Misuse or even usual doses of amphetamine in children and adolescents with structural cardiac abnormalities or other serious heart problems may cause sudden death and serious cardiovascular adverse events. Sudden death is one of the main concerns associated with CNS stimulant treatment.
Detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression screening, should be considered in these patients to evaluate the risk of bipolar disorder.Ĭardiovascular Events (US black box warning)
The bioavailable average half-lives are similar for both the sustained-release capsule and immediate-release tablet.Ĭaution is necessary when prescribing stimulants for ADHD to patients with comorbid conditions such as pre-existing psychosis and bipolar illness because they may worsen behavior disturbances and thought disorders that might occur in these patients. However, the mechanism of amphetamine's mental and behavioral effects in children is not clearly understood.īoth immediate-release tablets and extended-release capsules contain both enantiomer, d-amphetamine, and l-amphetamine salts in the ratio of 3:1. Īlpha-adrenergic stimulation causes vasoconstriction and an increase in total peripheral resistance, leading to elevations of both systolic and diastolic blood pressures, a weak bronchodilator, and respiratory stimulant action. Stimulation of beta-adrenergic receptor sites by these medications increases heart rate, stroke volume, and skeletal muscle blood flow. Released norepinephrine affecting both alpha-adrenergic receptor sites and beta-adrenergic receptor sites. They also block norepinephrine and dopamine reuptake into the presynaptic neuron by competitive inhibition. Amphetamines increase dopamine and norepinephrine in the synaptic space by promoting the release of catecholamines from the presynaptic nerve terminals. Measurable amounts of amphetamine were also present in the urine of the infant.Īmphetamines are non-catecholamines, sympathomimetic amines with central nervous system (CNS) stimulant activity. Studies showed amphetamines were 3 and 7 times higher in breast milk than maternal plasma on the 10th and 42nd days after delivery, respectively. The result of a study on a nursing mother with the diagnosis of narcolepsy who was receiving a daily dose of 20 mg amphetamine was significant for an elevated level of amphetamine in breast milk compared to maternal plasma. Physicians should consider an alternative medication or advise the patient to discontinue breastfeeding. Reported cases show biliary atresia in infants who were exposed to amphetamine in utero during the second and third trimesters.Īmphetamine should not be prescribed to nursing women as it is excreted in human breast milk. Reports exist of increased risk of premature delivery and low birth weight in infants born to mothers with amphetamine dependence as amphetamine crosses the placenta. Use during pregnancy only if the potential maternal benefit outweighs the potential fetal risk.
The American Academy of Pediatrics rates amphetamines as drugs of abuse for which there are reports of adverse effects on the infant during breastfeeding.Ĭonsider potential risks and benefits before prescribing amphetamines during pregnancy and breastfeeding.
Potential benefits may warrant use in women who are pregnant.) In the pediatric population, the immediate-release tablet is recommended for patients three years of age or older, and the extended-release capsule can be prescribed to patients six years or older.Īmphetamines are Pregnancy Category C (prior to 2015) (Category C Animal reproduction studies have shown an adverse effect on the fetus, but no adequate and well-controlled studies in humans. Amphetamines, along with other remedial measures such as psychological, educational, and social, are prescribed to manage patients with symptoms like distractibility, short attention span, hyperactivity, and impulsivity. However, another study showed conflicting results, as the mean scores on the Fugl-Meyer motor scale were not significant for the amphetamine group compared with the placebo group.Īmphetamine/dextroamphetamine is used off-label by college students for memory enhancement, test-taking ability, and study marathons.įDA-approved clinical uses for dextroamphetamine/amphetamine:Īttention Deficit Disorder with Hyperactivityĭextroamphetamine/amphetamine is FDA-approved for adult and pediatric (ages 3 to 16 years) populations. in 1988 shows that amphetamine use in patients with ischemic stroke improved motor function compared with patients undergoing physical therapy alone.
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