Dexamfetamine 10mg tablets

ImportanceThe use of stimulant medications has expanded substantially beyond the traditional treatment of attention-deficit/hyperactivity disorder (ADHD) to encompass a variety of other clinical conditions. Understanding the safety of these medications is important as their use increases across diverse patient populations.ObjectiveTo assess the safety of stimulant medications as reported in randomized clinical trials (RCTs) investigating methylphenidate, lisdexamfetamine, and other amphetamines.Data sourcesA comprehensive literature search was conducted from July 1, 2024, through February 28, 2025, using CINAHL, Embase, PubMed or MEDLINE, ScienceDirect, and Web of Science for studies published since 2000. Keywords included safety, adverse event, side effect, amphetamine, dextroamphetamine, stimulant, lisdexamfetamine, and methylphenidate.Study selectionRCTs published between January 1, 2000, and December 13, 2024, were included. These trials investigated the safety of stimulants in various clinical conditions, including ADHD, depression, binge eating disorder, schizophrenia, Alzheimer disease, and stimulant use disorders as well as in healthy individuals. Trials not focused on safety or adverse events (AEs) of stimulants, nonoriginal research, nonhuman research, trials with concomitant prescriptions other than stimulants, and trials without a placebo group were excluded.Data extraction and synthesisData extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Independent reviewers extracted study data, and a random-effects model was used to pool results. Heterogeneity was assessed using the I2 statistic.Main outcomes and measuresThe primary outcome was the risk ratio (RR) of developing any AE in participants taking stimulants vs placebo.ResultsA total of 93 RCTs were included after exclusions. The methodological quality assessment of the included trials showed overall low or unclear risk of bias. Trials with a duration of up to 52 weeks showed that stimulant medications were associated with an increased risk of overall AEs compared with placebo (RR, 1.34; 90% CI, 1.27-1.41), with high heterogeneity (I2 = 67%). Statistical significance of this finding was maintained when subgroups (ie, methylphenidate, lisdexamfetamine, and other amphetamines) were separately analyzed.Conclusions and relevanceThis meta-analysis found an increased risk of overall AEs associated with stimulants compared with placebo. Future research could provide more standardized and consistent assessments of this outcome and may improve understanding about misuse risk.

Abstract licence: CC BY

BackgroundAmong young people up to 18 years of age, approximately 5% have attention deficit hyperactivity disorder (ADHD), many of whom have symptoms persisting into adulthood. ADHD is associated with increased risk of co-morbid psychiatric disorders, including substance misuse. Many will be prescribed medication, namely methylphenidate, atomoxetine, dexamphetamine and lisdexamfetamine. If so, it is important to know if interactions exist and if they are potentially toxic.MethodsThree databases (Medline, EMBASE and PsychINFO) from a 22 year period (1992 - June 2014) were searched systematically. Key search terms included alcohol, substance related disorders, methylphenidate, atomoxetine, dexamphetamine, lisdexamfetamine, and death, which identified 493 citations (344 after removal of duplicates). The eligibility of each study was assessed jointly by two investigators, leaving 20 relevant articles.ResultsWe identified only a minimal increase in side-effects when ADHD medication (therapeutic doses) was taken with alcohol. None of the reviewed studies showed severe sequelae among those who had overdosed on ADHD medication and other coingestants, including alcohol.ConclusionsThe numbers across all the papers studied remain too low to exclude uncommon effects. Also, studies of combined effects with novel psychoactive substances have not yet appeared in the literature. Nevertheless, no serious sequelae were identified from combining ADHD medication with alcohol/illicit substances from the pre-novel psychoactive substance era.

Abstract licence: CC BY

SUMMARY Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterised by developmentally inappropriate levels of hyperactivity, impulsivity and/or inattention, with substantial impact on functioning. Stimulants (methylphenidate, dexamfetamine, lisdexamfetamine) are the main pharmacological treatment for children and adolescents with ADHD and are highly effective at reducing core ADHD symptoms. Non-stimulants such as atomoxetine, clonidine and guanfacine can also be useful in some patients.

