methamphetamine (Rx)

Brand and Other Names:Desoxyn
  • Print

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet: Schedule II

  • 5mg

Attention Deficit Hyperactivity Disorder

Initial: 5 mg PO qDay or q12hr; may increase daily dose at weekly intervals of 5 mg/day until optimal response

Maintenance: Usual effective dose is 20-25 mg/day; daily dose may be divided q12hr

Dosing Considerations

Where possible, drug administration should be interrupted occasionally to determine if there is a recurrence of behavioral symptoms sufficient to require continued therapy

Obesity, Short Term Treatment

5 mg PO q8hr, 30 minutes before each meal

Dosage Forms & Strengths

tablet: Schedule II

  • 5mg

Attention Deficit Hyperactivity Disorder

<6 years: Safety and efficacy not established

≥6 years: 5 mg PO qDay or q12hr, may increase daily dose at weekly intervals of 5 mg/day until optimal response (ususally 20-25 mg/day)

Daily dose may be divided q12hr

Dosing Considerations

Where possible, drug administration should be interrupted occasionally to determine if there is a recurrence of behavioral symptoms sufficient to require continued therapy

Obesity

<12 years: Safety and efficacy not established

≥12 years: As adults; 5 mg PO q8hr 30 minutes before each meal

Next:

Interactions

Interaction Checker

and methamphetamine

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 
            Previous
            Next:

            Adverse Effects

            Frequency Not Defined

            Common

            • Hypertension, palpitations, tachyarrhythmia
            • Dizziness, drug tolerance, dysphoric mood, euphoria, headache, insomnia, restlessness, tremor
            • Urticaria
            • Constipation, diarrhea, taste sense altered, xerostomia

            Serious

            • Cardiorespiratory arrest, sudden death (rare), myocardial infarction
            • Cerebrovascular accident, Gilles de la Tourette's syndrome, seizure, psychotic disorder
            • Also see sympathomimetic syndrome, amphetamine toxicity
            • Musculoskeletal: Rhabdomyolysis

            Postmarketing Reports

            Alopecia

            Previous
            Next:

            Warnings

            Black Box Warnings

            Amphetamine has a high potential for abuse. Particular attention should be paid to the possibility of patients obtaining amphetamine for nontherapeutic use or distribution to others, and the drugs should be prescribed or dispensed sparingly

            Administration of amphetamine for prolonged periods of time may lead to drug dependence and must be avoided

            Use therapy in weight reduction programs when alternative therapy has been ineffective

            Misuse of amphetamine may cause sudden death and serious cardiovascular adverse events

            Contraindications

            Within 14 days of MAOIs

            Advanced arteriosclerosis

            Symptomatic cardiovascular disease

            Hyperthyroidism

            Moderate-severe hypertension

            Hypersensitivity to sympathomimetic amines

            Glaucoma

            Agitated state

            History of drug abuse

            Patients with ADHD concomitant with Tourette's syndrome

            Breastfeeding

            Cautions

            Difficulties with accommodation and blurring of vision reported with stimulant treatment.

            Methamphetamine should not be used to combat fatigue or to replace rest in normal persons

            Prescribing and dispensing of methamphetamine should be limited to smallest amount that is feasible at one time in order to minimize possibility of overdosage.

            Do not give at late evening; may cause insomnia

            May impair ability to drive and/or operate heavy machinery

            Alkaline urine will significantly increase half-life

            Stimulants may lower convulsive threshold in patients with prior history of seizure, patients with prior EEG abnormalities in absence of seizures, and very rarely, patients without a history of seizures and no prior EEG evidence of seizures; discontinue therapy in the presence of seizures

            Amphetamines may exacerbate motor and phonic tics and Tourette’s syndrome; perform clinical evaluation for tics and Tourette’s syndrome in children and their families prior to treating with stimulant medications

            High abuse potential; use caution

            Rare instances of prolonged and sometimes painful erections (priapism), sometimes requiring surgical intervention, reported with methylphenidate products; typically not reported during initiation, but often subsequent to an increase in dose; seek immediate medical attention for abnormally sustained or frequent and painful erections

            Consistently methylphenidate medicated children (ie, treatment for 7 days per week throughout the year) have a temporary slowing in growth rate; published data are inadequate to determine whether chronic use of amphetamines may cause a similar suppression of growth, it is anticipated that they likely have this effect; monitor growth during treatment with stimulants; patients who are not growing or gaining height or weight as expected may need to have their treatment interrupted

