Dextroamphetamine

TUESDAY, Sept. 17, 2024 -- Past-month prescription amphetamine use is associated with increased odds of psychosis and mania , with increased odds for high doses (>30 mg dextroamphetamine equivalents), according to a study published online Sept. 12 in The American Journal of Psychiatry . Lauren V. Moran, M.D., M.P.H., from McLean Hospital in Belmont, Massachusetts, and colleagues conducted a case-control study using electronic health records to compare the odds of incident psychosis or mania with past-month exposure to prescription amphetamines. Cases were patients aged 16 to 35 years hospitalized for incident psychosis or mania between 2005 and 2019 (1,374 individuals), and controls were patients with an initial psychiatric hospitalization for other reasons, most commonly depression and/or anxiety (2,748 individuals). The researchers found that compared with no use, past-month prescription amphetamine use was associated with increased odds of psychosis and mania among cases and controls (adjusted odds ratio, 2.68; 95 percent confidence interval, 1.90 to 3.77). There was a dose-response relationship, with high doses of amphetamines (>30 mg dextroamphetamine equivalents) associated with 5.28-fold increased odds of psychosis or mania. Compared with no use, past-month methylphenidate use was not associated with increased odds of psychosis or mania (adjusted odds ratio, 0.91; 95 percent confidence interval, 0.54 to 1.55). "The clinical utility of prescribing doses of amphetamines that exceed 30 mg dextroamphetamine equivalents is unproven; coupled with the elevated risk of inducing psychosis or mania, we recommend minimizing this practice," the authors write. Several authors disclosed ties to the pharmaceutical industry.

THURSDAY, Sept. 12, 2024 -- Prescriptions for amphetamine stimulants to treat ADHD have increased significantly in recent years, particularly during the pandemic. Unfortunately, high doses of stimulants like Adderall can increase the risk of psychosis or mania by more than fivefold, a new study finds. Patients had a nearly 63% increased risk of psychosis or mania if they took any prescription amphetamine within the past month, researchers reported Sept. 12 in the American Journal of Psychiatry . Those on heavy doses of amphetamines were at even greater peril of a psychotic episode, with an 81% increased risk, results show. The highest risk occurred in patients taking 30 milligrams or more of dextroamphetamine, which corresponds to 40 milligrams of Adderall, the study says. “Stimulant medications don’t have an upper dose limit on their labels, and our results show that it is clear that dose is a factor in psychosis risk and should be a chief consideration when prescribing stimulants,” said lead investigator Dr. Lauren Moran , a pharmacoepidemiology researcher at McLean Hospital in Belmont, Mass. “This is a rare but serious side effect that should be monitored by both patients and their doctors whenever these medications are prescribed,” Moran added. Moran said she pursued this study based on her experiences as an inpatient psychiatrist. She and her Mclean colleagues would regularly see patients experiencing their first episode of psychosis. Medical records would reveal the patients had been prescribed high doses of stimulants by their doctors. For the study, researchers analyzed data on nearly 1,400 patients admitted to Mass General Brigham Hospital between 2005 and 2019 who were in the throes of their first episode of psychosis or mania. They compared those patients against more than 2,700 people hospitalized for other psychiatric conditions like depression or anxiety. They found that people taking amphetamines had a higher risk of psychosis and mania, and that the risk was greatest with heavy doses. This link could be explained by the fact that amphetamines prompt the release of dopamine, a brain hormone also implicated in psychosis, researchers said. People taking amphetamines for ADHD shouldn’t be alarmed, Moran said, but they might want to talk with their doctor about the dosage they’ve been prescribed. There also are alternative drugs to treat ADHD that don’t increase mental health risk. For example, this study found no increased risk of psychosis or mania in prescriptions for methylphenidate (Ritalin), Moran noted. “There’s limited evidence that prescription amphetamines are more effective in high doses,” Moran said in a Mass General Brigham news release. “Physicians should consider other medications our study found to be less risky, especially if a patient is at high risk for psychosis or mania.” Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.