Abstract licence: CC BY-NC-ND

Aims: The prevalence of attention deficit/hyperactivity disorder (ADHD) diagnoses and stimulant prescribing among women of reproductive age has increased substantially over the past two decades. Dextro-/amphetamine formulations, particularly dexamphetamine, are now among the most commonly used ADHD medications during pregnancy. Clinical decision making is complicated by uncertainty regarding maternal, fetal and long term child outcomes, leading to high rates of medication discontinuation. This review aims to synthesise current evidence on maternal, neonatal, congenital and long term neurodevelopmental outcomes associated with dexamphetamine and related stimulant use during pregnancy. Methods: A narrative review of population based cohort studies, registry analyses and clinical guidelines examining perinatal stimulant exposure was conducted. Outcomes of interest included neonatal and obstetric outcomes, congenital malformations, maternal complications and long term neurodevelopmental outcomes, with careful consideration of confounding by maternal ADHD, behavioural and sociodemographic factors. Studies were selected based on their quality, relevance and inclusion of contemporary perinatal data. Results: Population level data demonstrate a marked rise in perinatal stimulant use, primarily driven by dexamphetamine, with an 11-fold increase observed in a British Columbia registry study (2000-2021). Retrospective cohort studies suggest that continuing dexamphetamine during pregnancy is generally not associated with adverse maternal or neonatal outcomes compared with cessation. Evidence for hypertensive disorders, however, remains inconclusive. International registry studies report no increased risk of major congenital malformations following amphetamine exposure, with a small signal observed for methylphenidate. Long term follow up studies, after adjusting for confounding by maternal ADHD, found no meaningful increase in neurodevelopmental disorders among children exposed in utero. Maternal ADHD and related behavioural or sociodemographic factors may act as confounders underlining the importance of accounting for these factors in research and clinical decision making. Conclusion: Current evidence suggests that dexamphetamine exposure during pregnancy is not associated with major increases in adverse maternal, neonatal, congenital or long term neurodevelopmental outcomes when confounding is appropriately addressed. Shared, individualised decision making remains essential. Given the limitations of observational study designs and residual confounding, future research should prioritise dexamphetamine-specific data and include qualitative measures of maternal functioning as well as long term childhood outcomes.

Abstract licence: CC BY 4.0

Perfluorooctane sulfonate (PFOS) is a widely spread environmental contaminant. It accumulates in the brain and has potential neurotoxic effects. The exposure to PFOS has been associated with higher impulsivity and increased ADHD prevalence. We investigated the effects of developmental exposure to PFOS in zebrafish larvae, focusing on the modulation of activity by the dopaminergic system. We exposed zebrafish embryos to 0.1 or 1 mg/L PFOS (0.186 or 1.858 µM, respectively) and assessed swimming activity at 6 dpf. We analyzed the structure of spontaneous activity, the hyperactivity and the habituation during a brief dark period (visual motor response), and the vibrational startle response. The findings in zebrafish larvae were compared with historical data from 3 months old male mice exposed to 0.3 or 3 mg/kg/day PFOS throughout gestation. Finally, we investigated the effects of dexamfetamine on the alterations in spontaneous activity and startle response in zebrafish larvae. We found that zebrafish larvae exposed to 0.1 mg/L PFOS habituate faster than controls during a dark pulse, while the larvae exposed to 1 mg/L PFOS display a disorganized pattern of spontaneous activity and persistent hyperactivity. Similarly, mice exposed to 0.3 mg/kg/day PFOS habituated faster than controls to a new environment, while mice exposed to 3 mg/kg/day PFOS displayed more intense and disorganized spontaneous activity. Dexamfetamine partly corrected the hyperactive phenotype in zebrafish larvae. In conclusion, developmental exposure to PFOS in zebrafish induces spontaneous hyperactivity mediated by a dopaminergic deficit, which can be partially reversed by dexamfetamine in zebrafish larvae.

Abstract licence: CC BY 4.0

Females of reproductive age are increasingly using attention deficit hyperactivity disorder (ADHD) medication, but its use during pregnancy and breastfeeding is largely unknown. The aim of this study is to examine the prevalence of ADHD medication fills during pregnancy and breastfeeding, including characteristics of these females and cohort differences over time. We conducted a descriptive study using Danish nationwide registers. Within cohorts of pregnant and breastfeeding females, we calculated the prevalence of ADHD medication (methylphenidate, amphetamine, dexamfetamine, lisdexamfetamine, modafinil, atomoxetine, clonidine and guanfacine) fills and described sociodemographic and clinical characteristics across groups with fills, no fills and previous fills. Cohort differences in ADHD medication fills during pregnancy for 2005–2010, 2011–2016 and 2017–2022 were examined. In this cohort of 1,077,279 pregnancies, ADHD medication fills increased from 0.08 to 7.71 per 1000 individuals between 2005 and 2022. Among 446,485 breastfeeding females, fills increased from 0.55 to 3.67 per 1000 individuals from 2012 to 2022. Compared with the group with no fills, females filling ADHD medication during pregnancy and breastfeeding were younger, had lower levels of education, were more often smoking during pregnancy, utilised more psychiatric healthcare and had concurrent fills of other psychotropic medication. Cohort differences over time revealed that females filling ADHD medication during pregnancy in 2017–2022 were older, had higher levels of education, smoked less during pregnancy, had fewer psychiatric contacts and were less likely to fill other psychotropic medications compared with females in the earlier cohorts. Results showed an increasing prevalence of ADHD medication fills during pregnancy and breastfeeding in Denmark over time, surpassing the increase observed generally in females of reproductive age filling ADHD medication. Results revealed a difference in characteristics of females filling ADHD medication during pregnancy over time, suggesting a shift in pregnancy treatment patterns.

Abstract licence: CC BY-NC