Boxed Warnings for Stimulants
MED GUIDE
* C-II
* high potential for abuse & dependence
Stimulant CI
- do not use within 14 days of MAOi
- risk of CVD events - do not use with HF, recent MI, arrythmias, mod-severe HTN
- marked anxiety, tension, agitation, glaucoma, herpthyroidism, hx of tourette’s or other tic disorders
Stimulant Warnings
- increased HR/BP
- priapism
- Raynaud’s
- New onset psychosis/mania or exacerbation of pre-existing psychosis (mixed/manic episode in bipolar)
- may increase risk of seizures
- loss of appetite (decrease in growth in children)
- serotonin syndrome increased
- visual disturbances (blurry vision)
Ritalin
IR tab
methylphenidate
5 mg PO BID (max 60 mg/day)
Concerta
ER tab, OROS delivery (ghost tab in stool)
Do not use with GI narrowing conditions (small bowel disease, motility issues)
18-36 mg daily (max 72 mg/day)
ER capsule types & doses
methylphenidate
Ritalin LA: 10-20 mg daily
Adhansia XR: 25 mg daily
Aptensio XR: 10 mg daily
Metadate CD: 20 mg daily (max 60 mg)
Jornay PM: 20 mg AT NIGHT (max 100 mg/day)
ER oral suspension
ER chewable tab
methylphenidate
Quillivant XR
20 mg daily
Quillichew ER: 20 mg daily (max 60 mg daily)
ER orally-disintegrating tab
methylphenidate
Contempla XR-ODT
17.3 mg daily for 6-17 yrs (max: 51.8 mg/day)
Transdermal patch
methylphenidate
Daytrana
10 mg/9 hr patch qam (max 30 mg)
Warnings: loss of skin pigment in application sites and areas distant from application;allergic contact dermatitis
Apply 2 hrs before desired effect; remove after 9 hrs; alternate hips daily
Dexmethylphenidate
Brand: Focalin, Focalin XR
Adderall IR
dextroamphetamine/amphetamine
Start 5 mg qam or BID, 2nd dose 4-6 hrs later (max 40 mg/day)
Adderall XR, Mydayis
dextroamphetamine/amphetamine
ER capsules
Start 5-10 mg (6-12 yrs)
10 mg (13-17 yrs)
10-20 mg (adults) daily (max 60 mg for adults, 30 mg children)
Adzenys XR-ODT, Adzenys ER, Dynavel XR, Evekeo, Evekeo ODT
Adzenys ER, Dynavel XR (PO suspensions)
Strattera
Dose
Atomoxetine
Capsule (do not open)
>70 kg: 40 mg daily
< 70 kg: 0.5 mg/kg/day (max 100 mg/day)
strong cyp2d6i – > max 80 mg/day
Strattera warnings
- BW: suicidal ideation
- aggressive behavior, rare but severe hepatotox, serious CV events
- ht/wt of children can be reduced
ADE: low appetite, insomnia, somnolence, dry mouth, HTN, tachy, HA
Kapvay
clonidine ER tab
0.1 mg qhs, increase by 0.1 mg weekly or less (max: 0.4 mg/day)
Intuniv
Guanfacine ER tab
1 mg daily and increase by 1 mg/weekly or less
Do not take with high fat meal (increases absorption)
Rare skin rash (d/c if occurs)
Dose adjust with CYP3A4i
Guanfacine/clonidine warnings
dose-dependent CV effects (brady, hypotension, orthostasis, syncope); sedation, drowsiness
Do not d/c abruptly (rebound HTN). Must taper no more than 0.1 mg/day clonidine and 1 mg/day for guanfacine every 3-7 days
ADE: dry mouth, somnolence, fatigu, dizziness, constipation, low HR, hypotension
