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General Medication Discussion This section is to be used for general medication discussion and other medications not broken out in their own respective forums.

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  #1  
Old 02-09-16, 10:41 AM
jeffb74 jeffb74 is offline
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need advice on medication

I asked my psychiatrist last night about desoxyn or its generic counterpart methamphetamine hydrochloride. He didn't even know what it was. He told me " I know almost all the medicines out there". I am surprised a psychiatrist in his mid 50s would have no idea what desoxyn is and claims he never heard of it. I assume he has practiced for at least 20 -25 years and I am even more shocked that I am aware of a psychiatric medicine than the actual psyc dr.. who went to medical school and has all this training..

I told him that I feel more alert on the adderall IR 20 mg 2 x per day and it kills my appetite when i take it, but that in terms of add symptoms I still am pretty impulsive and inattention is an issue but that I am a little calmer(hyperactivity wise). Didn't even get a chance to discuss my temper because the sessions are so quick. I feel like he just wants to write a script for a prescrip and feel rushed like its a factory. He wanted me to give adderall IR 20 mg another month (this would be the 3rd month coming up) and I asked him if I stay on it if he could give me an extra dose for the late afternoon/early evening, so after insisting on it he now has me on Adderall IR 20 mg 3 times per day..

I would like a psychiatrist to at least discuss my medicine and not only see how i am doing in general but discuss my add symptoms and see if the medicine is helping me with that. I am debating going to another psychiatrist who might have a little more time to discuss my symptomlogy and the medicine.

I realize he's in an in network dr who makes his money in 10-15 medication monitoring session but I need someone who is listening when I say that the adderall ir doesnt last long enough in duration and is not working in terms of really helping my adhd symptoms. I am wondering if dexedrine IR might be better for me or I would like to try desoxyn(generic IR) knowing how my adhd is so pervasive throughout the day in terms of inattention, impulsivity, hyperactivy as an adult and procastration etc...
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Old 02-09-16, 07:24 PM
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Re: need advice on medication

It sounds like it may be time to consider finding another Psychiatrist. I would expect more out of a specialist.

My GP treats my ADHD and is wonderful with discussion and truly listens to me and my concerns regarding treatment and medication. I am very lucky to have found such a great Dr.
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  #3  
Old 02-09-16, 09:25 PM
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Re: need advice on medication

No need to be shocked. It really is that much of a unicorn in meds these days.

I’d first try the XR form of Adderall, then perhaps the spansule form of Dexedrine.

Desoxyn is a med of last resort, and with good reason...medically, legally, logistically, and otherwise.

---

You’ve asked for prescription methamphetamine by name. The last thing I would do at this point is look for another doctor. That could easily be perceived as two red flags from a drug seeker. To put it mildly, it would suck to find yourself blacklisted from being prescribed psychostimulant meds.


Cheers,
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Old 02-09-16, 09:46 PM
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Re: need advice on medication

Thanks for your advice. I only asked about the Desoxyn after reading as much as I could on this message boards and across the internet. I have thoroughly done my research and just asked the doctor if he was familiar with it and if he thought it would help me. I have read so many positive things about desoxyn in therapeiutic doses. I never consider myself a drug seeker and am not trying to get high or abuse my prescription medication. Adderall IR generic has definitely helped me feel more alert, and less need for coffee for energy:-) but not sure if it has really made a difference overall in my add symptoms. I would be willing to try Dexedrine IR(generic) to see if its better than Adderall for my adhd symptoms.

I don't understand why there is such a stigma by some on these boards about prescription methamphetamine sulfate(Desoxyn)? People can just as easily abuse amphetamines and probably some do such as Adderall, Dexedrine, Vyvanse. Desoxyn should be an option for those of us who really struggle with ADHD daily in our lives and really want to get better. From what I read Desoxyn and all the other amphetamines are Schedule II drugs that are heavily regulated and I totally understand why that is and I agree with that. So why differentiate prescription Amphetamines compared to prescription Desoxyn.

I am in therapy twice a month and am seeking a life coach/adhd coach so I realize medicine isnt the only thing that I need to get better. Bottom line I just asked my psychiatrist about Desoxyn and wanted to see what he thought of it, has he prescribed it others, would he think its an option for me. At the end of the day the dr. has final say about what drug and dosage to prescribe. I m just more surprised the psychiatrist claims he never heard of Desoxyn and claims he knows almost all the drugs out there for ADD. I couldn't believe he knew Evekeo but not Desoxyn. Just wonder how knowledgable he is , makes me wonder....
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Old 02-09-16, 10:24 PM
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Re: need advice on medication

Your doctor knows about Desoxyn. He doesn't want to talk about it.
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Old 02-09-16, 10:48 PM
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Re: need advice on medication

Quote:
Originally Posted by jeffb74 View Post
I don't understand why there is such a stigma by some on these boards about prescription methamphetamine sulfate(Desoxyn)? People can just as easily abuse amphetamines and probably some do such as Adderall, Dexedrine, Vyvanse. Desoxyn should be an option for those of us who really struggle with ADHD daily in our lives and really want to get better. From what I read Desoxyn and all the other amphetamines are Schedule II drugs that are heavily regulated and I totally understand why that is and I agree with that. So why differentiate prescription Amphetamines compared to prescription Desoxyn.
Methamphetamine is neurotoxic.

Dextroamphetamine is not.

That’s reason #1, and a big one at that.

