Desoxyn

Desoxyn® CII is a brand of methamphetamine hydrochloride (also known as desoxyephedrine, hence the name "Desoxyn"), indicated for treatment of Attention Deficit Disorder/Attention Deficit/Hyperactivity Disorder (ADD/ADHD), narcolepsy, and exogenous obesity. Desoxyn is a Schedule II medication under the U.S. DEA Schedule system.

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History

After being first developed in the United States in 1942, Desoxyn was manufactured and marketed by Abbott Laboratories as an immediate-release tablet. Later, a sustained-release formulation in the form of a plastic-matrix tablet, "Desoxyn Gradumet," was also distributed. Abruptly, however, Abbott discontinued production of the Gradumet form of Desoxyn in Fall 1999, citing "manufacturing difficulties" as the reason for discontinuation. The 5mg pill is the only form currently available

In 2002, Abbott sold their rights to Desoxyn to Ovation Pharma, which took over production and marketing of the drug (although initially, Abbott maintained production at their facilities). Able Labs produced a generic formulation of dextromethamphetamine hydrochloride at a lower price than brand-name Desoxyn, until the company went out of business.

Use and tolerance

Because methamphetamine hydrochloride, the active ingredient in Desoxyn, is reported to be effective longer and fifty percent more effective per dose than amphetamine, for example, prescriptions for this drug may increase as ADD/ADHD treatment increases and as long-term users of other treatments gain tolerance to the other stimulant drugs used to treat ADD/ADHD.

A typical initial prescription is 5mg (the only available tablet dosage), titrating upward weekly to determine the most effective dosage, if necessary.

Indications and contraindications

Generally, the recommended uses of Desoxyn are similar to the other amphetamine-class stimulants (such as Adderall, Dexedrine or methylphenidate, for example). Because of the enhanced potency of dextromethamphetamine hydrochloride over the aforementioned stimulant drugs, Desoxyn is often used as a "second-line" medication when the "first-line" (i.e., most commonly prescribed) medications have been found deficient, or with unacceptable side effects.

Further, because the secondary effects of dextromethamphetamine hydrochloride are least among the amphetamine-class stimulants or methylphenidate but the highest degree of primary effectiveness (i.e., most effective at enhancing concentration and decreasing distractibility, with the least occurrence of side effects), Desoxyn can be useful for patients who find other medications ineffective or for whom the side effects of such other medications are too severe.

The greater primary effectiveness of Desoxyn is believed to be caused by the extra methyl group of dextromethamphetamine hydrochloride which is lacking in basic amphetamine, which may increase the solubility of dextromethamphetamine hydrochloride in lipids (and therefore be more deeply and thoroughly absorbed into the fatty tissue of the brain).

Similarly to other stimulants, use of Desoxyn is not recommended for patients with known cardiovascular issues, or within fourteen days of having ingested an MAOI medication. It is also not recommended for patients with a history of psychotic episodes, because stimulants may exacerbate any preexisting tendencies toward psychotic behavior.

Pharmacology

DESOXYN (methamphetamine hydrochloride tablets, USP), chemically known as (S)-N,αlpha-dimethylbenzeneethanamine hydrochloride, is a member of the amphetamine group of sympathomimetic amines.

Chirality

The active salt of Desoxyn is dextro-methamphetamine hydrochloride. This is the right-hand isomer of methamphetamine bonded to hydrochloride. The left-handed isomer of methamphetamine, levomethamphetamine, is less centrally acting and more peripherally acting; therefore no racemic mixture of dextro/levo-methamphetamine salts is in production.

Effects to the central nervous system

Dextro-methamphetamine hydrochloride is a potent central nervous system stimulant that reverses the direction of flow in the norepinephrine, dopamine and serotonin transporters, sending these neurotransmitters from the vesicle into the synapse instead of storing them in the vesicle for future use. The compound also inhibits the reuptake of the transmitters into the pre-synaptic (sending) neuron, causing them to remain in the synaptic cleft longer. The resulting increased levels of dopamine and norepinephrine in these synapses affect neurochemical mechanisms responsible for regulating heart rate, body temperature, blood pressure, appetite, attention, mood and responses associated with alertness or alarm conditions.

Concerns impeding prescription

Adverse effects

Negative side effects at prescribed dosages are similar to those of other amphetamines, and include:

• Significant elevation of plasma corticosteroids
• Risk of premature birth and low birth weight
• Tachycardia, palpitations, arrhythmia, hyper/hypotension, and circulatory collapse
• Psychotic episodes, dizziness, dysphoria, insomnia, headache, and tremors
• Diarrhea, constipation, dryness of mouth, unpleasant taste, and other gastrointestinal disturbances
• Urticaria- a skin rash caused by an allergic reaction
• Impotence / unusual changes in libido
• Suppression of growth with long term use in children

As with other amphetamines, the majority of these side-effects are uncommon in therapeutic use, with the exception of growth retardation in children. Desoxyn also has a higher benefit relative to the incidence of side-effects than other amphetamines.