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Stimulants - Medication List

Adderall ® (dextroamphetamine plus amphetamine) armodafinil - NUVIGIL®
atomoxetine (Strattera ®) benzphetamine (Didrex ®)
Caffeine (NoDoz ® , Vivarin ® ) dexmethylphenidate (Focalin ® )
Dextroamphetamine (Dexedrine®) diethylpropion (Tenuate ® )
guanfacine -INTUNIV® extended-release tablets lisdexamfetamine dimesylate - Vyvanse®
Methylphenidate (Concerta ®; Metadate ® ER; Metadate ® CD) Modafinil (Provigil ®)
Pemoline (Cylert ® ) phendimetrizine (Bontril SR ® , Prelu-2 ® )
phentermine (Fastin ® , Ionamin ®) sibutramine (Meridia ® )
Disclaimer - Please see package insert for additional information and possible updates. The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   Read the disclaimer

 Adderall ® (dextroamphetamine plus amphetamine)   top of page

DOSAGE AND ADMINISTRATION
Regardless of indication, amphetamines should be administered at the lowest effective dosage, and dosage should be individually adjusted according to the therapeutic needs and response of the patient. Late evening doses should be avoided because of the resulting insomnia.

Attention Deficit Hyperactivity Disorder:  Not recommended for children under 3 years of age. In children from 3 to 5 years of age, start with 2.5 mg daily; daily dosage may be raised in increments of 2.5 mg at weekly intervals until optimal response is obtained.

In children 6 years of age and older, start with 5 mg once or twice daily; daily dosage may be raised in increments of 5 mg at weekly intervals until optimal response is obtained. Only in rare cases will it be necessary to exceed a total of 40 mg per day. Give first dose on awakening; additional doses (1 or 2) at intervals of 4 to 6 hours.

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


Narcolepsy: Usual dose 5 mg to 60 mg per day in divided doses, depending on the individual patient response.
Narcolepsy seldom occurs in children under 12 years of age; however, when it does, dextroamphetamine sulfate may be used. The suggested initial dose for patients aged 6 to 12 is 5 mg daily; daily dose may be raised in increments of 5 mg at weekly intervals until optimal response is obtained. In patients 12 years of age and older, start with 10 mg daily; daily dosage may be raised in increments of 10 mg at weekly intervals until optimal response is obtained. If bothersome adverse reactions appear (e.g., insomnia or anorexia), dosage should be reduced. Give first dose on awakening; additional doses (1 or 2) at intervals of 4 to 6 hours.

====================ADDERAL XL CAPSULES====================

Dosing Considerations for all Patients

Individualize the dosage according to the therapeutic needs and response of the patient. Administer ADDERALL XR at the lowest effective dosage.

Based on bioequivalence data, patients taking divided doses of immediate-release ADDERALL, (for example, twice daily), may be switched to ADDERALL XR at the same total daily dose taken once daily. Titrate at weekly intervals to appropriate efficacy and tolerability as indicated.

ADDERALL XR capsules may be taken whole, or the capsule may be opened and the entire contents sprinkled on applesauce. If the patient is using the sprinkle administration method, the sprinkled applesauce should be consumed immediately; it should not be stored. Patients should take the applesauce with sprinkled beads in its entirety without chewing. The dose of a single capsule should not be divided. The contents of the entire capsule should be taken, and patients should not take anything less than one capsule per day.

ADDERALL XR may be taken with or without food.

ADDERALL XR should be given upon awakening. Afternoon doses should be avoided because of the potential for insomnia.

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

Children: In children with ADHD who are 6-12 years of age and are either starting treatment for the first time or switching from another medication, start with 10 mg once daily in the morning; daily dosage may be adjusted in increments of 5 mg or 10 mg at weekly intervals. When in the judgment of the clinician a lower initial dose is appropriate, patients may begin treatment with 5 mg once daily in the morning. The maximum recommended dose for children is 30 mg/day; doses greater than 30 mg/day of ADDERALL XR have not been studied in children. ADDERALL XR has not been studied in children under 6 years of age.

Adolescents: The recommended starting dose for adolescents with ADHD who are 13-17 years of age and are either starting treatment for the first time or switching from another medication is 10 mg/day. The dose may be increased to 20 mg/day after one week if ADHD symptoms are not adequately controlled.

Adults: In adults with ADHD who are either starting treatment for the first time or switching from another medication, the recommended dose is 20 mg/day.

HOW SUPPLIED
5 mg, 7.5 mg, 10mg, 15mg, 20mg, 30 mg tablets.