Quote:
Originally Posted by Wikipedia
Methamphetamine hydrochloride is approved by the United States Food and Drug Administration (USFDA) under the trade name Desoxyn for attention deficit hyperactivity disorder and obesity in adults and children, and is sometimes prescribed off label for narcolepsy and idiopathic hypersomnia. It is rarely prescribed due to concerns involving human neurotoxicity and its high potential for recreational use, among other concerns, and the availability of safer substitute drugs with comparable treatment efficacy. Methamphetamine exists as two enantiomers: dextromethamphetamine and levomethamphetamine.[note 2] Methamphetamine properly refers to a specific chemical, the racemic free base, which is an equal mixture of levomethamphetamine and dextromethamphetamine in their pure amine forms. Dextromethamphetamine is a much stronger central stimulant than levomethamphetamine. Both enantiomers are neurotoxic and addictive.
I’m not aware of any placebo-controlled, randomized, double-blind clinical research that has demonstrated methamphetamine hydrochloride has any greater efficacy than dextroamphetamine sulfate in the treatment of ADHD, and I’ve searched at length to find anything in this regard.

That’s reason #2.

I could go on.

I agree that methamphetamine hydrochloride should be an option in the treatment of ADHD, but I think it should very much be an option of last resort because of the consequences and potential risks.

Until you’ve trialed, titrated, and failed on Ritalin, Focalin, Adderall, Vyvance, Dexedrine, Strattera, Kapvay, and Intuniv, in all of their relevant IR and XR forms, brand and/or generic, while maintaining good sleep hygiene, healthy diet, and engaging in daily exercise, there’s little reason to choose it, nothing to recommend it, and good reason to avoid it.


Cheers,
Ian
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Old 02-09-16, 11:43 PM
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Re: need advice on medication

Quote:
Originally Posted by Little Missy View Post
Your doctor knows about Desoxyn. He doesn't want to talk about it.
Jeff
This is most likely true or even worse if he doesn't know. Either way, if you can't discuss medications with your psychiatrist it's time to move on IMO.

aeon shared more time and knowledge about the medication just like your Dr. should have. Tell your psych. to send a check to aeon for finishing your appointment.
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Old 02-10-16, 12:16 AM
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Re: need advice on medication

Ian, You bring up interesting points, but I would like to see more research backing up what you found. Not to be argumentative, but the links you found from Wikipedia have no citations to refer to further.

Also I found this in the same wikipedia post on Desoxyn--"In low doses, methamphetamine can elevate mood, increase alertness, concentration and energy in fatigued individuals, reduce appetite and promote (initial) weight loss".
One can assume that sounds very similar if not exactly like dextroamphetamines or other prescription amphetamines prescribed for adhd under a doctors care. I am looking at this as one taking desoxyn in low doses as prescribed by a doctor such as the prescription amphetamines that are legal and prescribed everyday by psychiatrists.
Now I realize it's wikipedia(not exactly the medical authority or scientific authority) and there is no citation listed here for my quote here from Wikipedia post on Desoxyn.


Then I found this article which had an interesting point..

http://www.nature.com/npp/journal/v3...76a.html#bib47
Neuropsychopharmacology (2012) 37, 586–608; doi:10.1038/npp.2011.276; published online 16 November 2011

Review
Is Cognitive Functioning Impaired in Methamphetamine Users? A Critical Review

"There are several amphetamines used recreationally, including d-amphetamine, methamphetamine, 3,4-methylenedioxyamphetamine, and 3,4-methylenedioxymethamphetamine. Of these compounds, methamphetamine has generated the greatest amount of concern. Indeed, periodically there are statements in the scientific and popular literature attesting to methamphetamine's greater potency and ‘addictive’ potential, relative to other amphetamines. Such statements, however, are inconsistent with data collected in humans, which show that d-amphetamine and methamphetamine produce nearly identical physiological and behavioral effects (eg, Martin et al, 1971; Sevak et al, 2009; Kirkpatrick et al, in press a). One reason for the unfounded beliefs about the drugs might be related to the fact that methamphetamine is more readily available on the illicit market owing to its apparent easier synthesis." Now again this article discusses recreational use of methamphetamines, and I am not suggesting or recommending that to anyone. I am just going off what I have read on this website, other message boards, and other websites on how much Desoxyn has helped their ADD symptoms more so than many of the other drugs especially stimulants prescribed by psychiatrists. I am not a doctor, scientist, but just one who enjoys doing research at times and am trying to find an ADHD medicine to help me without all the trial and error ways of one taking different ADHD meds and different doses plus my insurance has made brand name drugs very expensive so I am limited to generic drugs at this point...

Finally if one took Desoxyn in therapeutic doses , say 5mg-25mg a day max, would that be neurotoxic? or is neurotoxicity for Desoxyn at higher recreational doses, for those who abuse the drug and are taking it to get high etc.. I would love to hear from others who have a medical background, scientific background, who have researched this, have the research and could cite it...
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Old 02-10-16, 12:25 AM
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Re: need advice on medication

You may find some answers in this old thread.
http://www.addforums.com/forums/showthread.php?t=112512
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Old 02-10-16, 01:51 AM
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Re: need advice on medication

Quote:
Originally Posted by jeffb74 View Post
Ian, You bring up interesting points, but I would like to see more research backing up what you found. Not to be argumentative, but the links you found from Wikipedia have no citations to refer to further.
Here you go: (from the same article)

Quote:
Originally Posted by Wikipedia
Unlike amphetamine, methamphetamine is directly neurotoxic to dopamine neurons in both lab animals and humans.[19][20][21] Moreover, methamphetamine neurotoxicity is associated with an increased risk of Parkinson's disease, an effect which partially arises through excessive cytosolic and synaptic production of reactive oxygen species and autoxidation of dopamine.[43][44][45][46][47] In addition to dopaminergic neurotoxicity, a review of evidence in humans also indicated that high-dose methamphetamine use can be neurotoxic to serotonin neurons.[21] It has been demonstrated that a high core temperature is correlated with an increase in the neurotoxic effects of methamphetamine.[48] As a result of methamphetamine-induced neurotoxicity to dopamine neurons, chronic use may also lead to post-acute withdrawal which persists months beyond the typical withdrawal period.[44]
Magnetic resonance imaging studies on human methamphetamine users have also found evidence of neurodegeneration, or adverse neuroplastic changes in brain structure and function.[21]
You can ignore the reference to serotonin neurons because clinical use is not high-dose methamphetamine use.

