopathy,
serious heart rhythm abnormalities, coronary artery disease, or other serious cardiac problems. Adults with such
abnormalities should also generally not be treated with stimulant drugs (see CONTRAINDICATIONS).
Hypertension and Other Cardiovascular Conditions: Stimulant medications cause a modest increase in
average blood pressure (about 2-4 mmHg) and average heart rate (about 3-6 bpm), and individuals may have

Case Study: Taking dextroamphetamine for  the treatment of ADHD
larger increases. While the mean changes alone would not be expected to have short-term consequences, all
patients should be monitored for larger changes in heart rate and blood pressure. Caution is indicated in treating
patients whose underlying medical conditions might be compromised by increases in blood pressure or heart
rate, e.g., those with pre-existing hypertension, heart failure, recent myocardial infarction, or ventricular
arrhythmia (see CONTRAINDICATIONS).
Assessing Cardiovascular Status in Patients Being Treated With Stimulant Medications:
Children, adolescents, or adults who are being considered for treatment with stimulant medications should have
a careful history (including assessment for a family history of sudden death or ventricular arrhythmia) and
physical exam to assess for the presence of cardiac disease, and should receive further cardiac evaluation if
findings suggest such disease (e.g., electrocardiogram and echocardiogram). Patients who develop symptoms
such as exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease during
stimulant treatment should undergo a prompt cardiac evaluation.

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