29.30 Stimulant Drugs and Atomoxetine
1037
for at least 10 seconds, to ensure that the proper dose is admin-
istered. The clinical effects of the drug are evident from 45 min-
utes to 12 hours after dosing.
The starting dosage of modafinil is 200 mg in the morning
in medically healthy individuals and 100 mg in the morning
in persons with hepatic impairment. Some persons take a sec-
ond 100 mg or 200 mg dose in the afternoon. The maximum
recommended daily dosage is 400 mg, although dosages of
600 to 1,200 mg a day have been used safely. Adverse effects
become prominent at dosages greater than 400 mg a day.
Compared with amphetamine-like drugs, modafinil promotes
wakefulness but produces less attentiveness and less irritabil-
ity. Some persons with excessive daytime sleepiness extend
the activity of the morning modafinil dose with an afternoon
dose of methylphenidate. Armodafinil is virtually identical
to modafinil, but is dosed differently, the dosing range being
50–250 mg daily.
Atomoxetine (Strattera)
Atomoxetine is the first nonstimulant drug to be approved by the
Food and Drug Administration (FDA) as a treatment of ADHD
in children, adolescents, and adults. It is included in this chapter
because it shares this indication with the stimulants described
earlier.
Pharmacological Actions
Atomoxetine is believed to produce a therapeutic effect
through selective inhibition of the presynaptic norepinephrine
transporter. It is well absorbed after oral administration and
Table 29.30-2
Sympathomimetics Commonly Used in Psychiatry
Generic Name
Trade Name
Preparations
Initial
Daily Dose
Usual Daily
Dose for
ADHD
a
Usual Daily Dose for Disorders
Associated with Excessive
Daytime Somnolence
Maximum Daily
Dose
Amphetamine–
dextroamphetamine
Adderall
5, 10, 20, and 30
mg tablets
5–10 mg 20–30 mg
5–60 mg
Children: 40 mg
Adults: 60 mg
Armodafinil
Nuvigil
50, 150, and 250
mg tablets
50–150 mg 150–250 mg 250 mg
Atomoxetine
Strattera
10, 18, 25, 40, and
60 mg tablets
20 mg
40–80 mg
Not used
Children: 80 mg
Adults: 100 mg
Dexmethylphenidate Focalin
2.5, 5, and 10 mg
capsules
5 mg
5–20 mg
Not used
20 mg
Dextroamphetamine Dexedrine,
Dextrostat
5, 10, and 15 mg
ER capsules;
5 and 10 mg
tablets
5–10 mg 20–30 mg
5–60 mg
Children: 40 mg
Adults: 60 mg
Lisdexamfetamine
Vyvanse
20, 30, 40, 50,
60, and 70 mg
capsules
20–30 mg
70 mg
Methamphetamine
Desoxyn
5 mg tablets; 5, 10,
and 15 mg ER
tablets
5–10 mg 20–25 mg
Not generally used
45 mg
Methylphenidate
Ritalin, Methidate,
Methylin,
Attenade
5, 10, and 20 mg
tablets; 10 and
20 mg SR tablets
5–10 mg 5–60 mg
20–30 mg
Children: 80 mg
Adults: 90 mg
Concerta
18 and 36 mg ER
tablets
18 mg
18–54 mg
Not yet established
54 mg
Methylphenidate
hydrochloride
Quillivant XR
20 mg
60 mg
Modafinil
Provigil
100 and 200 mg
tablets
100 mg
Not used
400 mg
400 mg
*Obstructive sleep apnea, narcolepsy, and shift work disorder.
a
For children 6 years of age and older.
ER, extended release; SR, sustained release.
Table 29.30-3
Lisdexamfetamine (Vyvanse) Dosage
Equivalency Conversions
Vyvanse and Adderall XR
Vyvanse
Adderall XR
20 mg
5 mg
30 mg
10 mg
40 mg
15 mg
50 mg
20 mg
60 mg
25 mg
70 mg
30 mg
Vyvanse, Adderall IR, and Dexedrine
Vyvanse
Adderall IR
Dexedrine
70 mg
30 mg
22.5 mg
50 mg
20 mg
15 mg
30 mg
10 mg
7.5 mg
XR, extended release; IR, immediate-release.