Quote:
Originally Posted by jeffb74 View Post
Also I found this in the same wikipedia post on Desoxyn--"In low doses, methamphetamine can elevate mood, increase alertness, concentration and energy in fatigued individuals, reduce appetite and promote (initial) weight loss".
One can assume that sounds very similar if not exactly like dextroamphetamines or other prescription amphetamines prescribed for adhd under a doctors care. I am looking at this as one taking desoxyn in low doses as prescribed by a doctor such as the prescription amphetamines that are legal and prescribed everyday by psychiatrists.
This is understood (by me).

Quote:
Originally Posted by jeffb74 View Post
Then I found this article which had an interesting point..

http://www.nature.com/npp/journal/v3...76a.html#bib47
Neuropsychopharmacology (2012) 37, 586–608; doi:10.1038/npp.2011.276; published online 16 November 2011

Review
Is Cognitive Functioning Impaired in Methamphetamine Users? A Critical Review

"There are several amphetamines used recreationally, including d-amphetamine, methamphetamine, 3,4-methylenedioxyamphetamine, and 3,4-methylenedioxymethamphetamine. Of these compounds, methamphetamine has generated the greatest amount of concern. Indeed, periodically there are statements in the scientific and popular literature attesting to methamphetamine's greater potency and ‘addictive’ potential, relative to other amphetamines. Such statements, however, are inconsistent with data collected in humans, which show that d-amphetamine and methamphetamine produce nearly identical physiological and behavioral effects (eg, Martin et al, 1971; Sevak et al, 2009; Kirkpatrick et al, in press a). One reason for the unfounded beliefs about the drugs might be related to the fact that methamphetamine is more readily available on the illicit market owing to its apparent easier synthesis."
It is interesting yes, but not relevant, given the focus on recreational use as you have already pointed out.

Quote:
Originally Posted by jeffb74 View Post
I am just going off what I have read on this website, other message boards, and other websites on how much Desoxyn has helped their ADD symptoms more so than many of the other drugs especially stimulants prescribed by psychiatrists.
I hear you, but I would ask you to consider that the plural of the word “anecdote” is not “data.”

Quote:
Originally Posted by jeffb74 View Post
I am not a doctor, scientist, but just one who enjoys doing research at times and am trying to find an ADHD medicine to help me without all the trial and error ways of one taking different ADHD meds and different doses...
I’m not sure anyone avoids that, not anyone who is truly interested in an efficacious dose that has been properly titrated, regardless of the med in question.

For methamphetamine hydrochloride specifically, lack of clinical evidence of greater efficacy as compared and contrasted with dextroamphetamine sulfate would suggest no time would be saved starting with methamphetamine.

(I tried methylphenidate (Ritalin/Concerta) and dextromethylphenidate (Focalin) before being prescribed dextroamphetamine (Dexedrine). I have also had a trial of Vyvance.)

Quote:
Originally Posted by jeffb74 View Post
Finally if one took Desoxyn in therapeutic doses , say 5mg-25mg a day max, would that be neurotoxic? or is neurotoxicity for Desoxyn at higher recreational doses, for those who abuse the drug and are taking it to get high etc.. I would love to hear from others who have a medical background, scientific background, who have researched this, have the research and could cite it...
The citations in my last quoting of Wikipedia link to research where the effects of chronic low-dose usage are studied.

My take on their conclusions, being careful to exclude high-dose/recreational use, is that methamphetamine hydrochloride is neurotoxic with chronic use at clinical/theraputic dosages.

Quote:
Originally Posted by Recent Advances in Methamphetamine Neurotoxicity Mechanisms and Its Molecular Pathophysiology
Shaobin Yu, 1 Ling Zhu, 1 Qiang Shen, 2 Xue Bai, 1 and Xuhui Di 1 , *
2.2. Long-Term Damage of Low Dose
Chronic use of METH is often associated with cognitive deficits ranging from impaired impulse control, attentional problems, working memory, and decision making to motor coordination, including inhibitory control, which do not display classic Parkinsonian motor impairments. However, chronic users of METH are at higher risk for developing Parkinson's disease (PD) than nonusers.
One other thing to consider...part of the reason I like Dexedrine (aside from the fact it works for me) is that it is pure dextrorotary amphetamine, with primarily CNS stimulation (as opposed to PNS), and less potential for side-effects. Desoxyn/generic equivalent is racemic...only 1/2 of the dosage is dextrorotary. The other half is levorotary, with primarily PNS stimulation. This makes Desoxyn “dirtier” than any other amphetamine-based ADHD med on a per dose basis.

Also, Desoxyn Gradumet is no longer manufactured, so only IR formulations are available. This may or may not be a downside for a given patient. Personally, I appreciate the availability of IR and XR formulations for Adderall and Dexedrine (as well as Ritalin and Focalin), leading to dosing flexibility and better chance of an efficacious prescription for a given patient.


Cheers,
Ian
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Old 02-10-16, 02:45 AM
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Re: need advice on medication

Ian,

without paying for each article linked to your wikipedia article you posted..what I was able to read for free in terms of neurotoxicity of desoxyn was not clear. If you click on the citations, references in the article you attached for me you can see that clearly by reading the abstracts, whatever is given when you open the article and whatever can be read without a subscription.

The articles referenced either those abusing( meth addicts taking large quantities) of methamphatemine, or not taking clinical therapeutic doses,

or the articles referred to testing methamphatemines and different amounts on primates or other animals which is not 100 percent comparable to a human and a similar dosing schedule of the same drug.

