Kaplan + Sadock's Synopsis of Psychiatry, 11e

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29.30 Stimulant Drugs and Atomoxetine

Table 29.30-2 Sympathomimetics Commonly Used in Psychiatry

Usual Daily Dose for Disorders Associated with Excessive Daytime Somnolence

Usual Daily Dose for ADHD a

Initial Daily Dose

Maximum Daily Dose Children: 40 mg Adults: 60 mg

Generic Name

Trade Name

Preparations

Amphetamine–

Adderall

5, 10, 20, and 30 mg tablets 50, 150, and 250 mg tablets 10, 18, 25, 40, and 60 mg tablets 2.5, 5, and 10 mg capsules 5, 10, and 15 mg ER capsules; 5 and 10 mg tablets 5 mg tablets; 5, 10, and 15 mg ER tablets 5, 10, and 20 mg tablets; 10 and 20 mg SR tablets 18 and 36 mg ER tablets 20, 30, 40, 50, 60, and 70 mg capsules

5–10 mg 20–30 mg

5–60 mg

dextroamphetamine

Armodafinil

Nuvigil

50–150 mg 150–250 mg 250 mg

Atomoxetine

Strattera

20 mg

40–80 mg

Not used

Children: 80 mg Adults: 100 mg

Dexmethylphenidate Focalin

5 mg

5–20 mg

Not used

20 mg

Dextroamphetamine Dexedrine, Dextrostat

5–10 mg 20–30 mg

5–60 mg

Children: 40 mg Adults: 60 mg

Lisdexamfetamine

Vyvanse

20–30 mg

70 mg

Methamphetamine

Desoxyn

5–10 mg 20–25 mg

Not generally used

45 mg

Methylphenidate

Ritalin, Methidate, Methylin, Attenade

5–10 mg 5–60 mg

20–30 mg

Children: 80 mg Adults: 90 mg

Concerta

18 mg

18–54 mg

Not yet established

54 mg

Methylphenidate hydrochloride

Quillivant XR

20 mg

60 mg

Modafinil

Provigil

100 and 200 mg tablets

100 mg

Not used

400 mg

400 mg

*Obstructive sleep apnea, narcolepsy, and shift work disorder. a For children 6 years of age and older. ER, extended release; SR, sustained release.

in persons with hepatic impairment. Some persons take a sec- ond 100 mg or 200 mg dose in the afternoon. The maximum recommended daily dosage is 400 mg, although dosages of 600 to 1,200 mg a day have been used safely. Adverse effects become prominent at dosages greater than 400 mg a day. Compared with amphetamine-like drugs, modafinil promotes wakefulness but produces less attentiveness and less irritabil- ity. Some persons with excessive daytime sleepiness extend the activity of the morning modafinil dose with an afternoon dose of methylphenidate. Armodafinil is virtually identical to modafinil, but is dosed differently, the dosing range being 50–250 mg daily. Atomoxetine (Strattera) Atomoxetine is the first nonstimulant drug to be approved by the Food and Drug Administration (FDA) as a treatment of ADHD in children, adolescents, and adults. It is included in this chapter because it shares this indication with the stimulants described earlier. Pharmacological Actions Atomoxetine is believed to produce a therapeutic effect through selective inhibition of the presynaptic norepinephrine transporter. It is well absorbed after oral administration and

for at least 10 seconds, to ensure that the proper dose is admin- istered. The clinical effects of the drug are evident from 45 min- utes to 12 hours after dosing. The starting dosage of modafinil is 200 mg in the morning in medically healthy individuals and 100 mg in the morning

Table 29.30-3 Lisdexamfetamine (Vyvanse) Dosage Equivalency Conversions Vyvanse and Adderall XR

Vyvanse

Adderall XR

20 mg 30 mg 40 mg 50 mg 60 mg 70 mg

5 mg

10 mg 15 mg 20 mg 25 mg

30 mg Vyvanse, Adderall IR, and Dexedrine

Vyvanse

Adderall IR

Dexedrine

70 mg 50 mg 30 mg

30 mg 20 mg 10 mg

22.5 mg 15 mg 7.5 mg

XR, extended release; IR, immediate-release.