pemoline; phenylisohydantoin (Cylert, PIO)
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Introduction
Tradename: Cylert. DEA-controlled substance: class 4.
Risk of hepatic toxicity exceeds risk[3]
Will be removed from market as supply is exhausted.
Indications
- treatment of attention deficit hyperactivity disorder (ADDH)
- narcolepsy
Medi-Cal: for patients between ages 4-16 years with ADDH
Contraindications
- liver disease
- children < 6 years of age
- Tourette's syndrome
Caution: patient with renal insufficiency
Dosage
- start 37.5 mg PO QD
- increase by 18.75 mg/day at weekly intervals
- usual effective dose: 56.25-75 mg/day
- max 112.5 mg/day
Tabs: 18.75, 37.5, 75 mg.
Pharmacokinetics
- significant benefit may not be noted until 3rd to 4th week of therapy
elimination via liver
elimination via kidney
Monitor
Adverse effects
- common (> 10%)
- less common (1-10%)
- uncommon (< 1%)
- jaundice, seizures, precipitation of Tourette's syndrome, hallucination, headache, growth redardation, diarrhea, abnormal liver function tests (generally reversible), hepatitis, movement disorders
- drug adverse effects of ADHD medications
- drug adverse effects of analeptics
- drug adverse effects of psychotropic agents
- drug adverse effects of sympathomimetic(s)
Drug interactions
- decreased effect of insulin*
- increased effect & toxicity with CNS depressants#
- CNS stimulants#
- sympathomimetics
* insulin requirements may be increased
# avoid caffeine & alcoholic beverages
More general terms
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998 (deleted 12/99)
- ↑ 3.0 3.1 Medwatch http://www.fda.gov/medwatch/safety/2005/safety05.htm#Cylert
Prescriber's Letter 12(12): 2005 Liver function test scheduling Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=211210&pb=PRL (subscription needed) http://www.prescribersletter.com