Adverse effects amphetamines

Common adverse reactions seen with phentermine use include heart palpitations, tachycardia, elevated blood pressure, stimulation, restlessness, dizziness, insomnia, euphoria, dysphoria, tremor, headache, dry mouth, constipation, and diarrhea. Phentermine should be avoided in patients with unstable cardiac status, hypertension, hyperthyroidism, agitated states, or glaucoma. In combination with fenfluramine or dexfenfluramine, pulmonary hypertension and valvular heart disease have been reported. The risk of developing either serious adverse effect cannot be ruled out with use of phentermine alone. Since phentermine is related to the amphetamines, the... 

Phentermine (30 mg in the morning or 8 mg before meals) has less powerful stimulant activity and lower abuse potential than amphetamines and was an effective adjunct in placebo-controlled studies. Adverse effects (e.g., increased blood pressure, palpitations, arrhythmias, mydriasis, altered insulin or oral hypoglycemic requirements) and interactions with monoamine oxidase inhibitors have implications for patient selection. 

Cardiac stimulation is an adverse effect associated with the use of the psychomotor stimulants, such as amphetamine. Which of the following mechanisms is most likely responsible for this peripheral effect ... 

Amphetamines and similar central nervous system stimulants have been available for many years, but the substantial abuse liability and potential cardiovascular adverse effects have largely limited their use to the treatment of narcolepsy and attention-deficit-hyperactivity disorder. There has also been some utilization of amphetamines to combat sleepiness during military operations. 

The stimulant drugs, including all methylphenidate and amphetamine products, produce a wide array of adverse effects on the brain and mind as well as the overall body. Strattera, marketed by Eli Lilly as a nonstimulant, shares most of these adverse effects. Table 11.1 summarizes the adverse drug reaction data from eight controlled clinic trials. Table 11.2... 

The DEA (1995b) also observed that adverse effects of irritability or sadness have not been well studied but have been reported in up to 22% of children on stimulant medication. Elsewhere in the same document, the DEA noted that with both Ritalin and amphetamine, psychotic episodes, violent behavior and bizarre mannerisms have been reported (p. 16). Emotionally disturbing adverse effects are even more common with the youngest children. Dulcan and Popper (1991) noted that in preschool children, there is a greater risk of side effects, especially sadness, irritability, clinging, insomnia, and anorexia (p. 188). 

Showing concern for possible abuse potential that might show up in the future, Kapit (1986c) warned about the fact that fluoxetine causes a set of adverse effects which resemble those caused by amphetamine (p. 23). 

Viloxazine, a bicyclic compound, is related structurally (but not pharmacologically) to the beta-adrenoceptor antagonists. In animal tests, its profile shows properties of both the imipramine-like compounds (reversal of reser-pine-induced hypothermia) and amphetamine (stimulation of the electroencephalogram). A review of animal and clinical data confirmed the impression that viloxazine has efficacy comparable to that of imipramine but with a different adverse effects profile (1). There is a reduced frequency of anticholinergic and sedative effects and a tendency to lose rather than to gain weight. However,... 

There was a high frequency of amphetamine abuse and withdrawal among patients from the Thai-Myanmar border area admitted to hospital with Plasmodium falciparum malaria (90). This co-morbidity can cause diagnostic confusion, alter malaria pathophysiology, and lead to drug interactions. Considering the potential neuropsychiatric adverse effects of mefloquine, an important component of current antimalarial treatment in Southeast Asia, it should be avoided in patients who abuse amphetamines. 

In the second study there were 174 patients in two similar experimental groups in whom injectable rather than inhaled heroin was used (5). A response to treatment was defined as at least a 40% improvement in physical, mental, or social domains of quality of life, if not accompanied by a substantial (over 20%) increase in the use of another illicit drug, such as cocaine or amphetamines. After 12 months those who took methadone and heroin (smoked or injected) had significantly better outcomes. The incidences of adverse effects (constipation and drowsiness) were similar in all the groups. However, owing to the limitations of the study and the complex nature of drug dependence, the therapeutic outcomes could not be justifiably and solely attributed to the specific drug(s). 

Adverse effects can develop after amphetamines are abused in combination (32). 

There is no truth to these stories, but both MDA and MDMA can cause bad reactions at high doses. Some people snort them or (rarely) inject them intravenously, intensifying their action and potential for harm. Combining these drugs with alcohol or other depressants also increases the possibility of adverse effects. As sexual drugs, hoth compounds may enhance the pleasure of touching, but they interfere with erection in men and with orgasm in both men and w omen, A few cases of dependence on MDMA have been reported they resemble cases of amphetamine dependence. 

Methylphenidate releases stored dopamine but most of its action is to irrhibit uptake of central neurotransmitters. Its effects and adverse effects are very similar to amphetamines. Methylphenidate has a low systemic availability and slow onset of... 

Anorectic drugs, which are structurally related to the amphetamines, act mainly on the satiety centre in the hypothalamus and also increase general physical activity (1). All of them, except fenfluramine, stimulate the central nervous system and can cause restlessness, nervousness, irritabihty, and insomnia. Adverse effects also occur through sympathetic stimulation and gastrointestinal irritation. Drug interactions can occur with monoamine oxidase inhibitors. Dexamfetamine, phenmetrazine, and benzfetamine can cause dependence. Some of them have been associated with cardiac valvulopathy and primary pulmonary hypertension (2). 

The adverse effects of amphetamine and related sympathomimetic appetite suppressants are well documented. All of these agents are classified by the U.S. Drug Enforcement Administration (DEA) as controlled substances (classes II-IV) according to their potential for causing addiction (see Table 15.4). Class II agents such as amphetamine are highly abused, with prescription restricted to speeial circumstances class TV anorectic drugs such as sibutramine, phentermine, di-ethylpropion, and mazindol have minimal abuse potential. 

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