You still haven't shown me one scientfic article from a journal or magazine that clearly backs up that desoxyn in low therapeutic doses is neurotoxic to humans. Show me a study based on humans taking low therapeutic doses given by a medica doctor who prescribed desoxyn or its generic version and being monitored by a doctor on the medication on a regular basis.

At this point One can find articles based on animal studies(primates for example) given therapeutic doses of dextroamphetamines etc... or looking at humans also that abuse amphetamines(prescription or street wise) and authors of those articles would say that this is neurotoxic also based on this research.

The reference to Parkinson's definitely needs more research but again I wonder if all of us that take prescription amphetamines in therapeutic doses as recommended and followed ( such as Adderall, Dexedrine, Vyvnase, etc.. are as much at risk as one who hypothetically takes Desoxyn for ADHD in a therapeutic dose prescribed by their doctor. I think the jury is still out on that until we see more studies of humans who take amphetamines and methamphatamines in the legal prescribed form in the therapeutic doses long term. I feel its a risk we all take with these legal prescription drugs. We hope that they are safe now and for our future health but at the same time we know there is a slight risk if it helps our everyday lives and function better now and for the foreseeable future for our add symtoms and how it impacts our lives.

But I appreciate you looking into it and giving me your opinion based on what you have but I still am not convinced based on what you have written or referenced so far.

I enjoy your input and would love to hear what others think?
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Old 02-10-16, 07:41 AM
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Re: need advice on medication

I would suggest that you gather up all your information on Desoxyn and show it to your psychiatrist and see how that works out for you. Go grab the newest Physicians Desk Reference while you're at it too. He probably has one in his office that you can borrow.

Psychiatrists, Doctors, etc. have to go through extra formal training every year. He knows about Desoxyn, and he is notating your inquiries about it. Don't look the gift horse in the mouth.
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Old 02-10-16, 12:00 PM
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Re: need advice on medication

Little Missy, I did look at the PDR this morning and here's a comparison of Desoxyn and Adderall.

Desoxyn
(methamphetamine hydrochloride)
BOXED WARNING
High potential for abuse; should be tried only in weight reduction programs for patients in whom alternative therapy has been ineffective. Prolonged use in obesity may lead to drug dependence and must be avoided. Misuse may cause sudden death and serious cardiovascular adverse events.

THERAPEUTIC CLASS

CNS stimulant

DEA CLASS

CII

ADULT DOSAGE & INDICATIONS

Obesity
Management of exogenous obesity as a short-term (few weeks) adjunct in a regimen of weight reduction based on caloric restriction, for patients in whom obesity is refractory to alternative therapy

Usual: 5mg, taken 30 min before each meal

PEDIATRIC DOSAGE & INDICATIONS

Attention-Deficit Hyperactivity Disorder
≥6 Years:
Initial: 5mg qd or bid
Titrate: May increase daily dose in increments of 5mg at weekly intervals until an optimum clinical response is achieved
Usual: 20-25mg/day

Total daily dose may be given in 2 divided doses

Where possible, interrupt administration occasionally to determine if there is a recurrence of behavioral symptoms sufficient to require continued therapy

Obesity
Management of exogenous obesity as a short-term (few weeks) adjunct in a regimen of weight reduction based on caloric restriction, for patients in whom obesity is refractory to alternative therapy

≥12 Years:
Usual: 5mg, taken 30 min before each meal

DOSING CONSIDERATIONS

Elderly
Start at lower end of dosing range

ADMINISTRATION

Oral route

Avoid late pm administration

HOW SUPPLIED

Tab: 5mg

CONTRAINDICATIONS

During or w/in 14 days following MAOI use. Glaucoma, advanced arteriosclerosis, symptomatic cardiovascular disease (CVD), moderate to severe HTN, hyperthyroidism, agitated states, and history of drug abuse.

WARNINGS/PRECAUTIONS

Tolerance to anorectic effect usually develops w/in a few weeks; d/c therapy. Do not use to combat fatigue or replace rest. Avoid w/ known serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, or other serious cardiac problems. Sudden death reported in children and adolescents w/ structural cardiac abnormalities or other serious heart problems. Sudden deaths, stroke, and MI reported in adults at ADHD doses. May cause a modest increase in average BP and HR; caution w/ conditions that might be compromised by increases in BP/HR. Promptly perform cardiac evaluation if symptoms suggestive of cardiac disease develop. May exacerbate symptoms of behavior disturbance and thought disorder in patients w/ preexisting psychotic disorder. Caution in patients w/ comorbid bipolar disorder; may induce mixed/manic episodes. May cause treatment-emergent psychotic or manic symptoms (eg, hallucinations, delusional thinking, mania) in children and adolescents w/o prior history of psychotic illness or mania; consider discontinuation if such symptoms occur. Aggressive behavior or hostility reported in children and adolescents w/ ADHD. May cause long-term suppression of growth in children; monitor growth. Treatment may need to be interrupted in patients not growing or gaining height or weight as expected. May lower convulsive threshold; d/c if seizures occur. Associated w/ peripheral vasculopathy, including Raynaud's phenomenon; carefully observe for digital changes. Difficulties w/ accommodation and blurring of vision reported. May exacerbate motor and phonic tics and Tourette's syndrome; evaluate for history of these conditions prior to therapy. May elevate plasma corticosteroid levels.

ADVERSE REACTIONS

BP elevation, tachycardia, palpitation, dizziness, dysphoria, overstimulation, euphoria, insomnia, diarrhea, constipation, dryness of mouth, urticaria, impotence, changes in libido, rhabdomyolysis.

DRUG INTERACTIONS

See Contraindications. May alter insulin requirements. May decrease hypotensive effect of guanethidine. Caution w/ TCAs. Phenothiazines may antagonize CNS stimulant action.

PREGNANCY AND LACTATION

Category C, not for use in nursing.

