Systematic Review of Treatment for Amphetamine-Related Disorders

How lisdexamfetamine’s distinctive pharmacokinetic/pharmacodynamic profile translates into sustained efficacy as a treatment for ADHD and its reduced potential for recreational abuse is also discussed. Amphetamine sulfate has a high potential for abuse and misuse, which can lead to the development of a substance use disorder, including addiction. Misuse and abuse of CNS stimulants, including amphetamine sulfate, can result in overdose and death, and this risk is increased with higher doses or unapproved methods of administration, such as snorting or injection.

• In addition, some medications were effective in reducing craving including topiramate [16], buprenorphine and methadone [18].
• Beta-blockers should not be used as sole antihypertensive therapies as their use may lead to unopposed α-adrenergic tone and a worsened hypertensive state.
• The AUC0-480 min values were identical, but the maximum concentration reached in plasma (the Cmax) was 50% lower after administration of lisdexamfetamine and the time to Cmax (the tmax) was doubled (Jackson et al., 2011).
• They’re often used and misused in search of a “high,” or to boost energy, to improve performance at work or school, or to lose weight or control appetite.
• In the USA, d-amphetamine-containing medications, especially MES-amphetamine, have been very widely used as treatments for ADHD.

How Can You Prevent Amphetamine Addiction?

However, a pleasurable experience from d-amphetamine can lead to excessive use of it as a prescribed drug by the patient and the (mis)use of the prescription by others (diversion). There is no evidence that amphetamines given to children diagnosed with ADHD cause addiction or drug abuse, but there is a potential for addiction or abuse if the person taking the stimulant has a history of substance abuse. Research shows that people with ADHD had a lower rate of substance use disorder if they were medically treated versus not receiving treatment.

Adverse effects

This activity will highlight the mechanism of action, adverse effect profile, and other key factors (e.g., dosing, monitoring, toxicity) pertinent for members of the interprofessional team in the treatment of patients with ADHD and narcolepsy. Some side effects of amphetamine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine.

Amphetamine, past and present – a pharmacological and clinical perspective

This comprises both studies that only enrolled males (nine studies, 21%) [24, 29, 30, 34, 46, 52, 55, 57, 58] and those enrolling both males and females but with higher male enrolments. Thirty-four (79.1%) of the studies we reviewed excluded participants with depression or psychotic disorders, or those taking an antidepressant or antipsychotic medication. Furthermore, the time of lisdexamfetamine’s peak pharmacological effect was substantially delayed compared with IR d-amphetamine, at 3.0 h versus 1.5–2.0 h. When lisdexamfetamine was given at an increased dose of 150 mg, it significantly increased the DQRS ‘Drug liking’ score to an equivalent extent to IR d-amphetamine (40 mg oral). However, the peak effect of the higher dose of lisdexamfetamine was even more delayed, at 4.0 h. Once again, the reproducible pharmacokinetics of its active metabolite, d-amphetamine, are probably due to the rate-limited, enzymatic cleavage of the precursor molecule that occurs primarily in red blood cells (Ermer et al., 2010).

A small effect size was considered as 0.2–0.49, a moderate effect size was considered as 0.5–0.79 and a large effect size was greater than 0.80 [13]. Due to the limited number of included studies, calculating effect sizes was not feasible. They treat attention deficit hyperactivity disorder and narcolepsy, a sleep disorder.

The secondary outcome was all-cause mortality, studied using between-individual analysis as traditional Cox models. Exposures  Medications for substance use disorders (SUDs) or for attention-deficit/hyperactive disorder, mood stabilizers, antidepressants, benzodiazepines and related drugs, and antipsychotics. Medication use vs nonuse was modeled with the PRE2DUP (from prescription drug purchases to drug use periods) method. Design, Setting, and Participants  This nationwide register-based cohort study was conducted from July 2006 to December 2018 with a median (IQR) follow-up time of 3.9 (1.0-6.1) years. When the intravenous route was explored, IR d-amphetamine (20 mg intravenous) produced a peak ‘Drug liking’ score 20 min after dosing, which coincided with plasma Cmax (Jasinsky and Krishnan, 2009b). In contrast, the equivalent dose of lisdexamfetamine (50 mg intravenous) did not significantly increase ‘Dug liking’ relative to placebo, and the Cmax of plasma d-amphetamine occurred considerably later at 2.0 h (Jasinski and Krishnan, 2009b).

The sooner you seek help, the greater your chances for a long-term recovery. Talk with your health care provider or see a mental health provider, such as a doctor who specializes in addiction medicine or addiction psychiatry, or a licensed alcohol and drug counselor. Examples include methylenedioxymethamphetamine, also called MDMA, ecstasy or molly, and gamma-hydroxybutyric acid, known as GHB. Other examples amphetamine addiction include ketamine and flunitrazepam or Rohypnol — a brand used outside the U.S. — also called roofie. These drugs are not all in the same category, but they share some similar effects and dangers, including long-term harmful effects. Stimulants include amphetamines, meth (methamphetamine), cocaine, methylphenidate (Ritalin, Concerta, others) and amphetamine-dextroamphetamine (Adderall XR, Mydayis).

Immediate effects

Topiramate was assessed in two studies reviewed here [32, 55], demonstrating reduced use and addiction severity compared with placebo. Furthermore, a secondary analysis of Elkashef et al. [32] found higher responders within groups in a latent class analysis [69], suggesting further studies with different eligibility criteria are warranted. A single, recent American study assessed varenicline (1 mg po BD) as a pharmacotherapy for MA dependence [27]. There were no differences between treatment and placebo arms for any measures of dependence; however, there was a reduction in cigarettes smoked in the treatment arm (consistent with its licensed indication as a smoking cessation medication).

Amphetamine users may also use other drugs inappropriately to manage the side effects of amphetamines. Benzodiazepines, for example, are anti-anxiety agents that may be used to help an individual sleep, but that can also be addictive. Future research should address small sample sizes and low participant retention and treatment adherence rates, leading to underpowered studies lacking meaningful results. Under-powered results can be avoided by planning recruitment for high attrition rates, collaborating on multi-centre research, potentially through clinical research networks, and a greater role for consumer and clinician engagement in the planning and establishment of trials. Medication adherence also needs to be better examined and monitored in trials, particularly when using medications with abuse liability (e.g. psychoactive medications such as stimulants). Amphetamines refer to both amphetamine (AMPH) and the structurally similar methamphetamines (MA), both of which are used extra-medically.

• Similarly, while women were often excluded by the study design, no study examined only women.
• Due to the limited number of studies, conducting a meta-analysis was not feasible.
• Medication adherence also needs to be better examined and monitored in trials, particularly when using medications with abuse liability (e.g. psychoactive medications such as stimulants).
• The brain’s reward circuit changes, reducing a person’s ability to exercise self-control and leading to strong urges to continue.
• Or, it can be through having unsafe sex because drug use can lead to risky behaviors.
• This activity will highlight the mechanism of action, adverse effect profile, and other key factors (e.g., dosing, monitoring, toxicity) pertinent for members of the interprofessional team in the treatment of patients with ADHD and narcolepsy.