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

Medi-Cal: for patients between ages 4-16 years with ADDH

Contraindications

Caution: patient with renal insufficiency

pregnancy category = b

safety in lactation = ?

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

Drug interactions

* insulin requirements may be increased

# avoid caffeine & alcoholic beverages

More general terms

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Kaiser Permanente Northern California Regional Drug Formulary, 1998 (deleted 12/99)
  3. 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

Database