MECHANISM OF ACTION

Sympathomimetic amine; not established. CNS stimulant and anorectic/anorexigenic. May suppress appetite.

PHARMACOKINETICS

Absorption: Rapid. Distribution: Found in breast milk. Metabolism: Liver, by aromatic hydroxylation, N-dealkylation, and deamination. Elimination: Urine (approx 62% w/in 1st 24 hrs; 1/3 unchanged); T1/2=4-5 hrs.

ASSESSMENT

Assess for hypersensitivity/idiosyncrasy to sympathomimetic amines, glaucoma, advanced arteriosclerosis, symptomatic CVD, moderate to severe HTN, hyperthyroidism, agitated states, history of drug abuse, tics, Tourette's syndrome, preexisting psychotic disorder, any other conditions where treatment is cautioned or contraindicated, pregnancy/nursing status, and possible drug interactions. Perform careful medical history and physical exam to assess for presence of cardiac disease. Adequately screen patients w/ comorbid depressive symptoms to determine risk for bipolar disorder.

MONITORING

Monitor for changes in HR and BP, signs/symptoms of cardiac disease, exacerbation of behavioral disturbance and thought disorder, psychosis, mania, aggressive behavior or hostility, seizures, peripheral vasculopathy (including Raynaud's phenomenon), visual disturbances, exacerbation of motor and phonic tics or Tourette's syndrome, and other adverse reactions. Monitor growth in pediatric patients.

PATIENT COUNSELING

Inform about risks and benefits of treatment and counsel about appropriate use. Inform about impairment in ability to engage in potentially hazardous activities (eg, operating machinery/vehicles). Instruct to report to physician any new numbness, pain, skin color change, or sensitivity to temperature in fingers or toes, and to contact physician immediately w/ any signs of unexplained wounds appearing on fingers or toes while taking the drug. Instruct not to increase dosage, except on advice of the physician.

STORAGE

<30°C (86°F).

Adderalldderall
(amphetamine aspartate monohydrate/amphetamine sulfate/dextroamphetamine saccharate/dextroamphetamine sulfate)
BOXED WARNING
High potential for abuse; prolonged use may lead to drug dependence and must be avoided. Misuse of amphetamine may cause sudden death and serious cardiovascular (CV) adverse events.

THERAPEUTIC CLASS

CNS stimulant

DEA CLASS

CII

ADULT DOSAGE & INDICATIONS

Narcolepsy
Initial: 10mg/day
Titrate: May increase in increments of 10mg at weekly intervals until optimal response is obtained
Usual: 5-60mg/day in divided doses

Give 1st dose on awakening; additional doses (1 or 2) at intervals of 4-6 hrs

Attention-Deficit Hyperactivity Disorder
Refer to pediatric dosing

PEDIATRIC DOSAGE & INDICATIONS

Narcolepsy
Usual: 5-60mg/day in divided doses

6-12 Years:
Initial: 5mg/day
Titrate: May increase in increments of 5mg at weekly intervals until optimal response is obtained

≥12 Years:
Initial: 10mg/day
Titrate: May increase in increments of 10mg at weekly intervals until optimal response is obtained

Give 1st dose on awakening; additional doses (1 or 2) at intervals of 4-6 hrs

Attention-Deficit Hyperactivity Disorder
3-5 Years:
Initial: 2.5mg/day
Titrate: May increase in increments of 2.5mg at weekly intervals until optimal response is obtained

≥6 Years:
Initial: 5mg qd or bid
Titrate: May increase in increments of 5mg at weekly intervals until optimal response is obtained. Only in rare cases will it be necessary to exceed a total of 40mg/day

Give 1st dose on awakening; additional doses (1 or 2) at intervals of 4-6 hrs

Interrupt occasionally to determine the need for continued therapy

DOSING CONSIDERATIONS

Adverse Reactions
Narcolepsy Patients:
Reduce dose if bothersome adverse reactions appear (eg, insomnia or anorexia)

ADMINISTRATION

Oral route

Give 1st dose on awakening; avoid late pm doses due to potential for insomnia.

HOW SUPPLIED

Tab: 5mg*, 7.5mg*, 10mg*, 12.5mg*, 15mg*, 20mg*, 30mg* *scored

CONTRAINDICATIONS

Advanced arteriosclerosis, symptomatic CV disease, moderate to severe HTN, hyperthyroidism, glaucoma, agitated states, history of drug abuse, during or w/in 14 days of MAOI use, hypersensitivity to Adderall.

WARNINGS/PRECAUTIONS

Sudden death reported in children and adolescents w/ structural cardiac abnormalities or other serious heart problems. Sudden death, stroke, and MI reported in adults. Avoid use in patients w/ serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, or other serious cardiac problems. May cause modest increase in average BP and HR. Perform prompt cardiac evaluation when symptoms suggestive of cardiac disease develop. May exacerbate symptoms of behavior disturbance and thought disorder in patients w/ preexisting psychotic disorder. Caution in patients w/ comorbid bipolar disorder; may induce mixed/manic episodes. May cause treatment-emergent psychotic/manic symptoms in children and adolescents w/o prior history of psychotic illness or mania; consider discontinuation if such symptoms occur. Aggressive behavior or hostility reported in children and adolescents w/ ADHD. May cause long-term suppression of growth in children; may need to interrupt treatment if patients are not growing or gaining weight as expected. May lower convulsive threshold; d/c if seizures develop. Associated w/ peripheral vasculopathy, including Raynaud's phenomenon. Difficulties w/ accommodation and blurring of vision reported. May exacerbate motor and phonic tics and Tourette's syndrome. May cause a significant elevation in plasma corticosteroid levels or interfere w/ urinary steroid determinations.

