Lisdexamfetamine dimesylate for childhood ADHD

Abstract

Stimulants are extremely effective and safe and have been the mainstay for the pharmacological treatment of attention deficit hyperactivity disorder (ADHD) for many years. However, there have been some concerns regarding their abuse, especially by teenagers and young adults. Lisdexamfetamine was recently approved for the treatment of ADHD in 6-12-year-olds and provides a novel approach to the treatment of ADHD. Lisdexamfetamine is a prodrug comprised of dextroamphetamine covalently attached to an essential amino acid, L-lysine. Following oral administration, the amide linkage between the two molecules is enzymatically hydrolyzed in the gastrointestinal tract, thus releasing active dextroamphetamine, which mediates the therapeutic effect in a fashion similar to other stimulants. The parent drug does not bind to sites responsible for the reuptake of norepinephrine and dopamine in vitro. Lisdexamfetamine does not produce high dextroamphetamine levels when injected or snorted, and thus may have lower abuse potential compared to conventional stimulants. Lisdexamfetamine appears to have efficacy and tolerability comparable to other extended-release stimulant formulations used to treat ADHD, but reduced potential for abuse-related liking effects. Compared to equivalent amounts of immediate-release dextroamphetamine.