Desoxyn
871614
222788668
2008-07-01T03:11:47Z
68.45.219.63
/* Use and tolerance */
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'''Desoxyn CII''' is a brand of [[methamphetamine]] hydrochloride (also known as desoxyephedrine, hence the name "Desoxyn"), indicated for treatment of [[Attention Deficit/Hyperactivity Disorder]] (ADHD), [[narcolepsy]], and exogenous [[obesity]]. Desoxyn is a [[Controlled_Substances_Act#Schedule_II_drugs|Schedule II]] medication under the U.S. [[Drug Enforcement Administration|DEA]] Schedule system.
==History==
In November of [[1943]], [[Abbott Laboratories]] submitted a [[New Drug Application]] (NDA) to the Drug Division at the U.S. [[FDA]] for Desoxyn. Abbott requested approval for narcolepsy, mild depression, [[postencephalitic Parkinson syndrome]], [[chronic alcoholism]], [[cerebral arteriosclerosis]], and [[hay fever]]. The NDA included review articles from academic journals, case histories from physicians, and a 3-page testimonial from a patient with narcolepsy. All these requests were accepted, and the drug was approved in December, [[1944]]. All of these indication approvals were eventually removed. The only two approved marketing indications remaining are for [[AD/HD]] and the short-term management of [[exogenous obesity]], although the drug is clinically established as effective in the treatment of [[narcolepsy]].
A sustained-release formulation in the form of a plastic-matrix tablet, "Desoxyn Gradumet," was introduced. Abbott discontinued production of the Gradumet form of Desoxyn in Fall 1999, citing "manufacturing difficulties" as the reason for its discontinuation. The 5mg immediate release tablet is the only formulation presently available.
In a joint sale for US$40 million, Abbott sold their rights to Desoxyn and [[Tranxene]] to [[Ovation Pharma]]. [[Able Labs]] produced the first [[generic drug|generic]] formulation of dextromethamphetamine hydrochloride in 2004, until the company went out of business the following year.
==Use and tolerance==
Like all other stimulants used in the treatment of [[AD/HD]], D-desoxyephederine ([[dextromethamphetamine]]) is a drug of abuse. There is no evidence to suggest it is clinically distinguishable from other amphetamines in either [[abuse potential]], [[drug preference]], [[sensitization]], or [[tolerance]].
==Indications and contraindications==
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Generally, the recommended uses of Desoxyn are similar to the other amphetamine-class stimulants (such as [[Adderall]] and [[Dexedrine]], for example). Despite confused claims to the contrary on the Internet, neither the FDA nor Ovation Pharmaceuticals claim the drug is a "second-line" treatment choice. This is only true for the drug's other indication, which is exogenous obesity. Amphetamines have a well-established record for clinical efficacy and are generally well-tolerated in patients with AD/HD.
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 [[lipid]]s (and therefore be more deeply and thoroughly absorbed into the fatty tissue of the [[brain]]).
Another AD/HD stimulant that features a molecule with a methyl group is Ritalin (d,l-methylphenidate).
Similar 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.
==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 [[dextrorotation|dextro]]-methamphetamine hydrochloride. This is the right-hand [[isomer]] of methamphetamine bonded to hydrochloride. The [[levorotation|left-handed isomer]] of methamphetamine, [[levomethamphetamine]], is less [[central nervous system|centrally]] acting and more [[Peripheral nervous system|peripherally]] acting; therefore no [[racemic]] mixture of [[dextrorotation|dextro]]/[[levorotation|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 transporter|norepinephrine]], [[dopamine transporter|dopamine]] and [[serotonin transporter]]s, sending these [[neurotransmitter]]s from the [[Vesicle (biology)|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.
==Clinical acceptance==
As the oldest AD/HD approved [[stimulant]] on the market today, Desoxyn's [[safety]] and [[efficacy]] is well-established. This has allowed the treatment to emerge as a highly profitable return for Ovation's US$40 million acquisition, which included the joint sale of it along with [[Tranxene]]. As is common with Ovation's business model, the drug was acquired and marketed to specialists, who are more typically familiar with drugs within their treatment populations. Desoxyn is often prescribed by doctors in adult and pediatric psychiatry and those who treat sleep disorders. Desoxyn has received a marked increase in sales since Ovation's acquisition in 2002, leading it vulnerable to generic competition. A generic formulation was introduced in 2004 by the now defunct [[Able Labs]].
==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.
==External links==
*[http://www.ovationpharma.com/products.php?prodid=1 Product description of Desoxyn at Ovation]
*[http://lb.chemie.uni-hamburg.de/static/data/56_xg6ywq7w.html Molecular Formula #10 Desoxyn]
*[http://www.fda.gov/medwatch/SAFETY/2006/Apr_PIs/Desoxyn_PI.pdf FDA MedWatch]
*[http://health.groups.yahoo.com/group/Desoxyn DESOXYN SUPPORT GROUP-----Talk with people who are prescribed to Desoxyn..]
{{Methamphetamine}}
[[Category:Methamphetamine]]
[[he:דסוקסין]]