Amphetamines are useful for supporting cancer patients with fatigue.
Amphatamines are occasionally used by oncologists to manage opioid side effects or to treat cancer fatigue. Methylphenidate (Ritalin®; Novartis Pharmaceuticals Corporation, East Hanover, NJ) is a central nervous system (CNS) stimulant that is structurally related to amphetamines. A recent publication found seven clinical trials (22%) of methylphenidate for the treatment of Cancer Related Fatigue. Although methylphenidate was shown to improve fatigue in these open-label studies in patients with cancer, its effect was not significantly different from that of placebo in a double-blind study. However, a recent randomized placebo-controlled trial in nonanemic patients with cancer who had completed chemotherapy showed that dexmethylphenidate (Focalin®; Novartis, an almost identical drug,) was associated with significantly greater improvements in fatigue than placebo. Given that relatively few randomized, placebo-controlled clinical trials have been conducted specifically to evaluate the use of psychostimulants in patients with Cancer Related Fatigue, adverse effects of psychostimulants, such as irritability, anorexia, insomnia, labile mood, nausea, and tachycardia, should be considered when making treatment decisions. On the basis of Phase II and randomized studies supporting Ritalin, I consider it medically necessary.
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