ADVERSE REACTIONS

Palpitations, tachycardia, BP elevation, psychotic episodes, tremor, blurred vision, mydriasis, dry mouth, unpleasant taste, anorexia, urticaria, rash, libido changes, alopecia, rhabdomyolysis.

DRUG INTERACTIONS

See Contraindications. GI alkalinizing agents (eg, sodium bicarbonate, antacids) and urinary alkalinizing agents (eg, acetazolamide, some thiazides) may increase blood levels and potentiate effects; avoid w/ GI alkalinizing agents. GI acidifying agents (eg, guanethidine, reserpine, glutamic acid HCl) and urinary acidifying agents (eg, ammonium chloride, sodium acid phosphate) may lower blood levels and efficacy. May inhibit adrenergic blockers. May enhance activity of TCAs or sympathomimetic agents; caution w/ other sympathomimetic drugs. Increased d-amphetamine levels in the brain w/ desipramine or protriptyline and possibly other tricyclics. May counteract sedative effect of antihistamines. May antagonize the hypotensive effects of antihypertensives. Chlorpromazine and haloperidol may inhibit the central stimulant effects. Lithium carbonate may inhibit the anorectic and stimulatory effects. May delay intestinal absorption of ethosuximide, phenobarbital, and phenytoin; may produce a synergistic anticonvulsant action if coadministered w/ phenobarbital or phenytoin. May potentiate analgesic effect of meperidine. May enhance the adrenergic effect of norepinephrine. Use in cases of propoxyphene overdose may potentiate CNS stimulation and cause fatal convulsions. Monitor for changes in clinical effect when coadministered w/ proton pump inhibitors. May inhibit the hypotensive effect of veratrum alkaloids.

PREGNANCY AND LACTATION

Pregnancy: Category C. Infants born to mothers dependent on amphetamines have an increased risk of premature delivery and low birth weight; also, these infants may experience symptoms of withdrawal as demonstrated by dysphoria, including agitation, and significant lassitude.
Lactation: Found in breast milk; not for use in nursing.

MECHANISM OF ACTION

Sympathomimetic amine w/ CNS stimulant activity; has not been established. Thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space.

PHARMACOKINETICS

Absorption: Tmax=3 hrs (fasted). Distribution: Found in breast milk. Metabolism: CYP2D6 (oxidation); 4-hydroxy-amphetamine and norephedrine (active metabolites). Elimination: Urine (30-40%, unchanged; 50%, α-hydroxy-amphetamine derivatives). T1/2=9.77-11 hrs (d-amphetamine), 11.5-13.8 hrs (l-amphetamine).

ASSESSMENT

Assess for advanced arteriosclerosis, symptomatic CV disease, moderate to severe HTN, hyperthyroidism, hypersensitivity or idiosyncrasy to sympathomimetic amines, glaucoma, agitation, history of drug abuse, psychiatric history, history of seizure, tics or Tourette's syndrome, pregnancy/nursing status, and possible drug interactions. Prior to treatment, adequately screen patients to determine risk for bipolar disorder.

MONITORING

Monitor for CV abnormalities, exacerbations of behavior disturbances and thought disorder, psychotic or manic symptoms, aggressive behavior, hostility, seizures, visual disturbances, exacerbation of motor and phonic tics and Tourette's syndrome, and other adverse reactions. Monitor BP and HR. Monitor growth and weight in children. Periodically reevaluate long-term usefulness of therapy. Observe carefully for signs and symptoms of peripheral vasculopathy; further clinical evaluation (eg, rheumatology referral) may be appropriate for certain patients.

PATIENT COUNSELING

Inform about benefits and risks of treatment, appropriate use, and about the potential for abuse/dependence. Instruct to use caution when engaging in potentially hazardous activities (eg, operating machinery or vehicles). Inform about the risk of peripheral vasculopathy, including Raynaud's phenomenon; instruct to report to physician any new numbness, pain, skin color change, or sensitivity to temperature in fingers or toes, and to call physician immediately if any signs of unexplained wounds appear on fingers or toes while on therapy.

STORAGE

20-25°C (68-77°F).

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Re: need advice on medication

Then I found this on another PDR website..

print PDR+ search for Desoxyn and Adderall for a comparison..
Desoxyn
Generic Name: (methamphetamine hydrochloride) Other Brands: N/A
Last Revised: 03/2014
What is this medication and its most common uses?
What should I know when beginning and continuing on this medication?
What are the possible side effects of this medication?
Who should not take this medication?
What should I tell my healthcare provider before I take the first dose of this medication?
What is the usual dosage?
How should I take this medication?
What should I avoid while taking this medication?
What are the possible food and drug interactions associated with this medication?
May I receive this medication if I am pregnant or breastfeeding?
What should I do if I miss a dose of this medication?
How should I store this medication?
Who should I contact in case of emergency or overdose?
Additional patient resources.

What is this medication and its most common uses?
Desoxyn is a medicine used to treat attention-deficit hyperactivity disorder (ADHD). Desoxyn is also used for weight loss, along with a low calorie diet, in people who are overweight and have not been able to lose weight on other therapies.

Desoxyn is a federally controlled substance because it has abuse potential.


What should I know when beginning and continuing on this medication?
How does this medication work?

Desoxyn works by changing the amount of certain chemicals in your brain, thereby improving symptoms of ADHD. Desoxyn also works by causing appetite suppression, leading to weight loss.

What are the beneficial effects of this medication and when should I begin to have results?

What:

ADHD: Desoxyn is an important part of a total treatment program for people with ADHD that may include counseling or other therapies. Desoxyn may help increase attention and decrease impulsiveness and hyperactivity in people with ADHD.

Weight Loss: Desoxyn has been shown to cause more weight loss when you take it along with dietary management compared to people on dietary management alone.

When:

ADHD: Everyone responds differently to treatment, so try to be patient and follow your healthcare provider's directions. It is important that you take Desoxyn exactly as your healthcare provider has prescribed.

