Dextroamphetamine, abuse

Symptoms of dextroamphetamine abuse include insomnia, irritability, hyperactivity, and psychosis. Psychosis is characterized by radical changes in personality, impaired functioning, and a distorted sense of reality. Hallucinations, delusions, and feelings of paranoia are also common features of psychosis. 

The side effects and potential for abuse with Adderall are essentially the same as for dextroamphetamine. We recommend starting Adderall at 2.5 mg twice a day or 5 mg each morning and then adding the second dose after a week or so. Using the extended-release formulation allows for the titration of the single dose with weekly adjustments as needed. 

Dopamine activity can be enhanced in one of four main ways. Medications can stimulate dopaminergic nerve cells to release dopamine into the synapse. This is the way that stimulants such as methylphenidate (Ritalin), dextroamphetamine (Dexe-drine), and dextroamphetamine/amphetamine (Adderall) work. In addition, certain drugs of abuse, notably cocaine and methamphetamine, act in part in this way. Providing more of the raw material that nerve cells use to manufacture dopamine can also increase dopamine activity. This is the approach that neurologists use when they prescribe L-DOPA (Sinemet) to patients with Parkinson s disease. Nerve cells convert L-DOPA into dopamine. L-DOPA otherwise has little place in the treatment of psychiatric disorders. Dopamine activity can also be increased by medications that directly stimulate dopamine receptors. Bromocriptine, another medication used to... 

Methylphenidate and amphetamines have been used for ADHD management for many years but due to abuse potentials, these drugs are controlled substances." " Lisdexamfetamine itself is inactive and acts as a prodrug to dextroamphetamine upon cleavage of the lysine portion of the molecule. It was developed for the intention of creating a longer-lasting and more-difficult-to-abuse version of dextroamphetamine, as the requirement... 

The therapeutic uses of amphetamine are based on its ability to stimulate the CNS. The o-isomer (dextroamphetamine) is three to four times as potent as the L-isomer in producing CNS effects. It has been used in the treatment of obesity because of its anorexic effect, although tolerance to this effect develops rapidly. It prevents or overcomes fatigue and has been used as a CNS stimulant. Amphetamine is no longer recommended for these uses because of its potential for abuse. Amphetamine is useful in certain cases of narcolepsy or minimal brain dysfunction. 

Dextroamphetamine, the d-isomer of amphetamine, is available in immediate-release and extended-release formulations. It is functionally more potent than methylphenidate and may be associated with a greater risk of growth retardation and abuse. 

The most commonly abused prescription drugs are opioids and opiates such as oxycodone and morphine, central nervous system depressants such as barbiturates and benzodiazepines, and stimulants such as dextroamphetamine and methylphenidate. Brand-name painkillers such as Vicodin and OxyContin, depressants such as Valium and Xanax, and stimulants such as Ritalin and Dexedrine are commonly abused (as are some OTC cough remedies). Although helpful and safe when used appropriately, these drugs can cause serious harm when taken in unapproved ways. 

The primary drug therapies are psychostimulants which are indicated for both emotional based sleep disorders (i.e., narcolepsy) as well as ADHD. The drugs of choice are Ritalin (methylphenidate), dextroamphetamine or Cylert (pemoline), all CNS stimulants that effect the monoamine systems. The current therapies provide symptomatic relief but the current medications are not without side effects, including abuse potential, cardiovascular effects, insomnia, appetite suppression, head and stomach aches, crying and nervous mannerisms. 

Dextroamphetamines are a part of the amphetamine class of drugs, central nervous system (CNS) stimulants that are used in the treatment of certain brain-based disorders. Because of their long-lasting and potent stimulant effects, they are also highly physically and psychologically addictive and have a high rate of abuse. 

The National Institute on Drug Abuse (NIDA) estimates that there were approximately 900,000 Americans age 12 and older misusing prescription stimulants in 1999. Because of its popularity as a treatment for ADHD, adolescents are at a special risk for misusing dextroamphetamine drugs. 

Chronic dextroamphetamine use and abuse can cause sexual dysfunction (impotence). Because of the stress amphetamines place on the cardiovascular system, heart attack, cardiovascular shock, and cerebral hemorrhage may also occur with chronic use. 

Methamphetamine is not discussed in this chapter only because political factors and a lack of public and/or organizational acceptance would most likely preclude the use of this compound in operational settings. Methamphetamine is a potent CNS stimulant that, in fact, is somewhat more selective and efficacious than dextroamphetamine. However, even the military has opted to rely on dextroamphetamine rather than methamphetamine presumably to avoid associations between legitimate operational applications and the illicit sale and abuse of methamphetamine that is widely depicted almost on a daily basis in the popular media. 

Medications play an important part in the treatment of ADD. Stimulants are the mainstay of the treatment of ADD methylphenidate (Ritalin), dextroamphetamine (Dexedrine), and pemoline (Cylert). These differ in their half-lives, with Ritalin having the shortest and Cylert the longest. A warning has recently been issued about Cylert because of reports of sometimes fatal liver toxicity. Thus, it is recommended that it be used only if methylphenidate and dextroamphetamine are ineffective. There is individual variability in resporise, so that a person who does not respond to one may respond well to another. Other medications can also be effective in the treatment of ADD and may be useful, especially in residual ADD, where substance abuse may be an issue. These include tricyclic antidepressants (especially desipramine and imi-pramine) SSRIs, bupropion, venlafaxine, and clonidine. There are reports of antipsy-chotics and lithium being helpful in selected cases, as well. 

N-methylation increases activity (c.g.. compare mcthaiti-phetaminc with dextroamphetamine). Di-N-mcthylation decreases activity. Mono-N substituents larger than methyl tk-crease excitatory properties, but many compounds reiaio anorexiant propettie.s. Consequently, some of these ageoK arc used as anorexiants, reportedly with less abuse poteniial than amphetamine. 

Methamphetamine Hydrochloride. Methampheta-mine, (-( )-1 -phenyl-2-methyiaminopropane hydrochloride desoxyephedrine hydrochloride (Dcsoxyn). is the N-methyl analogue of dextroamphetamine. It has more marked central and lc.ss peripheral action than dextroamphetamine. It has a very high abuse potential, and by the intravenous route, its sails are known as .speed." The overall abu.se problem presented by the drug is a national disaster. Medicinally acceptable u.scs of methamphetamine are analogous to tliose of dextroamphetamine. 

AMPHETAMINE AND RELATED AGENTS Subjective effects similar to those of cocaine are produced by amphetamine, dextroamphetamine, methamphetamine, phenmetrarine, methylphenidate, and diethylpropion. Amphetamines increase synaptic DA primarily by stimulating presynaptic release rather than by blockade of reuptake. Intravenous or smoked methamphetamine produces an abuse/dependence syndrome similar to that of cocaine, although chnical deterioration may progress more rapidly and methamphetamine is thought to be neurotoxic in DA and 5-HT neurons. Methamphetamine can be produced in small, clandestine laboratories starting with ephedrine, and access to this previously widely available nonprescription stimulant has been restricted. 

---