Name of the CNS stimulants-Dexamphetamine
Dexamphetamine
| Dexamphetamine |
| Availability Capsules (sustained release): 5 mg, 10 mg, 15 mg Oral solution: 5 mg/ml Tablets: 5 mg, 10 mg |
| Indications and dosages ➣ Attention deficit hyperactivity disorder Adults: 5 to 60 mg P.O. daily in divided doses until optimal response is obtained Children ages 6 and older: 5 mg (capsules, oral solution, or tablets) P.O. once or twice daily, increased by 5 mg at weekly intervals until optimal response is obtained Children ages 3 to 5: 2.5 mg (oral solution) P.O. daily, increased by 2.5 mg at weekly intervals until optimal response is obtained ➣ Narcolepsy Adults: 5 to 60 mg P.O. daily as a single dose or in divided doses Children ages 12 and older: 10 mg P.O. daily, increased by 10 mg at weekly intervals until desired response occurs or adult dosage is reached Children ages 6 to 11: 5 mg P.O. daily, increased by 5 mg at weekly intervals until desired response occurs or adult dosage is reached |
Mechanism of Action
Sympathomimetic amine that promotes release of dopamine and norepinephrine from their storage sites in the presynaptic nerve terminals; may also block reuptake of catecholamines by competitive inhibition.
Pharmacokinetics
- Peak plasma time: ~3 hr (immediate release); ~8 hr (sustained release)
- Hepatic via glucuronidation and mono-oxygenase
- Half-life: 7-24 hr, dependent on urinary pH
- Half-life elimination: 10-13 hr (adults)
- Excretion: Urine
Administration
- Make sure patient swallows sustained-release capsules whole without chewing or crushing.
- Before starting therapy, perform complete cardiac evaluation, including ECG and echocardiogram.
- Give last daily dose at least 6 hours before patient’s bedtime.
- Don’t give within 14 days of MAO inhibitor, because potentially fatal reaction may occur.
Contraindications
- Hypersensitivity to drug or tartrazine
- Glaucoma
- Psychotic disorders, agitated states
- Advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension
- Hyperthyroidism
- MAO inhibitor use within past 14 days
- Pregnancy or breastfeeding
Precautions:
- Cardiovascular disease, hypertension, diabetes mellitus
- History of substance abuse
- Elderly patients.
Adverse reactions
- CNS: hyperactivity, insomnia, restlessness, tremor, depression, dizziness, headache, irritability
- CV: palpitations, tachycardia, hypertension, hypotension, arrhythmias
- GI: nausea, vomiting, constipation, diarrhea, abdominal cramps, dry mouth
- GU: erectile dysfunction, increased libido
- Skin: urticaria
- Other: metallic taste, decreased appetite, physical or psychological drug dependence
Patient monitoring
- Interrupt therapy or reduce dosage periodically to assess drug efficacy in patients with behavior disorders.
- Monitor patient for new or worsening aggressive behavior.
- Monitor blood and urine glucose levels carefully in diabetic patient. Drug may alter regular insulin requirements.
Patient teaching
- Tell patient to swallow sustained release capsules whole with liquid without chewing or crushing.
- Advise patient to take drug early in day to avoid insomnia.
- Instruct patient to immediately notify prescriber if chest pain, irregular pulse, or worsening aggressive behavior occurs.
- Instruct patient to avoid driving and other hazardous activities until he knows how drug affects him.
- Caution patient not to stop therapy abruptly but to taper dosage gradually.
- As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
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