Urinary dextroamphetamine in adult attention deficit/hyperactivity disorder.

Attention Deficit/Hyperactivity Disorder (ADHD) is a well-recognized behavioral disorder estimated to affect 2-9% of school-age children (1,2). Historically, ADHD was not thought to continue beyond adolescence; however, long term followup studies in the 1980s showed that disabling core symptoms persist into adulthood in 11-50% of cases. Hence, 1-3% of adults may currently have symptoms of ADHD, which is referred to as adult ADHD (AADHD). As with children, AADHD patients exhibit the classic behavioral triad of inattention and distractibility, impulsiveness, and hyperactivity. Symptoms of AADHD include marked inattention, easy distractibility, impulsiveness, poor concentration, daydreaming, forgetfulness, low frustration tolerance, temper tantrums, intrusiveness, and extreme impatience. As with children, stimulants are generally the most effective pharmacotherapy for AADHD, particularly methylphenidate and pemoline. Some patients who do not respond to methylphenidate may be successfully managed with dextroamphetamine. A typical starting dosage of dextroamphetamine is 2.5-5 mg once daily. The dosage may be increased gradually to a maximum of 40 mg/day with a typical regimen being 10-20 rag/day (2). Because the maximum therapeutic benefit of amphetamine is associated with its absorption phase, patients divide the dose over two or three administrations daily or ingest a sustained-release formulation. To date, however, no studies are available concerning the long-term efficacy or adverse effects of sustained-release dextroamphetamine dosage forms in AADHD patients. There is an increased incidence of a history of ADHD and AADHD in populations of alcoholics and other drug abusers. However, with proper management strategies, the "dual diagnosis" of AADHD and substance abuse may be successfully treated (3). Approximately 30% of patients do not respond to or are unable to tolerate stimulants. Other drugs that have proved effective in controlling various symptoms in these patients include the antidepressants imipramine, desipramine, bupropion, venlafaxine, pargyline, and deprenyl and the antihypertensives clonidine and propanolol (1-3). To determine concentrations of dextroamphetamine that Table I. Urine Amphetamine Concentrations in Random Specimens from a Subject Treated for Adult Attention Deficit/Hyperactivity Disorder