Contraindications for Dexamphetamine
Dexamphetamine is absolutely contraindicated in patients with known hypersensitivity to amphetamine products, during or within 14 days following administration of monoamine oxidase inhibitors, in patients with glaucoma, symptomatic cardiovascular disease, hyperthyroidism, hypertension, and in patients with active psychotic disorders. 1, 2
Absolute Contraindications
- Hypersensitivity to amphetamine products 1
- Concomitant use of MAO inhibitors or within 14 days of their use (can result in severe hypertension and risk of cerebrovascular accident) 1, 2
- Active psychosis or psychotic disorders (stimulants are known psychotomimetics for individuals with schizophrenia) 2
- Glaucoma (sympathomimetics including stimulants may increase intraocular pressure) 2
- Symptomatic cardiovascular disease 2
- Hyperthyroidism 2
- Moderate to severe hypertension 2
Relative Contraindications
History of substance abuse - Dexamphetamine is an FDA Schedule II controlled substance with high potential for abuse and dependence 2
Pregnancy and breastfeeding - Based on animal data, dexamphetamine may cause fetal harm; human data are insufficient to determine risk 2
Liver disorders - Pre-existing liver disease or abnormal liver function tests 2
Household members with history of stimulant abuse - Steps should be taken to ensure prescribed medication is not diverted 2
Special Considerations
Conditions Previously Considered Contraindications
Recent clinical evidence suggests that dexamphetamine may be used with caution in the following conditions that were previously considered contraindications:
- Motor tics or Tourette's syndrome - Controlled studies have not found that stimulants necessarily worsen motor tics 2
- Anxiety disorders - ADHD with certain anxiety disorders (separation anxiety, generalized anxiety, social phobia) may still be treated with stimulants 2
- Seizure disorders - Studies show that patients taking anticonvulsants do not show changes in seizure frequency when methylphenidate is added; however, it is best to initiate treatment after seizure disorder is controlled 2
Monitoring Requirements
When prescribing dexamphetamine in patients with relative contraindications:
- Regular monitoring of vital signs (blood pressure, heart rate)
- Assessment for emergence of psychotic symptoms
- Evaluation for signs of abuse or diversion
- Monitoring for appetite suppression and weight loss
- Regular liver function tests if indicated
Clinical Context
Dexamphetamine is primarily indicated for:
- ADHD in children, adolescents, and adults 2
- Narcolepsy 2
- Can be considered for cancer-related fatigue, though evidence is limited 2
When prescribing dexamphetamine, clinicians should carefully weigh the potential benefits against the risks, particularly in patients with any of the contraindications listed above. In many cases, alternative medications with lower abuse potential may be more appropriate.