Clinical Overview
D-methamphetamine is a central nervous system stimulant indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) and narcolepsy. It is reserved for cases where other stimulant medications have been ineffective due to its high potential for abuse and dependence. Despite its controlled status, it remains a legitimate therapeutic option for treatment-resistant cases.
Primary Clinical Applications
D-methamphetamine is indicated for ADHD in patients 6 years and older when other treatments have failed, and for narcolepsy in adults. It is typically considered a last-line treatment due to its abuse potential, but can be highly effective for patients who do not respond to other stimulants.
Mechanism and Clinical Considerations
D-methamphetamine increases dopamine and norepinephrine levels by blocking reuptake and promoting release. Its longer duration of action compared to other stimulants may provide all-day symptom control with once-daily dosing. However, the medication requires careful monitoring and patient selection due to significant abuse liability.
Safety and Monitoring
Treatment requires comprehensive assessment for substance abuse risk, cardiovascular evaluation, and ongoing monitoring for signs of abuse or diversion. The medication is available only through restricted distribution and requires special prescribing considerations due to its Schedule II controlled substance status.
Prescribing Information
Dosing & Administration
ADHD – Children (≥6 years) and Adults:
- Initial: 5 mg once or twice daily
- Titration: Increase by 5 mg weekly intervals
- Range: 20-25 mg daily (typical effective dose)
- Maximum: 60 mg daily in divided doses
Narcolepsy – Adults:
- Initial: 5 mg daily
- Range: 5-60 mg daily in divided doses
- Typical dose: 20-25 mg daily
Administration:
- Give 30-60 minutes before meals
- Avoid late evening doses to prevent insomnia
- May divide total daily dose into 2-3 administrations
Indications
- ADHD in patients ≥6 years (when other treatments inadequate)
- Narcolepsy in adults
- Reserved for treatment-resistant cases
Contraindications
- Advanced arteriosclerosis, symptomatic cardiovascular disease
- Moderate to severe hypertension
- Hyperthyroidism, glaucoma
- Agitated states, history of drug abuse
- MAOI use within 14 days
- Known hypersensitivity to sympathomimetic amines
Warnings & Precautions
- Boxed Warning: High potential for abuse and dependence
- Cardiovascular effects: Monitor blood pressure and heart rate
- Psychiatric effects: May exacerbate psychosis, mania, or aggression
- Growth suppression: Monitor height and weight in pediatric patients
- Abuse potential: Assess for substance abuse risk before prescribing
- Sudden death: Rare reports in patients with structural cardiac abnormalities
Drug Interactions
- MAOIs: Contraindicated – hypertensive crisis risk
- Acidifying agents: Decrease methamphetamine absorption
- Alkalinizing agents: Increase methamphetamine absorption
- Tricyclic antidepressants: Enhanced cardiovascular effects
Adverse Reactions
Common (>10%):
- Decreased appetite, insomnia, weight loss, irritability
Cardiovascular:
- Increased blood pressure and heart rate, palpitations
Serious:
- Psychosis, seizures, sudden death (rare)
Special Populations
- Pediatric: Monitor growth parameters, avoid in children <6 years
- Pregnancy: Category C – high risk, avoid if possible
- Substance abuse history: Generally contraindicated
- Schedule II: Requires special prescribing and monitoring protocols
Medical Disclaimer: This information is for educational purposes only and is not intended as medical advice. Always consult with qualified healthcare professionals before making any treatment decisions. Individual patient circumstances may vary significantly.
