Methamphetamine Hydrochloride and Toremifene Citrate

• 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: toremifene
• Dosage Forms: n.a.
• Other Brand Names: Fareston

Palliative treatment of metastatic breast cancer in postmenopausal women with estrogen-receptor positive or estrogen-receptor unknown tumors (designated an orphan drug by FDA for this use). Not recommended for treatment of estrogen-receptor negative breast tumors. Similar efficacy and toxicity as tamoxifen. Not known whether toremifene offers a therapeutic advantage over tamoxifen for the treatment of advanced breast cancer in eligible patients.

Under investigation for use as adjuvant therapy for early-stage breast cancer in node-positive postmenopausal women. Results from trials to date suggest similar efficacy and toxicity as tamoxifen.

Efficacy in treatment of advanced breast cancer in men not demonstrated.

Because of demonstrated cross-resistance with tamoxifen, usefulness of toremifene as second-line endocrine therapy for treatment of metastatic breast cancer refractory to tamoxifen appears to be limited.

Under investigation as a preventive agent for prostate cancer in men with high-grade prostatic intraepithelial neoplasia and no evidence of prostate cancer.