Amphetamine Dexedrine Stimulants

Central Nervous System Stimulants Central nervous system stimulants include agents such as the amphetamines (Dexedrine) and methylphenidate hydrochloride (Ritalin), used to elevate mood, suppress appetite, and control hyperkinetic disorders in children. Other examples include the illegal drugs methamphet-amine and cocaine. The mechanism of action of these drugs is to augment actions of the adrenergic nervous system. 

The amphetamines, such as amphetamine, dextroamphetamine (Dexedrine), and metliainphetainine (Desoxyn), are sympatiiomimetic (ie, adrenergic) dru that stimulate the CNS (see Chap. 22). Their drug action results in an elevation of blood pressure, wakefulness, and an increase or decrease in pulse rate The ability of these drugs to act as anorexiants and suppress the appetite is thought to be due to their action on the appetite center in the hypothalamus. 

Amphetamines (speed sulph, sulphate, uppers, wake-ups, billy whizz, whizz, whites, base) are synthetic stimulants which as medicines have been formed into a variety of tablets. Their current medical use is very limited and in fact only dexamphetamine sulphate, Dexedrine, is now available for use solely in the treatment of narcolepsy. The only other amphetamine available for medical use is methylphenidate (Ritalin) for the treatment of attention deficit syndrome in children. As a street drug, amphetamine usually comes as a white, grey, yellowish or pinky powder. The purity rate of street powders is less than 10%, the rest being made up of milder stimulants such as caffeine, other drugs such as paracetamol or substances like glucose, dried baby milk, flour or talcum powder. 

Dextroamphetamine (Dexedrine). Dextroamphetamine is the second most widely used stimulant and the most commonly used amphetamine in the United States. It is about twice as potent as methylphenidate and should be initiated in the treatment of ADHD at 2.5 mg taken twice daily with breakfast and lunch. Like other stimulants, the benefits of dextroamphetamine can be seen almost immediately. With weekly visits while starting treatment, the dose can be increased in 2.5-5 mg increments until the effective dose is found. Because dextroamphetamine is also slightly longer acting than methylphenidate, patients may be less likely to need an evening dose. If an after-school dose is used, then like methylphenidate it should be 25-50% of the daytime dose. 

Many psychomotor stimulants possess activities similar to those of amphetamine and have been discussed previously (see Chapter 10). Of primary importance to our discussion of the psychomotor stimulants are amphetamine Adderall, Benzedrine, Dexedrine), methampheta-mine (Desoxyn), and methylphenidate (Concerta, Ritalin, Metadate, Methylin). 

Stimulants (amphetamines [Adderall, Dexedrine] and methylphenidate [Concerta, Ritalin]) increase alertness, attention, and energy. They also increase blood pressure and heart rate, constrict blood vessels, increase blood glucose, and open up the pathways of the respiratory system. Historically, stimulants were prescribed to treat asthma and other respiratory problems, obesity, neurological disorders, and a variety of other ailments. As their potential for abuse and addiction became apparent, the prescribing of stimulants by physicians began to wane. Now, stimulants are prescribed for treating only a few health conditions, most notably ADHD, narcolepsy, and, in some instances, depression that has not responded to other treatments. 

Some of these drugs, such as Dexedrine, are derivatives of the illegal stimulant amphetamine. Some drugs, such as Adderall , are also used to treat narcolepsy and ADHD and actually contain a mixture of dextroamphetamine and amphetamine. 

Amphetamines such as dextroamphetamine sulfate (Dexedrine), amphetamine and dextroamphetamine sulfate combinations (Adderall), and methamphetamine hydrochloride (Desoxyl) are standard therapies in the treatment of ADHD. Although it s not completely understood how it works, when used as part of a comprehensive treatment program, the stimulant can help improve symptoms of poor concentration, hyperactivity, and dis-tractibility for many children with ADHD. Other com-... 

Methylphenidate (e.g., Ritalin and Concerta ) is a stimulant drug prescribed to treat hyperactivity, impulsivity, and inattention in millions of American children. Methylphenidate was first synthesized in the mid-1940s in Europe. In the United States, it was approved by the Food and Drug Administration (FDA) in 1955. The effects of methylphenidate in the human body are almost identical to those of the amphetamines. Amphetamines—the collective name for levoamphetamine (Benzedrine), dextroamphetamine (Dexedrine ), and methamphetamine (Methedrine or speed )—are known to be potent psychomotor stimulants. 

Item taken from the 2002 FDA-approved overdose section of the labels for Dexedrine, Adderall, and Adderall XR, but not Ritalin. The remainder was taken from the Ritalin label with some overlap. The Dexedrine and Adderall labels both state that individual patient responses to amphetamines vary widely and toxic symptoms occasionally occur as an idiosyncrasy at doses as low as 2 mg. The Adderall XR label also states that patient responses vary widely and toxic symptoms may occur at low doses. Any of the symptoms can occur with any of the stimulants at routine clinical doses. 

All of the DEA s observations run contrary to the Ritalin label as found in the Physicians Desk Reference (2007), which continues to identify this potent, highly addictive drug as a mild central nervous system (CNS) stimulant (p. 2269), misleading doctors and consumers alike. Although the DEA and all responsible pharmacologists view Ritalin as essentially similar to amphetamine, the dependence warnings on the Ritalin label remain extremely weak in comparison to those on the Dexedrine and Adderall (amphetamine) labels. 

Medication to treat ADHD should generally be used in concert with behavioral, psychological, and educational interventions and support for the child and family that is, medication alone is not recommended. Although some new nonstimulant medications are coming on the market for the treatment of ADHD, it will be some time until we know how well they work and with what side effects and risks. Meanwhile, the mainstay of medication treatment continues to be the stimulants, such as methylphenidate (trade name Ritalin), dextroamphetamine (trade name Dexedrine), and amphetamine/dextroamphetamine (trade name Ad-derall). The stimulant drug pemoline (trade name Cylert) is sometimes... 

Almost all analogs of ephedrine and epinephrine have been synthesized and subjected to pharmacological evaluation. Some of them are used in medicine. The list includes amphetamine or benzedrine (XX), deoxy-ephedrine (XXI), vonedrine (XXII), propadrine (XXIII), paredrine (XXIV), veritol (XXV), suprifen (XXVI), and neosynephrine (XXVII). They are advocated as vasoconstrictors in otolaryngology. The marketed form of neosynephrine is the Z-isomer. Amphetamine and deoxyephedrine are now better known for their stimulating action on the central nervous system (78, 79) and are used by persons whose duties call for long periods of alertness. The d-forms of both amines are more effective than the Z-forms in this respect. The commercial names of cZ-deoxyephedrine and cZ-amphetamine are pervitin and dexedrine, respectively. Two catechol derivatives have been recommended as substitutes for epinephrine. They are epinine (XXVIII) and corbasil (XXIX). 

The systematic name of this compound is (S)-1-phenyl-2-propanamine. Its common name is amphetamine.The dextrorotatory isomer of amphetamine (shown here) is a central nervous system stimulant and is manufactured and sold under several trade names. The salt with sulfuric acid is marketed as Dexedrine sulfate. 

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