ADDERALL XL:
5 mg, 10mg, 15mg, 20mg, 25MG, 30 mg CAPSULES.

 armodafinil - NUVIGIL®  top of page

DOSAGE AND ADMINISTRATION
Obstructive Sleep Apnea (OSA) and Narcolepsy:
The recommended dose of NUVIGIL for patients with OSA or narcolepsy is 150 mg or 250 mg given as a single dose in the morning. In patients with OSA, doses up to 250 mg/day, given as a single dose, have been well tolerated, but there is no consistent evidence that this dose confers additional benefit beyond that of the 150 mg/day dose.

Shift Work Sleep Disorder (SWD) :
The recommended dose of NUVIGIL for patients with SWD is 150 mg given daily approximately 1 hour prior to the start of their work shift.

Dosage adjustment should be considered for concomitant medications that are substrates for CYP3A4/5, such as steroidal contraceptives, triazolam, and cyclosporine.

Drugs that are largely eliminated via CYP2C19 metabolism, such as diazepam, propranolol, and phenytoin may have prolonged elimination upon coadministration with NUVIGIL and may require dosage reduction and monitoring for toxicity.

In patients with severe hepatic impairment, NUVIGIL should be administered at a reduced dose.

There is inadequate information to determine safety and efficacy of dosing in patients with severe renal impairment.  In elderly patients, elimination of armodafinil and its metabolites may be reduced as a consequence of aging. Therefore, consideration should be given to the use of lower doses in this population
HOW SUPPLIED
NUVIGIL® (armodafinil) Tablets [C-IV]
50 mg, 150mg, 250 mg tablets

 atomoxetine (Strattera ®)  top of page

Drug Category: Selective Norepinephrine Reuptake Inhibitor.
Indication
: attention-deficit/hyperactivity disorder (ADHD).

Dosing (usual): Treatment of ADHD in children and adolescents up to 70 kg body weight. Optimal doses appear to be 1.2 mg/kg daily, given once daily or in two divided doses. For children/adolescents over 70 kg body wt and adult patients, dose titration to 80 mg daily is recommended (single dose or two divided doses).

Dosing (Adults): Treatment of ADHD: Oral: Initial: 40 mg/day, increased after minimum of 3 days to ~80 mg/day; may administer as either a single daily dose or 2 evenly divided doses in morning and late afternoon/early evening. May increase to 100 mg in 2-4 additional weeks to achieve optimal response. Dosage adjustment in patients receiving strong CYP2D6 inhibitors (eg, paroxetine, fluoxetine, quinidine): Do not exceed  80 mg/day; dose adjustments should occur only after 4 weeks.

Note: Atomoxetine may be discontinued without the need for tapering dose.

Supplied:  Capsule: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg

benzphetamine  (Didrex ®)  top of page

Initial: 25-50 mg po qd. Titrate to 25-50 mg po 1-3 times daily. Max dose: 50 mg tid.

[Supplied: 50 mg tablet]

Caffeine (NoDoz ® , Vivarin ® ) top of page

Dosing (Adults): 100-200 mg orally every 3 to 4 hours as needed

dexmethylphenidate  (Focalin ® ) top of page

CNS stimulant. d-threo -enantiomer of racemic methylphenidate hydrochloride. Indication: attention-deficit/hyperactivity disorder. Focalin is administered twice daily, at least 4 hours apart.
Patients new to methylphenidate: recommended starting dose for patients who are not currently taking methylphenidate, or for patients who are on stimulants other than methylphenidate: 5 mg/day (2.5 mg twice daily). Dosage may be adjusted in 2.5 to 5 mg increments to a maximum of 20 mg/day (10 mg twice daily).

In general, dosage adjustments may proceed at approximately weekly intervals. Patients currently using methylphenidate: recommended starting dose is half the dose of methylphenidate.
The maximum recommended dose is 20 mg/day (10 mg twice daily).

Dextroamphetamine (Dexedrine ® ) top of page

Narcolepsy/ADHD: 2.5 to 10 mg orally every morning or 2 to 3 times daily. Long acting: 10-15mg orally once daily.

diethylpropion (Tenuate ® ) top of page

Adult (usual) Obesity: controlled release: 75 mg orally daily. Take mid-morning. Obesity: immediate release: 25 mg orally 3 times a day, 1 hr before meals. May take 1 dose mid-evening, if desired, to overcome night hunger.
Supplied: 75 mg CR, 25 mg tablet.

 guanfacine -INTUNIV® extended-release tablets  top of page

INDICATIONS AND USAGE
INTUNIV® is indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) as monotherapy and as adjunctive therapy to stimulant medications. The efficacy of INTUNIV® was studied for the treatment of ADHD in two controlled monotherapy clinical trials (8 and 9 weeks in duration) and one controlled adjunctive trial with psychostimulants (9 weeks in duration) in children and adolescents ages 6-17 who met DSM-IV® criteria for ADHD. The effectiveness of INTUNIV® for longer-term use (more than 9 weeks) has not been systematically evaluated in controlled trials.

