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dorsolateral prefrontal cortex) that can improve attention, concentration, executive function & wakefulness Enhancement of dopamine actions in the basal ganglia may improve hyperactivity Enhancement of dopamine & norepinephrine in the medial prefrontal cortex & hypothalamus may improve depression, fatigue & sleepiness Indications: Attention deficit hyperactivity disorder (ADHD) in children & adults (approved ages varies based upon the formulation) Narcolepsy (Metadate ER, Methylin ER, Ritalin, Ritalin SR) Off Label : treatment-resistant depression (not FDA approved use) Contraindications: marked anxiety, tension and agitation glaucoma use with caution during lactation history of hypertension or convulsive disease (use with great caution) Side Effects: nervousness insomnia headaches dizziness drowsiness chorea nausea anorexia, weight loss Pharmacokinetics: Oral tablets, sustained-release, extended-release & transdermal formulations are available The formulation determines the speed of onset & duration of action Warnings: may affect blood pressure & should be used with caution in patients with hypertension, hyperthyroidism, or history of drug abuse children that are not growing or gaining weight should stop treatment (at least temporarily) may inhibit the metabolism of SSRIs, avoid concomitant/overlapping use with MAOIs stimulants have a high potential for abuse Notes: DEA Schedule II drug with abuse potential References: Biaggioni I, Gurevich VV (2024): Adrenoceptor Agonists & Sympathomimetic Drugs (Chapter 9)

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doi: 10.1016/S0140-6736(17)31491-5 249 LawSTTaylorPC

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