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Hospice, Cancer Pain Management, and Symptom Control
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
Samira Kanaan Beckwith, Charles Wellman
Psychostimulants, such as dextroamphetamine and methylphenidate, are useful for the relief of depression, diminishing excessive sedation due to opioids, potentiating the analgesic effect of opioids in patients with postoperative and cancer pain, promoting a sense of wellbeing, and lessening feelings of weakness and fatigue (Breitbart et al., 1998; Homsi et al., 2000). Doses commonly used are 5 to 10 mg once or twice daily (breakfast and lunch), with few patients requiring more than 30 mg per day (Emanuel et al., 1999). Compared with traditional antidepressants, the psychostimulants can show beneficial effects within several days rather than several weeks. Appetite can be enhanced (if significant depression is relieved) or suppressed, which can be a problem in patients with cancer. Pemoline, a unique alternative to the amphetamine-like medications, lacks abuse potential, has mild sympathomimetic effects, has low DEA scheduling permitting telephone orders, and comes in a chewable tablet form that can be absorbed through the buccal mucosa. It is not established, however, that it potentiates opioids, although it counters the sedation of opioids and relieves depression (Breitbart et al., 1998). Pemoline should be used with caution in patients having underlying liver disease.
Stimulants
Published in Clete A. Kushida, Sleep Deprivation, 2004
John A. Caldwell, J. Lynn Caldwell
Pemoline is a mild psychostimulant with CNS effects that are not clearly understood; the exact mechanism and site of action of the drug are not known. While it is structurally different from amphetamine and methylphenidate, its actions are similar to those of the other stimulants (56). The typical use of pemoline is for the treatment of the symptoms of distractibility, hyperactivity, and impulsivity in ADHD. It has not been approved for the treatment of narcolepsy, but it does have alerting effects in adults (31,33). Researchers have examined the use of pemoline as an aid to fatigued individuals. Although it has been shown to improve some aspects of performance and alertness, it does not appear to affect mood. Its physiological effects are mild, and it does not exert pronounced effects on blood pressure or heart rate. However, it is not recommended as a first line treatment for ADHD or as an alerting drug owing to potentially lethal liver toxicity (57).
Drugs affecting the autonomic nervous system
Published in Bev-Lorraine True, Robert H. Dreisbach, Dreisbach’s HANDBOOK of POISONING, 2001
Bev-Lorraine True, Robert H. Dreisbach
Prolonged nasal use of epinephrine or substitutes leads to nasal congestion. Prolonged oral use of amphetamine or ephedrine or similar drugs in large doses by emotionally unstable individuals may lead to personality changes with a psychic craving to continue the use of the drug. Use of these compounds can also cause reactions of tension and anxiety progressing to psychosis. Abuse of methylphenidate has caused fever with eosinophilia. Long-term use of dextroamphetamine or methylphenidate for control of hyperactivity in children has caused growth retardation. Pemoline is suspected of causing liver damage. Isoxsuprine can cause skin rash. Dobutamine has caused anginal pain and dyspnea.
Pharmacokinetic and pharmacodynamic of the cognitive enhancer modafinil: Relevant clinical and forensic aspects
Published in Substance Abuse, 2020
Ana Sousa, Ricardo Jorge Dinis-Oliveira
Due of its wake-promoting and psychotropic effects, modafinil is prescribed to improve wakefulness in adults who have excessive day sleepiness due to one of the following diagnosed sleep disorders:96–98 i) narcolepsy, as first-line treatment; ii) obstructive sleep apnea (OSA), as an adjunct to continuous positive airway pressure (CPAP); and iii) shift work disorder sleep (SWSD), as first-line treatment. The usual starting dose is 200 mg per day (100 mg twice daily). Nonetheless, it can be gradually increased to 400 mg per day (200 mg twice daily) in case of insufficient response.99 Modafinil is also approved for Air Force missions in the U.S. as an alternative to amphetamines for military usage and has also been shown to reduce jet lag symptomatology.24 In 2007, the longer-acting form of modafinil, armodafinil, was also approved for the treatment of excessive sleepiness associated with narcolepsy, OSA and SWSD,100,101 taken in a single dose (varying from 100 to 250 mg) in the morning.99,102 In narcoleptic patients previously treated unsatisfactorily with psychostimulants like d-amphetamine, methylphenidate, or pemoline, modafinil seems to be an effective and well-tolerated treatment for improving daytime wakefulness, regardless of which psychostimulant was taken formerly.103
Advances in pharmaceutical treatment options for narcolepsy
Published in Expert Opinion on Orphan Drugs, 2018
Tatsunori Takahashi, Sakai Noriaki, Mari Matsumura, Chenyu Li, Kayo Takahashi, Seiji Nishino
EDS is defined as ‘irresistible sleepiness in a situation when an individual would be expected to be awake, and alert’ [24]. Although non-pharmacological treatments (i.e. avoiding sleep deprivation and maintaining a regular sleep pattern) may help to control EDS [15], almost all patients require pharmacological therapies, mostly stimulant medications [25]. Milder stimulants with low efficacy and potency (e.g. modafinil and armodafinil, Schedule IV controlled substance) are tried first. Sodium oxybate (Schedule III controlled substance) is approved for both EDS and cataplexy and is also the first line medication for both NT1 and NT2 patients. Based on a study by Black J et al. [26], the combination therapy of sodium oxybate and modafinil demonstrated an increase in daytime sleep latency while sodium-oxybate alone was as efficacious in treating EDS as the previously administered modafinil. This result indicates additive effects and the combination therapy should be considered as an alternative approach when the monotherapy is insufficient. Amphetamine-like compounds are also used, and these include methamphetamine, d-amphetamine, methylphenidate (Schedule II controlled substances), and mazindol (a Schedule IV controlled substances) [17]. Patients with EDS are usually started on a low dose which is then increased progressively to achieve satisfactory results. Pemoline is another mild sympathomimetic stimulant which selectively blocks dopamine reuptake and only weakly stimulates dopamine release [27]. However, this drug has been withdrawn from the market in most countries due to its potential fatal hepatotoxicity [27,28].
Current perspectives on the diagnosis and management of fatigue in multiple sclerosis
Published in Expert Review of Neurotherapeutics, 2022
Olga Marchesi, Carmen Vizzino, Massimo Filippi, Maria A. Rocca
Among the most frequently used drugs to treat fatigue in MS are amantadine [133], stimulants like modafinil or methylphenidate, pemoline and aminopyridine. However, these treatments fail to demonstrate a significant clinical effect over placebo even in recent trials [134,135] and can present relevant side-effects [135].