Weight Loss: Desoxyn may start working within the first weeks of therapy.

How do I know it is working?

You may start to notice improvement in your ADHD symptoms. You may also notice a reduction in your weight if you are using Desoxyn for weight loss. These are good indicators that your medication is working. Your healthcare provider may ask you questions from time to time to assess how well your medicine is working and to check for improvement of your condition.


What are the possible side effects of this medication?
The following is not a full list of side effects. Side effects cannot be anticipated. If any develop or change in intensity, tell your healthcare provider as soon as possible. Only your healthcare provider can determine if it is safe for you to continue taking this medication.

Desoxyn is a federally controlled substance because it can be abused or lead to dependence. Keep Desoxyn in a safe place to prevent misuse and abuse. Selling or giving away Desoxyn may harm others, and is against the law.

More common side effects may include: fast heartbeat, tremors, dizziness, trouble sleeping, headache, weight loss, decreased appetite, dry mouth, stomach upset.

Less common side effects may include:

Sudden death in people who have heart problems or heart defects; stroke and heart attack in adults; increased blood pressure and heart rate with symptoms such as chest pain, shortness of breath, or fainting.

Mental problems with symptoms such as new or worsening behavior and thought problems, bipolar illness, aggressive behavior, or hostility. Children and teenagers may also begin to hear voices, believe in things that are not true, or become suspicious.

Slowing of growth (height and weight) in children.

Seizures, mainly in people with a history of seizures.

Eyesight changes or blurred vision.

Circulation problems in your fingers and toes, with symptoms such as feeling numb, cool, or painful, or changing in color (such as from pale to blue to red).


Who should not take this medication?
Do not take Desoxyn if you are allergic to it or any of its ingredients.

Do not take Desoxyn if you are very anxious, tense, or agitated.

Do not take Desoxyn if you have glaucoma (high pressure in the eye), tics (repeated movements or sounds that cannot be controlled), Tourette's syndrome (a brain disorder characterized by tics), or a family history of Tourette's syndrome.

Do not take Desoxyn if you have high blood pressure, heart problems, or hyperthyroidism (an overactive thyroid gland).

Do not take Desoxyn if you are taking an antidepressant medication called a monoamine oxidase inhibitor (MAOI) (such as phenelzine or selegiline) or have taken any within the past 14 days.

Do not take Desoxyn if you have a history of drug abuse.


What should I tell my healthcare provider before I take the first dose of this medication?
Tell your healthcare provider about all prescription, over-the-counter, and herbal medications you are taking before beginning treatment with Desoxyn. Also, talk to your healthcare provider about your complete medical history, including heart problems, heart defects, high blood pressure, mental problems (such as psychosis, mania, bipolar disorder, or depression), or a family history of these problems; thyroid problems; tics or Tourette's syndrome; seizures; diabetes; or if you have ever abused or been dependent on alcohol, prescription medicines, or street drugs.


What is the usual dosage?
The information below is based on the dosage guidelines your healthcare provider uses. Depending on your condition and medical history, your healthcare provider may prescribe a different regimen. Do not change the dosage or stop taking your medication without your healthcare provider's approval.

ADHD

Children >6 years: The recommended starting dose is 5 milligrams (mg) once or twice a day. Your healthcare provider may increase your dose as needed.

Weight Loss

Adults and children ≥12 years: The recommended starting dose is 5 mg half an hour before each meal.


How should I take this medication?
Take Desoxyn exactly as prescribed by your healthcare provider. Do not change your dose or stop taking Desoxyn without first talking to your healthcare provider.


What should I avoid while taking this medication?
Do not drive or operate machinery before you know how Desoxyn affects you.


What are the possible food and drug interactions associated with this medication?
If Desoxyn is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your healthcare provider before combining Desoxyn with the following: antidepressants known as tricyclic antidepressants (such as amitriptyline or imipramine), phenothiazines (such as chlorpromazine or prochlorperazine), guanethidine, or insulin.


May I receive this medication if I am pregnant or breastfeeding?
The effects of Desoxyn during pregnancy are unknown. Desoxyn can be found in your breast milk if you take it while breastfeeding. Do not breastfeed while you are taking Desoxyn. Tell your healthcare provider immediately if you are pregnant, plan to become pregnant, or are breastfeeding.


What should I do if I miss a dose of this medication?
If you miss a dose of Desoxyn, take it as soon as you remember. However, if it is almost time for your next dose, skip the one you missed and return to your regular dosing schedule. Do not take two doses at once.


How should I store this medication?
Store at room temperature.


Who should I contact in case of emergency or overdose?
In the event of a medical emergency call your doctor or 9-1-1 immediately. In the event of overdose, call your doctor or poison control for further instructions.
National Poison Control#: Call 1-800-222-1222

This PDR+ drug information has been developed by the Physicians’ Desk Reference Network (PDRN), a source of medication information trusted by doctors for over 65 years.

This monograph summarizes the most important information about your medication and does not cover all the information you may need. If you have any questions or concerns or want to learn more about your medication, ask your healthcare provider; he/she will be able to provide answers to your questions. This medication should only be used by the patient for whom it was prescribed and should not be shared with other people.

Adderall
Adderall
Generic Name: (amphetamine aspartate monohydrate/amphetamine sulfate/dextroamphetamine saccharate/dextroamphetamine sulfate) Other Brands: N/A
Last Revised: 12/2015
What is this medication and its most common uses?
What should I know when beginning and continuing on this medication?
What are the possible side effects of this medication?
Who should not take this medication?
What should I tell my healthcare provider before I take the first dose of this medication?
What is the usual dosage?
How should I take this medication?
What should I avoid while taking this medication?
What are the possible food and drug interactions associated with this medication?
May I receive this medication if I am pregnant or breastfeeding?
What should I do if I miss a dose of this medication?
How should I store this medication?
Who should I contact in case of emergency or overdose?
Additional patient resources.

