OMUDHOME OGBRU, Pharm.D.Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. Dr. graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Lisdexamfetamine is an oral drug used for
increasing attention and decreasing impulsiveness and hyperactivity in patients
with attention deficit hyperactivity disorder (ADHD). Lisdexamfetamine is a
prodrug; after administration it is converted to
dextroamphetamine (Adderall) in
the intestines and/or liver. The dextroamphetamine, an amphetamine and stimulant
for the brain, is responsible for the effect of lisdexamfetamine in ADHD. The
mechanism of action of dextroamphetamine in ADHD is unknown, but scientists
believe that they may stimulate the nervous system by increasing the release or
reducing the inactivation of norepinephrine and dopamine in the brain.
Norepinephrine and dopamine are chemicals (neurotransmitters) that nerves use
for communicating with each other. The net effect of amphetamines is an increase
in the effects of dopamine and norepinephrine. The FDA approved lisdexamfetamine
in February 2007.
GENERIC AVAILABLE: No
PRESCRIPTION: Yes
PREPARATIONS: Capsules: 20, 30, 40, 50, 60, and 70 mg
STORAGE: Lisdexamfetamine should be stored at room temperature, 15-30 C
(59-86 F), and protected from light.
PRESCRIBED FOR: Lisdexamfetamine is used for the treatment of
attention deficit hyperactivity disorder (ADHD).
DOSING: The recommended dose of lisdexamfetamine for adults and
pediatric patients ages (6-12) is 30 mg once daily in the morning. Doses may be
increased by 10-20 mg/day at weekly intervals. The maximum dose is 70 mg daily.
Lisdexamfetamine should not be administered in the afternoon because it may
cause insomnia. Capsules may be swallowed whole or the contents may be dissolved
in a glass of water.
DRUG INTERACTIONS: Monoamine oxidase inhibitor (MAOIs)
antidepressants such as isocarboxazid (Marplan), phenelzine (Nardil),
tranylcypromine (Parnate), selegiline (Eldepryl) and
procarbazine (Matulane),
slow the elimination of amphetamines in the body. This increases the
concentration of amphetamines and their effect. This can cause serious
elevations in blood pressure (hypertensive crisis) with
headaches, other signs
of hypertensive crisis, and even fatal reactions. Lisdexamfetamine should not be
administered until 14 days after MAOIs have been discontinued in order to allow
the effects of the MAOIs to dissipate.
Amphetamines increase the effect of norepinephrine. Combining both drugs may
lead to serious cardiovascular toxicity.
PREGNANCY: There are no adequate studies of lisdexamfetamine in
pregnant women. Amphetamines may cause premature delivery, low birth weight, and
withdrawal symptoms in infants born to mothers who are dependent on
amphetamines.
NURSING MOTHERS: Amphetamines are excreted in breast milk. Mothers
taking amphetamines should not breast feed.
Lisdexamfetamine may cause blurred vision, growth retardation in children,
and seizures in patients with a history of seizures. Increased blood pressure,
sudden death in patients with heart problems,
strokes and
heart attacks have
been associated with lisdexamfetamine. Patients may experience new or worsening
of psychiatric symptoms (for example,
manic episodes, hearing voices, hallucinations)
or worsening of aggressive behavior or hostility.
Lisdexamfetamine like other amphetamines may be abused. Amphetamines have
been associated with tolerance, psychological dependence, and social disability.
Stopping amphetamines suddenly may cause a withdrawal syndrome that includes
extreme fatigue and mental depression. Therefore, there use should be
discontinued by slowly reducing the dose.
Attention deficit hyperactivity disorder (ADHD) is a behavioral disorder characterized by the symptoms hyperactivity, impulsivity, and inattention. Treatment for ADHD may involve behavioral therapy and psychostimulant or antidepressant medication.
ADHD afflicts approximately 3 percent to 5 percent of school-age children and an estimated 60 percent of those maintain the disorder into adulthood. Symptoms of adult ADHD include chronic lateness, anxiety, low self esteem, employment problems, difficulty controlling anger, impulsiveness, poor organization skills, procrastination, chronic boredom among others.
What is attention deficit hyperactivity disorder (ADHD)?
ADHD refers to a chronic biobehavioral disorder that initially manifests in childhood and
is characterized by hyperactivity, impulsivity, and/or inattention. Not all of
those affected by ADHD manifest all three behavioral categories. These symptoms
can lead to difficulty in academic, emotional, and social functioning. The
diagnosis is established by satisfying specific criteria and may be associated
with other neurological, significant behavioral, and/or developmental/learning
disabilities. Therapy may consider the use of medication, behavioral therapy, and
adjustments in day-to-day lifestyle activities.
Studies in the United States indicates approximately 8%-10% of
children satisfy diagnostic criteria for ADHD. ADHD is, therefore, one of the
most common disorders of childhood. ADHD occurs two to four times more commonly
in boys than girls (male to female ratio 4:1 for the predominant...