Lisdexamfetamine for Treatment of Attention-Deficit/Hyperactivity Disorder

2009 ◽  
Vol 43 (4) ◽  
pp. 669-676 ◽  
Author(s):  
Brian J Cowles

Objective: To review the pharmacology, pharmacokinetics, efficacy, and safety of the prodrug lisdexamfetamine for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children and adults and describe its potential place in therapy. Data Sources: Primary literature published between January 1, 1990, and August 1, 2008, was selected from PubMed using the search key words lisdexamfetamine, Vyvanse, and NRP104. References of selected publications were also reviewed. Posters and abstracts of research presented at national meetings were reviewed when available. The product labeling for Vyvanse was also used. Study Selection and Data Extraction: Preference was given to published, randomized, and controlled research describing the pharmacokinetics, efficacy, and safety of lisdexamfetamine. Noncontrolled studies, postmarketing reports, and poster presentations were considered secondly. All published studies were included. Data Synthesis: Lisdexamfetamine is a prodrug of dextroamphetamine covatently bound to Hysine, which is activated during first-pass metabolism. The unique pharmacokinetic profile owing to lisdexamfetamine's prodrug design and rate-limited enzymatic biotransformation allows for once-daily dosing with a duration of activity of approximately 12 hours. Lisdexamfetamine has been proven to reduce the symptoms of ADHD both in children aged 6–12 years and adults aged 18–55 years, decreasing ADHD rating scale scores by approximately 27 and 19 points, respectively. Adverse effects with an incidence greater than 10% during preclinical trials included appetite suppression, insomnia, and headache. Lisdexamfetamine's unique pharmacokinetic properties may provide additional safety with regard to reducing abuse potential. As with other central nervous system (CNS) stimulants, concerns regarding sudden cardiac death and adverse effects on growth also apply to lisdexamfetamine. Conclusions: Lisdexamfetamine provides another amphetamine-based CNS stimulant option for treatment of children and adults with ADHD. However, its use may be limited by a lack of significant differentiation when compared with cunently used stimulants and a lack of evidence to support its use in adolescents.

2021 ◽  
pp. E299-E307
Author(s):  
Satoshi Kasahara

Background: Associations between attention-deficit/hyperactivity disorder (ADHD) and chronic pain disorders, such as fibromyalgia, have been reported. However, associations between persistent chronic nonspecific low back pain (CNLBP) and ADHD have not yet been investigated. Objectives: This study aimed to investigate the positive rates of possible ADHD, as assessed by selfreported ADHD scales, in patients with persistent CNLBP, using data from self-reported questionnaires completed by patients and their families. This study also aimed to compare the self-reported scores obtained from existing standardized data for healthy individuals, and to examine whether the ADHD scale scores of patients with persistent CNLBP are associated with pain variables. Study Design: Cross-sectional study. Setting: The specialized pain clinic at our university hospital. Methods: This cross-sectional study included 60 consecutive patients with persistent CNLBP who were diagnosed with a possible somatic symptom disorder and were referred to a psychiatrist in our pain clinic. The Conners’ Adult ADHD Rating Scales (CAARS) self-report (CAARS-S) and observer-rated (CAARS-O) questionnaires were utilized. We investigated the CAARS scores, and the association between the CAARS subscale scores and pain variables (pain duration and pain Numeric Rating Scale) in patients with persistent CNLBP. Results: Of the 60 patients, 19 (31.7%) were positive on both CAARS-S and CAARS-O questionnaires (T-score > 65). The ADHD indices, which comprised subscales of the CAARS estimating the necessity of treatment for ADHD, were significantly higher in both male and female patients with persistent CNLBP than in the Japanese standardized sample (P < 0.005). CAARS-S hyperactivity/restlessness, CAARS-O hyperactivity/restlessness, and the Diagnostic and Statistical Manual of Mental Disorders, fourth edition hyperactive-impulsive symptom subscale scores also correlated with the pain intensity (P < 0.05). Limitations: In this study, ADHD tendency was evaluated using only a self-reported questionnaire. Hence in the future, accurate and precise assessments of ADHD symptoms using structured clinical interviews conducted by ADHD experts are warranted. Additionally, the study only included patients with persistent CNLBP. Therefore in the future, it will be valuable to investigate ADHD scale scores (e.g., CAARS) among patients with CNLBP and nonspecific low back pain with larger sample sizes. Conclusions: Our findings revealed that the subscale scores on an ADHD scale were considerably high in patients with persistent CNLBP. As a previous study of our clinical experience indicates that persistent CNLBP can be substantially relieved by administering ADHD medications, ADHD screening is warranted in the treatment of persistent CNLBP. Key words: Attention-deficit/hyperactivity disorder, neurodevelopmental disorders, chronic nonspecific low back pain, chronic pain, Conners’ Adult ADHD Rating Scales (CAARS), Numeric Rating Scale, pain duration, pain clinic, somatic symptom disorder


