Sucky, here is the official drug info off of uptodate, which is an online bible for medical professionals like myself. Read the adverse S.E.'s. Be cautious my friend.
Methamphetamine: Drug informationCopyright 1978-2012 Lexicomp, Inc. All rights reserved.
(For additional information see "Methamphetamine: Patient drug information")
ALERT: U.S. Boxed Warning The FDA-approved labeling includes a boxed warning. See Warnings/Precautions section for a concise summary of this information. For verbatim wording of the boxed warning, consult the product labeling or
www.fda.gov.
Brand Names: U.S. Desoxyn®
Brand Names: Canada Desoxyn®
Pharmacologic Category Anorexiant;Stimulant;Sympathomimetic
Dosing: Adult
ADHD: Oral: 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: Oral: 5 mg, 30 minutes before each meal; treatment duration should not exceed a few weeks
Dosing: Pediatric
ADHD: Oral: Children ≥6 years: Refer to adult dosing.
Exogenous obesity: Oral: Children ≥12 years: Refer to adult dosing.
Dosing: Geriatric Refer to adult dosing.
Dosage Forms: U.S. Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet, oral, as hydrochloride: 5 mg
Desoxyn®: 5 mg
Generic Equivalent Available: U.S. Yes
Controlled Substance C-II
Medication Guide An FDA-approved patient medication guide, which is available with the product information and at
http://www.fda.gov/downloads/Drugs/DrugSafety/ucm088582.pdf, must be dispensed with this medication.
Use Treatment of attention-deficit/hyperactivity disorder (ADHD); exogenous obesity (short-term adjunct)
Pharmacotherapy for weight loss is recommended only for obese patients with a body mass index ≥30 kg/m2, or ≥27 kg/m2 in the presence of other risk factors such as hypertension, diabetes, and/or dyslipidemia or a high waist circumference; therapy should be used in conjunction with a comprehensive weight management program.
Use - Unlabeled/Investigational Narcolepsy
Medication Safety Issues
Sound-alike/look-alike issues:
Desoxyn® may be confused with digoxin
BEERS Criteria medication:
This drug may be inappropriate for use in geriatric patients (high severity risk).
Adverse Reactions Significant Frequency not defined.
Cardiovascular: Hypertension, palpitation, tachycardia
Central nervous system: Dizziness, dysphoria, euphoria, exacerbation of motor and phonic tics and Tourette's syndrome, headache, insomnia, overstimulation, psychosis, restlessness
Dermatologic: Rash, urticaria
Endocrine & metabolic: Change in libido
Gastrointestinal: Anorexia, constipation, diarrhea, nausea, stomach cramps, unpleasant taste, vomiting, weight loss, xerostomia
Genitourinary: Impotence
Neuromuscular & skeletal: Tremor
Miscellaneous: Suppression of growth in children, tolerance and withdrawal with prolonged use
Contraindications Hypersensitivity to methamphetamine, any component of the formulation, or idiosyncrasy to amphetamines or other sympathomimetic amines; patients with advanced arteriosclerosis, symptomatic cardiovascular disease, moderate-to-severe hypertension, 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
Warnings/Precautions
Boxed warnings:
• Abuse potential: See “Disease-related concerns” below.
• Weight reduction: Appropriate use: See “Disease-related concerns” below.
Concerns related to adverse effects:
• Cardiovascular events: Use has been associated with serious cardiovascular events including sudden death in patients with pre-existing structural cardiac abnormalities or other serious heart problems (sudden death in children and adolescents; sudden death, stroke and MI in adults). These products should be avoided in the patients with known serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or other serious cardiac problems that could increase the risk of sudden death that these conditions alone carry. Patients should be carefully evaluated for cardiac disease prior to initiation of therapy.
• CNS effects: Amphetamines may impair the ability to engage in potentially hazardous activities.
• Visual disturbance: Difficulty in accommodation and blurred vision has been reported with the use of stimulants.
Disease-related concerns:
• Abuse potential: [U.S. Boxed Warning]: Potential for drug dependency exists; prolonged use may lead to drug dependency. Use is contraindicated in patients with history of ethanol or drug abuse. Prescriptions should be written for the smallest quantity consistent with good patient care to minimize possibility of overdose.
• Diabetes: Use with caution in patients with diabetes mellitus; antidiabetic agent requirements may be altered with anorexigens and concomitant dietary restrictions.
• Hypertension: Use with caution in patients with hypertension and other cardiovascular conditions that might be exacerbated by increases in blood pressure or heart rate. Use is contraindicated in patients with moderate-to-severe hypertension.
• Psychiatric disorders: Use with caution in patients with pre-existing psychosis or bipolar disorder (may induce mixed/manic episode). May exacerbate symptoms of behavior and thought disorder in psychotic patients; new onset psychosis or mania may occur with stimulant use; observe for symptoms of aggression and/or hostility.
• Seizure disorder: Use with caution in patients with a history of seizure disorder; may lower seizure threshold leading to new onset or breakthrough seizure activity.
• Tourette's syndrome: Use with caution in patients with Tourette's syndrome; stimulants may unmask tics.
• Weight reduction: Appropriate use: [U.S. Boxed Warning]: Use in weight reduction programs only when alternative therapy has been ineffective.
Special populations:
• Elderly: May be inappropriate in this age group due to the risk for causing dependence, hypertension, angina, and myocardial infarction (Beers Criteria).
• Pediatrics: Safety and efficacy have not been established in children <12 years of age for obesity. Use of stimulants has been associated with suppression of growth; monitor growth rate during treatment.
Other warnings/precautions:
• Discontinuation of therapy: Abrupt discontinuation following high doses or for prolonged periods may result in symptoms for withdrawal. Discontinue if satisfactory weight loss has not occurred within the first 4 weeks of treatment, or if tolerance develops.
