Methamphetamine Hydrochloride and Scopolamine

• Generic Name: methamphetamine
• Dosage Forms: n.a.
• Other Brand Names: Desoxyn, Desoxyn Gradumet

Used as an adjunct to psychological, educational, social, and other remedial measures in the treatment of attention deficit hyperactivity disorder (ADHD) (hyperkinetic disorder, hyperkinetic syndrome of childhood, minimal brain dysfunction).

Almost all studies comparing behavioral therapy versus stimulants alone have shown a much stronger therapeutic effect from stimulants than from behavioral therapy, and stimulants (e.g., amphetamines, methylphenidate) remain the drugs of choice for the management of ADHD.

Drug therapy is not indicated in all patients with ADHD, and such therapy should be considered only after a complete evaluation, including medical history, has been performed.

Use should depend on age and the clinician’s assessment of the severity and duration of symptoms and should not depend solely on one or more behavioral characteristics.

Not recommended for ADHD symptoms associated with acute stress reactions.

Has been used as an adjunct to caloric restriction in the short-term (i.e., a few weeks) treatment of exogenous obesity. However, because of limited efficacy (short-lived), such use no longer is recommended.

The anorexigenic effect appears to be temporary, seldom lasting more than a few weeks, and tolerance may occur.

Obesity usually is a chronic disease, and short-term or intermittent therapy with anorexigenic drugs is unlikely to maintain long-term benefit.

Misuse and abuse have experienced a resurgence, in large part, due to the relative ease with which methamphetamine can be synthesized clandestinely from readily available chemicals such as ephedrine, phenylpropanolamine (no longer commercially available in the US), or pseudoephedrine. Recent restrictions (including enactment of the Comprehensive Methamphetamine Control Act of 1996, the Methamphetamine Anti-Proliferation Act [MAPA] of 2000, and the Combat Methamphetamine Epidemic Act [CMEA] of 2005) on the availability of these compounds are hoped to reverse this resurgence in misuse and abuse.

• Generic Name: scopolamine
• Dosage Forms: n.a.
• Other Brand Names: Transderm-Scop

Prevention of motion-induced nausea and vomiting; considered most effective drug for this use.

Oral or IM administration usually reserved for patients exposed to short periods of intense motion or those highly susceptible to motion because these routes have short duration of effect and high incidence of adverse effects.

Transdermal administration is effective and has fewer adverse effects and increased duration compared with oral administration.

Used transdermally for prevention of nausea and vomiting associated with recovery from anesthesia and surgery, but efficacy is equivocal.

Has been used preoperatively to inhibit salivation and excessive respiratory tract secretions, but use of general anesthetics (e.g., thiopental [no longer commercially available in the US], halothane) that do not stimulate secretions has reduced the need for this use.

Used preoperatively and in obstetrics in conjunction with analgesics or sedatives to produce tranquilization and amnesia; however, benzodiazepines may be preferred.

Has greater sedative, antisecretory (e.g., on respiratory secretions), and antiemetic effects than atropine; however, less effective than atropine in preventing intraoperative cholinergic effects (e.g., cardiac arrhythmias, hypotension, bradycardia).

Has been used for symptomatic treatment of parkinsonian syndrome; however, antimuscarinincs generally have been replaced with dopaminergic drugs.