Lisdexamfetamine

INTRODUCTION

Indications

Management of attention deficit hyperactivity disorder (ADHD) (in adults and children).

Action

Blocks reuptake and increases release of norepinephrine and dopamine resulting in increased levels in extraneuronal space. Therapeutic Effects: Improved attention span in ADHD.

Adverse Reactions/Side Effects

CNS: behavioral disturbances, dizziness, hallucinations, insomnia, irritability, mania, psychomotor hyperactivity, thought disorder, tics. EENT: blurred vision, poor accommodation. GI: abdominal pain, ↓ appetite, dry mouth, nausea, vomiting. Derm: rash. Metab: ↓ weight. Misc: long-term growth suppression.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor attentiveness and behavior in patients with ADHD. Report any changes in attention and hyperactivity, and document whether this drug appears to be producing the desired effects.

• Be alert for signs of excessive CNS stimulation, including increased activity, hallucinations, mania, irritability, tics, disordered thoughts, or behavioral disturbances. Report these signs to the physician.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Assess growth rate in children receiving chronic therapy; report delayed or stunted growth to the physician.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight loss or decreased body fat.

Patient/Client-Related Instruction

• Instruct patient and family/caregivers to report other troublesome side effects, including severe or prolonged sleep loss, vision disturbances, skin rash, or GI problems (nausea, vomiting, decreased appetite, abdominal pain, dry mouth).

Pharmacokinetics

Absorption: Rapidly absorbed and converted to dextroamphetamine, the active drug.

Distribution: Unknown.

Metabolism and Excretion: 42% excreted in urine as amphetamine.

Half-life: <1 hr for lisdexamfetamine.

Contraindications/Precautions

Contraindicated in: Hypersensitivity to lisdexamfetamine or other sympathomimetic amines; Advanced arteriosclerosis; Symptomatic cardiovascular disease, including known structural cardiac abnormalities (may increase the risk of sudden death); Moderate-to-severe hypertension; Glaucoma; Agitation; OB: Lactation; History of substance abuse; During or within 14 days of monoamine oxidase inhibitor therapy.

Use Cautiously in: History of preexisting psychosis, bipolar disorder, aggression, tics, Tourette's syndrome or seizures (may exacerbate condition); OB: Use in pregnancy only if maternal benefit outweighs fetal risk.

Interactions

Drug-Drug: Serious adverse reactions, including hyperpyrexia and hypertension, may occur with monamine oxidase inhibitors; avoid use within 14 days. Concurrent use of other ...