Metabolism/Transport Effects Substrate of CYP2D6 (major)
Drug Interactions
(For additional information: Launch Lexi-Interact™ Drug Interactions Program )Abiraterone Acetate: May increase the serum concentration of CYP2D6 Substrates. Management: Avoid concurrent use of abiraterone with CYP2D6 substrates that have a narrow therapeutic index whenever possible. When concurrent use is not avoidable, monitor patients closely for signs/symptoms of toxicity. Risk D: Consider therapy modification
Alkalinizing Agents: May decrease the excretion of Amphetamines. Risk D: Consider therapy modification
Ammonium Chloride: May decrease the serum concentration of Amphetamines. This effect is likely due to an enhanced excretion of amphetamines in the urine. Risk C: Monitor therapy
Analgesics (Opioid): Amphetamines may enhance the analgesic effect of Analgesics (Opioid). Risk C: Monitor therapy
Antacids: May decrease the excretion of Amphetamines. Risk C: Monitor therapy
Antihistamines: Amphetamines may diminish the sedative effect of Antihistamines. Exceptions: Levocabastine (Nasal). Risk C: Monitor therapy
Antipsychotics: May diminish the stimulatory effect of Amphetamines. Risk C: Monitor therapy
Atomoxetine: May enhance the hypertensive effect of Sympathomimetics. Atomoxetine may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Cannabinoids: May enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Carbonic Anhydrase Inhibitors: May decrease the excretion of Amphetamines. Exceptions: Brinzolamide; Dorzolamide. Risk C: Monitor therapy
CYP2D6 Inhibitors (Moderate): May decrease the metabolism of CYP2D6 Substrates. Risk C: Monitor therapy
CYP2D6 Inhibitors (Strong): May decrease the metabolism of CYP2D6 Substrates. Risk D: Consider therapy modification
Darunavir: May increase the serum concentration of CYP2D6 Substrates. Risk C: Monitor therapy
Ethosuximide: Amphetamines may diminish the therapeutic effect of Ethosuximide. Amphetamines may decrease the serum concentration of Ethosuximide. Risk C: Monitor therapy
Gastrointestinal Acidifying Agents: May decrease the serum concentration of Amphetamines. Risk C: Monitor therapy
Iobenguane I 123: Sympathomimetics may diminish the therapeutic effect of Iobenguane I 123. Risk X: Avoid combination
Lithium: May diminish the stimulatory effect of Amphetamines. Risk C: Monitor therapy
MAO Inhibitors: May enhance the hypertensive effect of Amphetamines. Risk X: Avoid combination
Methenamine: May decrease the serum concentration of Amphetamines. This effect is likely due to an enhanced excretion of amphetamines in the urine. Risk C: Monitor therapy
Peginterferon Alfa-2b: May decrease the serum concentration of CYP2D6 Substrates. Risk C: Monitor therapy
PHENobarbital: Amphetamines may decrease the serum concentration of PHENobarbital. Risk C: Monitor therapy
Phenytoin: Amphetamines may decrease the serum concentration of Phenytoin. Risk C: Monitor therapy
Proton Pump Inhibitors: May increase the serum concentration of Amphetamines. Specifically, data indicate that Proton Pump Inhibitors may increase the rate at which Amphetamines are absorbed. Total exposure to Amphetamines is not significantly changed. Risk C: Monitor therapy
Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Risk C: Monitor therapy
Tricyclic Antidepressants: May enhance the stimulatory effect of Amphetamines. Tricyclic Antidepressants may also potentiate the cardiovascular effects of Amphetamines. Risk C: Monitor therapy
Ethanol/Nutrition/Herb Interactions
Ethanol: Avoid ethanol (may cause CNS depression).
Food: Amphetamine serum levels may be altered if taken with acidic food, juices, or vitamin C. Avoid caffeine.
Herb/Nutraceutical: Avoid ephedra (may cause hypertension or arrhythmias).
Pregnancy Risk Factor C (show table)
Pregnancy Implications Teratogenic and embryocidal effects have been observed in animal studies. Infants may deliver prematurely and suffer withdrawal symptoms. There are no adequate and well-controlled studies in pregnant women.
Lactation Enters breast milk/contraindicated
Dietary Considerations Most effective when combined with a low calorie diet and behavior modification counseling.
Pricing: U.S. (
www.drugstore.com)
Tablets (Desoxyn)
5 mg (20): $107.99
Monitoring Parameters Heart rate, respiratory rate, blood pressure, CNS activity, body weight (BMI); growth rate in children
When used for the treatment of ADHD, thoroughly evaluate for cardiovascular risk. Monitor heart rate, blood pressure, and consider obtaining ECG prior to initiation (Vetter, 2008).
Reference Range
Adult classification of weight by BMI (kg/m2):
Underweight: <18.5
Normal: 18.5-24.9
Overweight: 25-29.9
Obese, class I: 30-34.9
Obese, class II: 35-39.9
Extreme obesity (class III): ≥40
Waist circumference: In adults with a BMI of 25-34.9 kg/m2, high-risk waist circumference is defined as:
Men >102 cm (>40 in)
Women >88 cm (>35 in)
International Brand Names Cidrin (CL);Desoxyn (CA)
Mechanism of Action A sympathomimetic amine related to ephedrine and amphetamine with CNS stimulant activity; causes release of catecholamines (primarily dopamine and other catecholamines) from their storage sites in the presynaptic nerve terminals. Inhibits reuptake and metabolism of catecholamines through inhibition of monoamine transporters and oxidase.
Pharmacodynamics/Kinetics
Absorption: Rapid from GI tract
Metabolism: Hepatic; forms metabolite
Half-life elimination: 4-5 hours
Excretion: Urine primarily (dependent on urine pH)
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