Amphetamine question

[cbrons]

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Ever seen or heard of patients complaining of peripheral neuropathy, either as side effect of ADD med (amphetamine specifically) or worsened by taking them?

 

[whopper]

Ever seen or heard of patients complaining of peripheral neuropathy, either as side effect of ADD med (amphetamine specifically) or worsened by taking them?

There is some data showing stimulants could cause neuropathy but as far as I know this is weak data. Some theories include micro-strokes, vasospasm possibly being increased by the stimulants. It's rare as far as I know.

From personal experience, some patients are oddballs and don't follow the norm. I get a case maybe on the order of every several months to maybe once a year where something real odd happens. These are not the norm and their treatment or diagnosis should only be considered after the evidenced based medicine approach is tried and failed. E.g. I've seen one person's bipolar disorder improve dramatically with Topamax (and other mood stabilizers such as lithium but she hated the latter's side effects. She didn't mind Topamax. I am in no way advocating Topamax be given first, second, or even 3rd-line. It should only be tried after all of at least of the evidenced-based approaches have been tried and failed).

Do not use the above statement to justify treating everybody with unconventional approaches. Oddball cases should be rare, one the order of the extreme minority. If someone's medicating everyone outside the norm, that's a sign the doc doesn't know how to practice evidenced-based medicine.

Point is, don't be too quick to dismiss an oddball case. You might be dismissing something important that doesn't fit the norm. If you study statistics, it's normal to find the abnormal once in awhile. There's a reason why they make you memorize zebras in medschool.

 

[cbrons]

not sure this would be prinzmetal angina, since theres no associated chest pain, just complaints of radiating nerve pain. It happens at night when pt is at rest. Patient does studying at night and is only 25. Wasnt sure if this would be expected with small "booster" doses of dextrostat especially if theres no complaints during the day with Vyvanse.

 

[Armadillos]

not sure this would be prinzmetal angina, since theres no associated chest pain, just complaints of radiating nerve pain. It happens at night when pt is at rest. Patient does studying at night and is only 25. Wasnt sure if this would be expected with small "booster" doses of dextrostat especially if theres no complaints during the day with Vyvanse.

Probably a stretch, but could it possibly just be pain related to ergonomics of however they are studying? Maybe they were the type who was used to getting up every 5 minutes while studying and now they are sitting in some crappy chair for hours every night?

 

[dozitgetchahi]

Where is the pain specifically? Muscular cramps are a known side effect of stimulants...does the guy have nerve entrapment somewhere?

 

[cbrons]

Probably a stretch, but could it possibly just be pain related to ergonomics of however they are studying? Maybe they were the type who was used to getting up every 5 minutes while studying and now they are sitting in some crappy chair for hours every night?

Maybe not as much of a stretch as you think, they did say they spend several hours a day laying on an "uncomfortable" couch at weird angles reading non-stop. Patient is a law student.

 

[Tarasaurusrex]

Stimulants - such as amphetamines can cause magnesium deficiency due to excessive urination, decreased absorption of nutrients (due to anorectic side effects and/or increased metabolism and a diuretic effect), or overexertion of muscles, which can cause calcium leakage in the attempt to decrease the contractile exertions of the muscles that are being overexerted. Decreased magnesium levels leads to hypocalcemia, which can cause "twitching" in ones' nerves and muscles and even tingling/numbness in extremities and muscle spasms. If there is a shortage of calcium to support muscle cells in their contractile movements this could eventually effect the heart and your body will produce more hormones like nor-epinephrine, and other stimulating hormones to keep your blood circulating and temporarily compensate. However, this would cause a noticeable effect on your skeletal muscles, whose calcium that has been siphoned from them is now producing an enzyme that will degrade muscle fibers in order to maintain the energy output required to keep the heart beating. This is very plausible, and may be due to abuse of medication or may be an individual's increased sensitivity. Either way, stimulants may not be the best resolution for someone that experiences this kind of hypersensitivity.