What is this medication and its most common uses?
Adderall is a medicine used to treat attention-deficit hyperactivity disorder (ADHD). Adderall is also used to treat a condition known as narcolepsy (a sleep disorder characterized by excessive daytime sleepiness).

Adderall is a federally controlled substance because it has abuse potential.


What should I know when beginning and continuing on this medication?
How does this medication work?

Adderall works by changing the amount of certain chemicals in your brain, thereby improving symptoms of ADHD and narcolepsy.

What are the beneficial effects of this medication and when should I begin to have results?

What: Adderall is an important part of a total treatment program for people with ADHD that may include counseling or other therapies. Adderall may help increase attention and decrease impulsiveness and hyperactivity in people with ADHD.

When: Everyone responds differently to treatment, so try to be patient and follow your healthcare provider's directions. It is important that you take Adderall exactly as your healthcare provider has prescribed.

How do I know it is working?

You may start to notice an improvement in your symptoms. This is a good indicator that your medication is working. Your healthcare provider may ask you questions from time to time to assess how well your medicine is working and to check for improvement of your condition.


What are the possible side effects of this medication?
The following is not a full list of side effects. Side effects cannot be anticipated. If any develop or change in intensity, tell your healthcare provider as soon as possible. Only your healthcare provider can determine if it is safe for you to continue taking this medication.

Adderall is a federally controlled substance because it can be abused or lead to dependence. Keep Adderall in a safe place to prevent misuse and abuse. Selling or giving away Adderall may harm others, and is against the law. Misuse of Adderall may cause sudden death and serious heart-related side effects.

More common side effects may include: stomach ache, decreased appetite, restlessness.

Less common side effects may include:

Serious and potentially life-threatening heart problems, including strokes or heart attacks in adults, and increased blood pressure or heart rate, with symptoms such as chest pain, shortness of breath, or fainting.

Mental problems with symptoms such as new or worsening behavior and thought problems, bipolar illness, aggressive behavior, or hostility. Children and teenagers may also begin to hear voices, believe in things that are not true, or become suspicious.

Slowing of growth (height and weight) in children.

Seizures, mainly in people with a history of seizures.

Eyesight changes or blurred vision.

Circulation problems in your fingers and toes, with symptoms such as feeling numb, cool, or painful, or changing color (such as from pale to blue to red).


Who should not take this medication?
Do not take Adderall if you are allergic to it, any of its ingredients, or to similar medicines (such as methylphenidate).

Do not take Adderall if you have heart disease, hardening of your arteries, high blood pressure, hyperthyroidism (an overactive thyroid gland), or glaucoma (high pressure in the eye).

Do not take Adderall if you are very anxious, tense, or agitated.

Do not take Adderall if you have a history of drug abuse.

Do not take Adderall if you are taking an antidepressant medication called a monoamine oxidase inhibitor (MAOI) (such as phenelzine or selegiline) or have taken any within the past 14 days.


What should I tell my healthcare provider before I take the first dose of this medication?
Tell your healthcare provider about all prescription, over-the-counter, and herbal medications you are taking before beginning treatment with Adderall. Also, talk to your healthcare provider about your complete medical history, especially if you have heart problems or heart defects; high blood pressure; mental problems (such as psychosis, mania, bipolar disorder, or depression); Tourette's syndrome (a brain disorder characterized by involuntary movements and vocalizations called tics); liver, kidney, or thyroid problems; seizures or have had an abnormal brain wave test (called EEG); circulation problems in your fingers and toes; or if you are pregnant, plan to become pregnant, or are breastfeeding.


What is the usual dosage?
The information below is based on the dosage guidelines your healthcare provider uses. Depending on your condition and medical history, your healthcare provider may prescribe a different regimen. Do not change the dosage or stop taking your medication without your healthcare provider's approval.

ADHD

Children ≥6 years: The recommended starting dose is 5 milligrams (mg) once or twice a day.

Children 3-5 years: The recommended starting dose is 2.5 mg once a day.

Narcolepsy

Adults and children ≥12 years: The recommended starting dose is 10 mg once a day.

Children 6-12 years: The recommended starting dose is 5 mg once a day.

Your healthcare provider may increase your or your child's dose as needed.


How should I take this medication?
Take Adderall exactly as prescribed by your healthcare provider. Do not change your dose or stop taking Adderall without first talking to your healthcare provider.

Take the first dose of Adderall in the morning when you wake up, with or without food. If you take Adderall more than once a day, separate the doses by 4 to 6 hours.


What should I avoid while taking this medication?
Do not drive or operate machinery until you know how Adderall affects you.

Do not take any antacids without first talking to your healthcare provider.


What are the possible food and drug interactions associated with this medication?
If Adderall is taken with certain other drugs, the effects of either could be increased, decreased, or altered. Adderall may interact with numerous medications. Therefore, it is very important that you tell your healthcare provider about any other medications you are taking.


May I receive this medication if I am pregnant or breastfeeding?
Adderall can harm your newborn baby if you take it during pregnancy, and can be found in your breast milk if you take it while breastfeeding. Do not breastfeed while you are taking Adderall. Tell your healthcare provider immediately if you are pregnant, plan to become pregnant, or are breastfeeding.


What should I do if I miss a dose of this medication?
If you miss a dose of Adderall, take it as soon as you remember. However, if it is almost time for your next dose, skip the one you missed and return to your regular dosing schedule. Do not take two doses at once.


How should I store this medication?
Store at room temperature.


Who should I contact in case of emergency or overdose?
In the event of a medical emergency call your doctor or 9-1-1 immediately. In the event of overdose, call your doctor or poison control for further instructions.
National Poison Control#: Call 1-800-222-1222
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