4/17/2021 0 Comments Amphetamine Salts Er Dosage
Daily dose may be given in 1 to 3 divided doses at 4 to 6 hour intervals.The FDA recommends that, in general, stimulant medications not be used in patients with known serious cardiac structural abnormalities, a history of acute myocardial infarction, aortic stenosis, prosthetic heart valves, valvular heart disease, cardiomyopathy, ventricular dysfunction or heart failure, cardiac arrhythmias, coronary artery disease, or other serious cardiac problems.Stimulant medications may increase blood pressure or heart rate in some individuals, but more serious cardiac effects have also been associated with stimulant use.
![]() ![]() Similar results were seen when current users of ADHD drugs were compared to former users and when current users with severe underlying cardiovascular disease were included in the analysis. The authors concluded that although the absolute magnitude of risk appears to be low, a modest increase in risk could not be ruled out. The American Heart Association (AHA) states that it is reasonable to consider the use of these medications in pediatric patients with congenital heart disease without current hemodynamic or arrhythmic concerns or congenital heart disease that is considered stable by the patients pediatric cardiologist, unless the cardiologist has specific concerns. However, these patients should be closely monitored and treatment discontinuation should be considered if the patient develops any of the following conditions: heart condition associated with sudden cardiac death (SCD), arrhythmia requiring cardiopulmonary resuscitation, direct current cardioversiondefibrillation or overdrive pacing, arrhythmia associated with SCD, any clinically significant arrhythmia that is not treated or controlled, QTc on electrocardiogram (ECG) 0.46 sec, or heart rate or blood pressure 2 SD above the mean for age. All patients being considered for treatment with stimulant medications should have a careful history taken, including assessment for a family history of sudden death or ventricular arrhythmias, and a physical exam to assess for the presence of cardiac disease. If cardiac disease is suspected, further cardiac evaluation including an ECG and echocardiogram is warranted. For pediatric patients, the AHA states that it is reasonable to obtain a baseline ECG as a part of the initial evaluation. If a child or adolescent has any significant findings on physical examination, ECG, or family history, consult a pediatric cardiologist before initiating the stimulant medication. Once the medication is started, a repeat ECG may be helpful if the original ECG was obtained before the child was 12 years old, if cardiac symptoms develop, or there is a change in family history. NOTE: Dosage should be individualized; use lowest effective dose after stabilization. Lack of response to one stimulant does not predict a response to other stimulants. ADHD is a chronic condition that will require ongoing management and monitoring. Sixty to eighty percent of children will continue to need treatment in adulthood. The effect of behavioral therapy is controversial; however, combined drug and behavioral therapy has been shown to be more effective than behavioral therapy alone. In many cases, drug treatment alone showed a consistent dose-sensitive effect in improving core ADHD symptoms. Treatment strategies must be individualized for patients based on psychosocial and comorbid factors. Stimulants have been shown to be effective first-line agents in the treatment of ADHD. If divided doses are required, give first dose upon awakening and the subsequent doses (1 or 2) at 4 to 6 hour intervals. Titrate the daily dose by no more than 5 mgweek; dosage above 40 mgday PO is not usually necessary. Dosage should be individualized based upon response and tolerability; use the lowest effective dose after stabilization. Stimulants are agents of choice in the management of ADHD in adults. Children and Adolescents 6 years and older Initially, 5 mg PO once or twice daily. May titrate daily dose in 5 mg increments at weekly intervals to minimum effective dose.
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