Levine J, Swanson H
University of Minnesota Medical School, Minneapolis, MN, USA.
VA Medical Center, Minneapolis, MN, USA.
Case Rep Psychiatry. 2023 Aug 14;2023:5574677. doi: 10.1155/2023/5574677. eCollection 2023.
The treatment of attention deficit hyperactivity disorder (ADHD) with stimulants among patients with stimulant use disorder carries concern for efficacy and exacerbation of addictive behaviors. Lisdexamfetamine is a unique stimulant used to treat ADHD with a lower abuse potential compared to other stimulants, as the medication is the only prodrug in its class. To our knowledge, there are no reports in the literature of the use of lisdexamfetamine to treat ADHD in patients with stimulant use disorder.
We present a 33-year-old male with a history of stimulant (methamphetamine) use disorder, who was found to have long-standing ADHD. The patient was treated with lisdexamfetamine 30 mg, which was increased and sustained at 40 mg.
The patient reported significant improvement in focus, concentration, calmness, organization of thoughts, and less of a tendency to procrastinate. Additionally, he denied exacerbation of anxiety or sleep disturbances. He reported his cravings for stimulants were significantly decreased. After 2 months of treatment, he had moved out from his sober living facility, started a new job, and gained a promotion. He had no use of illicit substances, which was proven by routine urine drug screens.
Our patient's ADHD was successfully treated with lisdexamfetamine. Not only did the patient's ADHD symptoms improve, but his cravings for stimulants were relieved. ADHD is common among patients with stimulant use disorder. Patients with ADHD and stimulant use disorder should not necessarily forgo pharmacologic treatment with stimulants for concerns of abuse. Due to its unique pharmacokinetic profile, lisdexamfetamine is a feasible treatment for patients with ADHD and a history of stimulant use disorder.
在患有兴奋剂使用障碍的患者中，使用兴奋剂治疗注意力缺陷多动障碍（ADHD）引发了对疗效以及成瘾行为加重的担忧。赖右苯丙胺是一种用于治疗ADHD的独特兴奋剂，与其他兴奋剂相比具有较低的滥用潜力，因为该药物是其同类中唯一的前体药物。据我们所知，文献中尚无关于使用赖右苯丙胺治疗患有兴奋剂使用障碍的ADHD患者的报道。
我们报告一名33岁男性，有兴奋剂（甲基苯丙胺）使用障碍病史，被发现患有长期ADHD。该患者接受30毫克赖右苯丙胺治疗，剂量增加并维持在40毫克。
患者报告在注意力、专注力、平静度、思维组织方面有显著改善，拖延倾向减轻。此外，他否认焦虑或睡眠障碍加重。他报告对兴奋剂的渴望显著降低。经过2个月的治疗，他搬出了戒酒康复机构，开始了新工作并获得晋升。常规尿液药物筛查证明他未使用非法物质。
我们的患者使用赖右苯丙胺成功治疗了ADHD。不仅患者的ADHD症状得到改善，而且他对兴奋剂的渴望也得到缓解。ADHD在患有兴奋剂使用障碍的患者中很常见。患有ADHD和兴奋剂使用障碍的患者不一定因担心滥用而放弃使用兴奋剂进行药物治疗。由于其独特的药代动力学特征，赖右苯丙胺是治疗患有ADHD和兴奋剂使用障碍病史患者的一种可行治疗方法。