A diagnosis of ADHD implies the presence of hyperactive-impulsive and/or inattentive symptoms that cause impairment and were present before the age of 7 years. The symptoms must cause clinically significant impairment, e.g., in social, academic, or occupational functioning, and be present in two or more settings, e.g., school (or work) and at home. The symptoms must not be better accounted for by another mental disorder. For the Inattentive Type, at least six of the following symptoms must have persisted for at least 6 months: lack of attention to details/careless mistakes; lack of sustained attention; poor listener; failure to follow through on tasks; poor organization; avoids tasks requiring sustained mental effort; loses things; easily distracted; forgetful. For the Hyperactive-Impulsive Type, at least six of the following symptoms must have persisted for at least 6 months: fidgeting/squirming; leaving seat; inappropriate running/climbing; difficulty with quiet activities; "on the go"; excessive talking; blurting answers; can't wait turn; intrusive. The Combined Type requires both inattentive and hyperactive-impulsive criteria to be met.

Special Diagnostic Considerations
Specific etiology of this syndrome is unknown, and there is no single diagnostic test. Adequate diagnosis requires the use not only of medical but also of special psychological, educational, and social resources. Learning may or may not be impaired. The diagnosis must be based upon a complete history and evaluation of the patient and not solely on the presence of the required number of DSM-IV® characteristics.

Need for Comprehensive Treatment Program
INTUNIV® is indicated as an integral part of a total treatment program for ADHD that may include other measures (psychological, educational, and social) for patients with this syndrome. Drug treatment may not be indicated for all patients with this syndrome. INTUNIV® is not intended for use in patients who exhibit symptoms secondary to environmental factors and/or other primary psychiatric disorders, including psychosis. Appropriate educational/vocational placement is essential and psychosocial intervention is often helpful. When remedial measures alone are insufficient, the decision to prescribe INTUNIV® will depend upon the physician's assessment of the chronicity and severity of the patient's symptoms and on the level of functional impairment.

DOSAGE AND ADMINISTRATION
2.1 General Dosing Information
INTUNIV® is an extended-release tablet and should be dosed once daily. Tablets should not be crushed, chewed or broken before swallowing because this will increase the rate of guanfacine release. Do not administer with high fat meals, due to increased exposure.

Do not substitute for immediate-release guanfacine tablets on a mg-per-mg basis, because of differing pharmacokinetic profiles. INTUNIV® has a delayed Tmax, reduced Cmax and lower bioavailability compared to those of the same dose of immediate-release guanfacine.


2.2 Dose Selection
If switching from immediate-release guanfacine, discontinue that treatment, and titrate with INTUNIV® according to the following recommended schedule.

Begin at a dose of 1 mg/day, and adjust in increments of no more than 1 mg/week, for both monotherapy and adjunctive therapy to a psychostimulant.

Maintain the dose within the range of 1 mg to 4 mg once daily, depending on clinical response and tolerability, for both monotherapy and adjunctive therapy to a psychostimulant. In clinical trials, patients were randomized or dose optomized to doses of 1 mg, 2 mg, 3 mg or 4 mg and received INTUNIV® once daily in the morning in monotherapy trials and once daily in the morning or the evening in the adjunctive therapy trial.

In monotherapy trials, clinically relevant improvements were observed beginning at doses in the range 0.05-0.08 mg/kg once daily. Efficacy increased with increasing weight-adjusted dose (mg/kg). If well tolerated, doses up to 0.12 mg/kg once daily may provide additional benefit. Doses above 4 mg/day have not been systematically studied in controlled clinical trials.

In the adjunctive trial, the majority of subjects reached optimal doses in the 0.05-0.12 mg/kg/day range.

In clinical trials, there were dose-related and exposure-related risks for several clinically significant adverse reactions (hypotension, bradycardia, sedative events). Thus, consideration should be given to dosing INTUNIV® on a mg/kg basis, in order to balance the exposure-related potential benefits and risks of treatment.

2.3 Maintenance Treatment
The effectiveness of INTUNIV® for longer-term use (more than 9 weeks) has not been systematically evaluated in controlled trials. Therefore the physician electing to use INTUNIV® for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient.


