Skip to content

Cancer Health Center

Font Size

Fatigue (PDQ®): Supportive care - Health Professional Information [NCI] - Intervention

continued...

The package inserts for all Schedule IV stimulant medications carry boxed warnings indicating risk of abuse potential and/or risk of psychological dependence. Additionally, boxed warnings for certain stimulant medications (methylphenidate and dexmethylphenidate products) indicate risk of psychotic episodes.[13] Other stimulant medications (amphetamine, dextroamphetamine, lisdexamfetamine dimesylate, methamphetamine, and mixed salts of amphetamine products) carry boxed warnings alerting clinicians that misuse of these medications may cause serious cardiovascular adverse events, including sudden death.[15]

Bupropion is a stimulating antidepressant with a primarily dopaminergic and noradrenergic mechanism of action. (Refer to Table 2 in the PDQ summary on Depression for more information.) Preliminary evidence from a small open-label study (n = 21) suggests that the sustained release (SR) form of bupropion has potential as an effective therapeutic agent for treating CRF with or without comorbid depressive symptoms.[16][Level of evidence: II] Seizure, a rare but serious side effect of this agent, did not occur in this study (the maximum dose of bupropion SR used in this study was 300 mg).

Table 2. Centrally Acting Stimulants for Adult Cancer Patients

DrugDosageComments/Primary Side Effects
AUC = area under the curve; MAOI = monoamine oxidase inhibitor; SSRI = selective serotonin reuptake inhibitor.
Dextroamphetamine (Dexedrine)2.5 mg/d (start)Schedule II. Major potential interactions with citalopram and venlafaxine.
5–30 mg/d in 2 to 3 divided doses
Methylphenidate (Ritalin)2.5 mg/d (start)Schedule II. High-fat meals may increase AUC. Peak concentration 102 hours after ingestion. Do not use with MAOIs as it can precipitate hypertensive crisis. Antidepressants that increase norepinephrine can cause increased amphetamine side effects. Concomitant use with SSRI can result in increased SSRI concentrations.
Titrate up to 54 mg/d (27 mg D-isomer)
Modafinil (Provigil)50–100 mg (start)Schedule IV. Avoid driving/operation of machinery until effects are known. Do not take at bedtime. Peak concentration in 2–4 hours. Food slows absorption by about 1 hour but does not affect bioavailability. Decreases efficacy of birth control pills.
100–200 mg every morning
Armodafinil (Nuvigil)50 mg (start)Schedule IV. Avoid driving/operation of machinery until effects are known. Do not take at bedtime. Peak concentration in 2 hours if fasting, slowed to as many as 4 hours if fed, but food does not affect bioavailability. Decreases efficacy of birth control pills.
25–250 mg every morning
1|2|3|4|5|6|7|8|9|10|11
Next Article:

Today on WebMD

Colorectal cancer cells
A common one in both men and women.
Lung cancer xray
See it in pictures, plus read the facts.
 
sauteed cherry tomatoes
Fight cancer one plate at a time.
Ovarian cancer illustration
Do you know the symptoms?
 
Jennifer Goodman Linn self-portrait
Blog
what is your cancer risk
HEALTH CHECK
 
colorectal cancer treatment advances
Video
breast cancer overview slideshow
SLIDESHOW
 
prostate cancer overview
SLIDESHOW
lung cancer overview slideshow
SLIDESHOW
 
ovarian cancer overview slideshow
SLIDESHOW
Actor Michael Douglas
Article