Central Nervous System Stimulants

Definition

Central nervous system (CNS) stimulants are medicines that speed up physical and mental processes.

Purpose

Central nervous system stimulants are used to treat conditions characterized by lack of adrenergic stimulation, including narcolepsy and neonatal apnea. Additionally, methylphenidate (Ritalin) and dextroamphetamine sulfate (Dexedrine) are used for their paradoxical effect in attention-deficit hyperactivity disorder (ADHD).

The anerexiants, benzphetamine (Didrex), diethylpropion (Tenuate), phendimetrazine (Bontril, Plegine), phentermine (Fastin, Ionamine), and sibutramine (Meridia) are CNS stimulants used for appetite reduction in severe obesity. Although these drugs are structurally similar to amphetamine, they cause less sensation of stimulation, and are less suited for use in conditions characterized by lack of adrenergic stimulation.

Phenylpropanolamine and ephedrine have been used both as diet aids and as vasoconstrictors.

Description

The majority of CNS stimulants are chemically similar to the neurohormone norepinephrine, and simulate the traditional "fight or flight" syndrome associated with sympathetic nervous system arousal. Caffeine is more closely related to the xanthines, such as theophylline. A small number of additional members of the CNS stimulant class do not fall into specific chemical groups.

Precautions

Amphetamines have a high potential for abuse. They should be used in weight reduction programs only when alternative therapies have been ineffective. Administration for prolonged periods may lead to drug dependence. These drugs are classified as schedule II under federal drug control regulations.

The amphetamines and their cogeners are contraindicated in advanced arteriosclerosis, symptomatic cardiovascular disease, and moderate to severe hypertension and hyperthyroidism. They should not be used to treat patients with hypersensitivity or idiosyncrasy to the sympathomimetic amines, or with glaucoma, a history of agitated states, a history of drug abuse, or during the 14 days following administration of monoamine oxidase (MAO) inhibitors.

Methylphenidate may lower the seizure threshold.

Benzphetamine is category X during pregnancy. Diethylpropion is category B. Other anorexiants have not been rated; however their use during pregnancy does not appear to be advisable. Safety for use of anorexiants has not been evaluated.

Amphetamines are all category C during pregnancy. Breastfeeding while receiving amphetamines is not recommended because the infant may experience withdrawal symptoms.

There have been reports that when used in children, methylphenidate and amphetamines may retard growth. Although these reports have been questioned, it may be suggested that the drugs not be administered outside of school hours (because most children have behavior problems in school), in order to permit full stature to be attained.

The most common adverse effects of CNS stimulants are associated with their primary action. Typical responses include overstimulation, dizziness, restlessness, and similar reactions. Rarely, hematologic reactions, including leukopenia, agranulocytosis, and bone marrow depression have been reported. Lowering of the seizure threshold has been noted with most drugs in this class.

Withdrawal syndrome

Abrupt discontinuation following prolonged high dosage results in extreme fatigue, mental depression and changes on the sleep EEG. This response is most evident with amphetamines, but may be observed with all CNS stimulants taken over a prolonged period of time.

PERIODICALS

"Are our children overmedicated?" Parade, (October 12, 1997): 4.

"Attention deficit hyperactivity disorder: not just for kids." Mayo Clinic Health Letter, 13 (September 1995): 6.

"Attention deficit hyperactivity disorder: there is no easy answer on whether to medicate or not." British Medical Journal, 315 (October 11, 1997): 894.

"The run on Ritalin: attention deficit disorder and stimulant treatment in the 1990s." The Hastings Center Report, 26 (March-April 1996): 12.

ORGANIZATION

Children and Adults with Attention Deficit Disorders (CH.A.D.D.). 499 N.W. 70th Avenue, Suite 109, Plantation, FL 33317. (305) 587-3700.

OTHER

Attention deficit hyperactivity disorder Pamphlet. National Institute of Mental Health, 1994.

Facts about childhood hyperactivity Pamphlet. National Institute of Child Health and Human Development, 1990.

Nancy Ross-Flanigan

KEY TERMS

Agranulocytosis—An acute febrile condition marked by severe depression of the granulocyteproducing bone marrow, and by prostration, chills, swollen neck, and sore throat sometimes with local ulceration.

Anorexiant—A drug that suppresses appetite.

Anxiety—Worry or tension in response to real or imagined stress, danger, or dreaded situations. Physical reactions, such as fast pulse, sweating, trembling, fatigue, and weakness, may accompany anxiety.

Attention-deficit hyperactivity disorder (ADHD)—A condition in which a person (usually a child) has an unusually high activity level and a short attention span. People with the disorder may act impulsively and may have learning and behavioral problems.

Central nervous system—The brain and spinal cord.

Depression—A mental condition in which people feel extremely sad and lose interest in life. People with depression may also have sleep problems and loss of appetite, and may have trouble concentrating and carrying out everyday activities.

Leucopenia—A condition in which the number of leukocytes circulating in the blood is abnormally low and which is most commonly due to a decreased production of new cells in conjunction with various infectious diseases or as a reaction to various drugs or other chemicals.

Pregnancy category—A system of classifying drugs according to their established risks for use during pregnancy. Category A: Controlled human studies have demonstrated no fetal risk. Category B: Animal studies indicate no fetal risk, but no human studies, or adverse effects in animals, but not in well-controlled human studies. Category C: No adequate human or animal studies, or adverse fetal effects in animal studies, but no available human data. Category D: Evidence of fetal risk, but benefits outweigh risks. Category X: Evidence of fetal risk. Risks out-weigh any benefits.

Withdrawal symptoms—A group of physical or mental symptoms that may occur when a person suddenly stops using a drug on which he or she has become dependent.