2.4 Discontinuation
In a pharmacodynamic study in healthy young adult volunteers receiving INTUNIV® (4 mg once daily) or placebo, the effects of abrupt discontinuation were compared to tapering. There were greater mean increases in systolic and diastolic blood pressure and heart rate after abrupt discontinuation of INTUNIV®, but these changes generally reflected a return to original baseline and were not meaningfully different for the two discontinuation strategies. However, infrequent, transient elevations in blood pressure above original baseline (i.e., rebound) have been reported to occur upon abrupt discontinuation of guanfacine. To minimize these effects, the dose should generally be tapered in decrements of no more than 1 mg every 3 to 7 days.

2.5 Missed Doses
When reinitiating patients to the previous maintenance dose after two or more missed consecutive doses, physicians should consider titration based on patient tolerability.


DOSAGE FORMS AND STRENGTHS
1 mg, 2 mg, 3 mg and 4 mg extended-release tablets

 lisdexamfetamine dimesylate - Vyvanse®  top of page

INDICATIONS AND USAGE:
Attention Deficit Hyperactivity Disorder
Vyvanse® is indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD).

The efficacy of Vyvanse in the treatment of ADHD was established on the basis of two controlled trials in children aged 6 to 12, one controlled trial in adolescents aged 13 to 17, and two controlled trials in adults who met DSM-IV-TR® criteria for ADHD.

A diagnosis of Attention Deficit Hyperactivity Disorder (ADHD; DSM-IV®) implies the presence of hyperactive-impulsive and/or inattentive symptoms that cause impairment and were present before the age of 7 years. The symptoms must cause clinically significant impairment, e.g. in social, academic, or occupational functioning, and be present in two or more settings, e.g. school (or work) and at home. The symptoms must not be better accounted for by another mental disorder. For the Inattentive Type, at least 6 of the following symptoms must have persisted for at least 6 months: lack of attention to details/careless mistakes; lack of sustained attention; poor listener; failure to follow through on tasks; poor organization; avoids tasks requiring sustained mental effort; loses things; easily distracted; forgetful. For the Hyperactive-Impulsive Type, at least 6 of the following symptoms (or adult equivalent symptoms) must have persisted for at least 6 months: fidgeting/squirming; leaving seat; inappropriate running/climbing; difficulty with quiet activities; "on the go"; excessive talking; blurting answers; can't wait turn; intrusive. The Combined Type requires both inattentive and hyperactive-impulsive criteria to be met.

Special Diagnostic Considerations
Specific etiology of this syndrome is unknown, and there is no single diagnostic test. Adequate diagnosis requires the use not only of medical but also of special psychological, educational, and social resources. Learning may or may not be impaired. The diagnosis must be based upon a complete history and evaluation of the patient and not solely on the presence of the required number of DSM-IV characteristics.

Need for Comprehensive Treatment Program
Vyvanse is indicated as an integral part of a total treatment program for ADHD that may include other measures (psychological, educational, social) for patients with this syndrome. Drug treatment may not be indicated for all patients with this syndrome. Stimulants are not intended for use in patients who exhibit symptoms secondary to environmental factors and/or other primary psychiatric disorders, including psychosis. Appropriate educational/vocational placement is essential and psychosocial intervention is often helpful. When remedial measures alone are insufficient, the decision to prescribe stimulant medication will depend upon the physician's assessment of the chronicity and severity of the patient's symptoms and on the level of functional impairment.

Long-Term Use
The effectiveness of Vyvanse for long-term use, i.e., for more than 4 weeks, has not been systematically evaluated in controlled trials. Therefore, the physician who elects to use Vyvanse for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient.

DOSAGE AND ADMINISTRATION
Dosage should be individualized according to the therapeutic needs and response of the patient. Vyvanse should be administered at the lowest effective dosage.

In patients who are either starting treatment for the first time or switching from another medication, 30 mg once daily in the morning is the recommended dose. If the decision is made in the judgment of the clinician to increase the dose beyond 30 mg/day, daily dosage may be adjusted in increments of 10 mg or 20 mg at approximately weekly intervals. The maximum recommended dose is 70 mg/day; doses greater than 70 mg/day of Vyvanse have not been studied. Vyvanse has not been studied in children under 6 years of age.

Vyvanse should be taken in the morning. Afternoon doses should be avoided because of the potential for insomnia.

Vyvanse may be taken with or without food.

Vyvanse capsules may be taken whole, or the capsule may be opened and the entire contents dissolved in a glass of water. The solution should be consumed immediately and should not be stored. The dose of a single capsule should not be divided. The contents of the entire capsule should be taken, and patients should not take anything less than one capsule per day.