CNS Spectrums ◽  
2008 ◽  
Vol 13 (7) ◽  
pp. 614-620 ◽  
Author(s):  
Robert L. Findling ◽  
Ann C. Childress ◽  
Suma Krishnan ◽  
James J. McGough

ABSTRACTIntroduction:Lisdexamfetamine dimesylate (LDX), a prodrug stimulant, is indicated for attention-deficit/hyperactivity disorder (ADHD) in children 6–12 years of age and in adults. In shortterm studies, once-daily LDX provided efficacy throughout the day. This study presented here was conducted to assess the long-term safety, tolerability, and effectiveness of LDX in 6- to 12-year-olds with ADHD.Methods:This open-label, multicenter, singlearm study enrolled children with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision criteria for ADHD. Following 1-week screening and washout periods, subjects were titrated to LDX 30, 50, or 70 mg/day over 4 weeks and placed on maintenance treatment for 11 months. The ADHD Rating Scale and Clinical Global Impression-Improvement scale measured effectiveness.Results:Of 272 subjects receiving LDX, 147 completed the study. Most adverse events were mild to moderate and occurred during the first 4 weeks. There were no clinically meaningful changes in blood pressure or electrocardiographic parameters. From baseline to endpoint, mean ADHD Rating Scale scores improved by 27.2 points (P<.0001). Improvements occurred during each of the first 4 weeks, and were maintained throughout. Based on Clinical Global Impression-Improvement scale scores, >80% of subjects at endpoint and >95% of completers at 12 months were rated “improved.”Conclusion:Long-term 30, 50, and 70 mg/day LDX was generally well tolerated and effective in children with ADHD.


2019 ◽  
pp. 85-91
Author(s):  
Dinh Duong Le ◽  
Van Thang Vo ◽  
Thi Mai Nguyen ◽  
Thi Han Vo ◽  
Huu Chau Duc Nguyen ◽  
...  

Objectives: The study aims to explore the prevalence of attention deficit hyperactivity disorder and to examine the associated factors with ADHD among primary students by Vanderbilt ADHD rating scale for teacher and parents. Methods: A cross-sectional study design was conducted in 564 students who selected randomly in 4 primary schools in Hue city. Vanderbilt ADHD rating scale for parents and teachers were applied to evaluate the ADHD of children over 6 months ago. Results: The overall prevalence of children who had high risk with ADHD was 4.1% (95%CI: 2.44 - 5.72), including 4.6% and 4.8% in the rating of teachers and parents, respectively. Male was more likely to have ADHD than female (OR adj: 4.64 (95%CI: 1.53 - 14.05) and lack of closely friend (OR adj: 5.11 (95% CI: 2.13 - 12.24). Conclusion: Vanderbilt ADHD diagnosis rating scale for teachers and parents can be used to early recognization children with a high risk of ADHD. Key words: ADHD, Vanderbilt, ratings scale, teacher, parent, children


Scientifica ◽  
2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Mostafa Sadeghi ◽  
Homayoun Sadeghi-Bazargani ◽  
Shahrokh Amiri

Background. The Barkley Adult Attention Deficit/Hyperactivity Disorder (ADHD) Rating Scale-IV (BAARS-IV) was developed, and it demonstrated good psychometric properties. The BAARS-IV includes 27 questions on the symptoms of adult ADHD. The purpose of the present study is to investigate the psychometric testing of the Persian version of BAARS-IV among the elderlies in Tabriz City. Method. This cross-sectional study was conducted in Tabriz City—in the west of Iran—in 2015 via enrolling of 121 old-aged people. We did the process of translation and adaptation of BAARS-IV and examined its concurrent validity, internal consistency, and test-retest reliability. Result. The BAARS-IV demonstrated good internal consistency and test-retest reliability. Correlations between the BAARS-IV and the CAARS-S: SV were high and evidence supporting concurrent validity was revealed. Cronbach’s alpha for the overall scale and subscales stood at 0.89, 0.81, 0.66, 0.56, and 0.82, respectively. Conclusion. The Persian BAARS-IV showed acceptable reliability and validity. BAARS-IV was determined to be composed of internally consistent and psychometrically sound items.


2020 ◽  
Vol 22 (2) ◽  
pp. 98-113
Author(s):  
Yaakov Ophir ◽  
Yaffa Shir-Raz

This article raises awareness to manipulations and “spins” that occur in Attention Deficit/Hyperactivity Disorder (ADHD) research. An in-depth inspection was conducted on a high-profile study that suggested that ADHD is a risk factor for infection with COVID-19 and that stimulants reduce that risk (Merzon et al., 2020b). Two additional studies by the same first author were inspected as well, one that was published in the same journal and one that relied on the same dataset. Seven manipulations and spins were identified, including inappropriate operational definitions, misrepresentations, and omissions that produced bogus results and might have concealed potential adverse effects of medications. These distortions illustrate how biased science can contribute to the ethically problematic phenomena of overdiagnosis and overmedication.


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