            Serotonin syndrome

            • Serotonin syndrome, a potentially life-threatening reaction, may occur when amphetamines are used in combination with other drugs that affect the serotonergic neurotransmitter systems
            • Symptoms may include mental status changes (eg, agitation, hallucinations, delirium, and coma), autonomic instability (eg, tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, hyperthermia), neuromuscular symptoms (eg, tremor, rigidity, myoclonus, hyperreflexia, incoordination), seizures, and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea)
            • Discontinue treatment if above symptoms occur, and initiate supportive symptomatic treatment; if concomitant use with other serotonergic drugs or CYP2D6 inhibitors is clinically warranted, initiate therapy with lower doses, monitor patients for emergence of serotonin syndrome during drug initiation or titration, and inform patients of increased risk for serotonin syndrome

            Peripheral vasculopathy

            • Stimulants are associated with peripheral vasculopathy, including Raynaud’s phenomenon; signs and symptoms are usually intermittent and mild; however, very rare sequelae include digital ulceration and/or soft tissue breakdown
            • Effects of peripheral vasculopathy, including Raynaud’s phenomenon, observed in post-marketing reports at different times and at therapeutic doses in all age groups throughout the course of treatment
            • Signs and symptoms generally improve after reduction in dose or discontinuation of drug; careful observation for digital changes is necessary during treatment with ADHD stimulants; further clinical evaluation (eg, rheumatology referral) may be appropriate for certain patients

            Cardiovascular events

            • Patients who develop symptoms such as exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease during stimulant treatment should undergo a prompt cardiac evaluation
            • Sudden death has been reported in association with CNS stimulant treatment at usual doses in patients with structural cardiac abnormalities or other serious heart problems
            • Not for use in children, adolescents or adults with known serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or other serious cardiac problems that may place them at increased vulnerability to the sympathomimetic effects of a stimulant drug
            • Stimulant medications cause a modest increase in average blood pressure (about 2-4 mmHg) and average heart rate (about 3-6 bpm), and individuals may have larger increases
            • All patients should be monitored for larger changes in heart rate and blood pressure; caution is indicated in treating patients whose underlying medical conditions might be compromised by increases in blood pressure or heart rate, eg, those with pre-existing hypertension, heart failure, recent myocardial infarction, or ventricular arrhythmia
            • Children, adolescents, or adults who are being considered for treatment with stimulant medications should have a careful history (including assessment for a family history of sudden death or ventricular arrhythmia) and physical exam to assess for the presence of cardiac disease, and should receive further cardiac evaluation if findings suggest such disease (eg, electrocardiogram and echocardiogram)
            • Patients who develop symptoms such as exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease during stimulant treatment should undergo a prompt cardiac evaluation

            Psychiatric effects

            • Administration of stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with a pre-existing psychotic disorder
            • Particular care should be taken in using stimulants to treat ADHD patients with comorbid bipolar disorder because of concern for possible induction of mixed/manic episode in such patients
            • Prior to initiating treatment with a stimulant, patients with comorbid depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.
            • Treatment-emergent psychotic or manic symptoms, eg, hallucinations, delusional thinking, or mania in children and adolescents without a prior history of psychotic illness or mania can be caused by stimulants at usual doses; if such symptoms occur, consideration should be given to a possible causal role of the stimulant, and discontinuation of treatment may be appropriate
            • Aggressive behavior or hostility is often observed in children and adolescents with ADHD, and has been reported in clinical trials and the postmarketing experience of some medications indicated for the treatment of ADHD; although there is no systematic evidence that stimulants cause aggressive behavior or hostility, patients beginning treatment for ADHD should be monitored for appearance of or worsening of aggressive behavior or hostility

            Drug interaction overview

            • Serotonin syndrome, a potentially life-threatening reaction, may occur when amphetamines are used in combination with other drugs that affect the serotonergic neurotransmitter systems such as monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, and St. John’s Wort
            • Amphetamines are known to be metabolized, to some degree, by cytochrome P450 2D6 (CYP2D6) and display minor inhibition of CYP2D6 metabolism; potential for a pharmacokinetic interaction exists with coadministration of CYP2D6 inhibitors which may increase risk with increased exposure to amphetamines; in these situations, consider alternative non-serotonergic drug or alternative drug that does not inhibit CYP2D6
            • If concomitant use with other serotonergic drugs or CYP2D6 inhibitors is clinically warranted, initiate therapy with lower doses, monitor patients for emergence of serotonin syndrome during drug initiation or titration, and inform patients of increased risk for serotonin syndrome
            Previous
            Next:

            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: do not nurse

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

            Previous
            Next:

            Pharmacology

            Mechanism of Action

            Amphetamine anorexigenic agent; sympathomimetic amine related to ephedrine and amphetamine with CNS stimulant activity; causes release of dopamine and other catechoamines from their storage in the presynaptic nerve terminals; inhibits monoamine transporters and oxidase, causing reuptake and metabolism of catecholamines

            Pharmacokinetics

            Half-Life: 4-5 hr

            Absorption: Rapid

            Metabolism: Liver

            Excretion: Urine, varies with pH

            Previous
            Next:

            Images

            Previous
            Next:

            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.