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

DOSAGE FORM AND STRENGTHS
20 mg, 30mg, 40mg, 50mg, 60mg, 70mg capsules

Methylphenidate (Concerta ®; Metadate ® ER; Metadate ® CD) top of page

Other:   Methylin  ® ER; Methylin ®; Ritalin-SR ®; Ritalin ® LA; Ritalin ®

Dosing (Adults):
Narcolepsy: Oral: 10 mg 2-3 times/day, up to 60 mg/day.
Depression: Oral: Initial: 2.5 mg every morning before 9 AM; dosage may be increased by 2.5-5 mg every 2-3 days as tolerated to a maximum of 20 mg/day. May be divided (eg, 7 AM and 12 noon), but should not be given after noon. Do not use sustained release product. ADHD: Oral: Refer to pediatric dosing.

Pediatric:
ADHD: Oral: Children >/= 6 years: Initial: 0.3 mg/kg/dose or 2.5-5 mg/dose given before breakfast and lunch; increase by 0.1 mg/kg/dose or by 5-10 mg/day at weekly intervals; usual dose: 0.5-1 mg/kg/day; maximum dose: 2 mg/kg/day or 90 mg/day

Extended release products:
Metadate® ER, Methylin® ER, Ritalin® SR: Duration of action is 8 hours. May be given in place of regular tablets, once the daily dose is titrated using the regular tablets and the titrated 8-hour dosage corresponds to sustained release tablet size.
Metadate® CD, Ritalin® LA: Initial: 20 mg once daily; may be adjusted in 10-20 mg increments at weekly intervals; maximum: 60 mg/day

Concerta®: Initial dose: Children not currently taking methylphenidate: 18 mg once daily in the morning.  Children currently taking methylphenidate: Note: Dosing based on current regimen and clinical judgment; suggested dosing listed below:
Patients taking methylphenidate 5 mg 2-3 times/day or 20 mg/day sustained release formulation: 18 mg once every morning.  Patients taking methylphenidate 10 mg 2-3 times/day or 40 mg/day sustained release formulation: 36 mg once every morning.
Patients taking methylphenidate 15 mg 2-3 times/day or 60 mg/day sustained release formulation: 54 mg once every morning.
Dose adjustment: May increase dose in increments of 18 mg; dose may be adjusted at weekly intervals. A dosage strength of 27 mg is available for situations in which a dosage between 18-36 mg is desired. Maximum dose should not exceed 2 mg/kg/day or 54 mg/day in children 6-12 years or 72 mg/day in children 13-17 years.

Supplied:
Capsule, extended release:  Metadate® CD: 10 mg, 20 mg, 30 mg.  Ritalin® LA: 10 mg, 20 mg, 30 mg, 40 mg.
Solution, oral:   Methylin®: 5 mg/5 mL (500 mL); 10 mg/5 mL (500 mL)]
Tablet: 5 mg, 10 mg, 20 mg  (Methylin®, Ritalin®: 5 mg, 10 mg, 20 mg)
Tablet, chewable: Methylin®: 2.5 mg; 5 mg; 10 mg.
Tablet, extended release: 20 mg.  Concerta®: 18 mg, 27 mg, 36 mg, 54 mg [osmotic controlled release].  Metadate® ER, Methylin® ER: 10 mg, 20 mg.
Tablet, sustained release (Ritalin-SR®): 20 mg

Modafinil  (Provigil ®)  top of page

Narcolepsy: Usual dose: 200mg orally once daily. [100, 200mg]

Pemoline  (Cylert ® ) top of page

REMOVED FROM THE MARKET

Adult
(usual):  Start 37.5 mg orally once daily in the morning. Usual effective dose: 56.25 to 75 mg/day. Max: 112.5 mg/day. Follow LFT's.

phendimetrizine  (Bontril SR ® ,  Prelu-2 ® ) top of page


Adult
(usual): Obesity: sustained release forms: 105 mg orally once daily in the morning or before the morning meal. (Immediate release forms): 35 mg orally 2-3 times daily. Maximum: 70 mg 3 times daily. In some patients, one-half tablet (17.5 mg) was adequate.

[Supplied: 105 mg SR, 35 mg tablet]

phentermine (Fastin ® ,  Ionamin ®) top of page

Adult (usual):  8 mg orally three times daily or 15 to 37.5 mg every morning.

Supplied: 8, 15, 18.75, 30. 37.5 mg

sibutramine   (Meridia ® )  top of page

Anorexiant. Start -Obesity: 10 mg orally every morning. After 4 weeks may titrate up to 15 mg once daily as needed and tolerated (may be used for up to 2 years). Max: 15 mg/day.

[Supplied: 5, 10, 15 mg capsule]
top of page

Disclaimer

Listed dosages are for - Adult patients ONLY. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.
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