Adult ADHD

Generic Name: pemoline (PEM-oh-leen)

Brand Name: Cylert® (SIGH-lert)

Manufacturer: Abbott Laboratories

What Is Cylert®?
Like many drugs used to treat adult ADHD, Cylert, and its generic pemoline, are central nervous system (CNS) stimulants. Cylert has generally been one of the least favorite ADHD drugs due to its potential to cause serious side effects.

Cylert® (pemoline) has been around for a while, and is one of the treaditional drugs used to treat ADHD. But even since 1999, this drug has carried black box warnings in its prescribing information regarding its potential to cause liver damage. In March of 2005, US manufacture of Cylert® and its generic was discontinued. However, the name brand and generic supplies that were already on the market, were not withdrawn. The FDA did urge physicians to prescribe other treatments for ADHD, rather than continue to use the Cylert® (pemoline) that was still available on the market.

How Do I Take Cylert®?
Cylert® (pemoline) is supplied as tablets of 18.75 mg, 37.5 mg or 75 mg for oral administration, typically as a single dose each morning. The drug is also available as chewable tablets containing 37.5 mg pemoline.

The recommended starting dose is 37.5 mg daily. Then, under physician assessment, the dose is gradually titrated up, increased by 18.75 mg increments at one week intervals until the dose is deemed sufficient. The daily dose for most patients ranges from 56.25 to 75 mg and is not recommended above 112.5 mg.

How Does Pemoline Work?

Cylert® (pemoline) works in a similar way as other known central nervous system stimulants. Its exact mechanism and site of action is not known.

How Long Does It Take to Work?

After you begin taking Cylert® (pemoline), you may begin to feel its effects within just a few days, although it may take up to four weeks for you to feel the full benefits of the drug.

Is Cylert® Effective for Adult ADHD?

Due to its dangerous adverse effects, pemoline is rarely used as a first choice. Even when it was commonly prescribed for ADHD, it was considered, at best, a second-line drug.

Regarding the relative effectiveness of Cylert® (pemoline) in treating ADHD, although the manufacturer’s clinical trials showed the drug to be as effective as methylphenidate or dextroamphetamine, many physicians are of the opinion that pemoline is less effective than other drugs for controlling the symptoms of ADHD [6].

Cylert® Side Effects
The most common side effects of Cylert® (pemoline) include irritability and insomnia. Less frequently, patients may experience dry mouth, headache, nausea and loss of appetite. The rarer and more serious side effects include hallucinations, liver irritation, increased heart rate, tics and exacerbation of Tourette’s Syndrome.

Cylert® Precautions
Pemoline has a black box warning on its prescribing information about the possibility of its use being associated with serious and sometimes deadly liver damage. As a stimulant medication, Cylert® (pemoline) also has the potential for abuse. This drug should not be taken with anti-epileptic drugs or other drugs that affect the central nervous system.

Cylert® (pemoline) is a Pregnancy Category B medication. Studies performed in rats and rabbits have not revealed evidence of impaired fertility or harm to the fetus. However, there have been no adequate studies in pregnant women. It is also not known whether this drug is excreted in human milk. Therefore, this drug only be used during pregnancy and breast feeding if clearly needed.

Sources
1. Adult ADHA website: http://www.adult-adhd.com/Drugs/cylert.html
2. Rx List: http://www.rxlist.com/cgi/generic/pemoline.htm
3. WebMD: http://www.webmd.com/add-adhd/news/20051025/fda-updates-alert-on-adhd-drug-cylert
4. FDA: http://www.fda.gov/cder/foi/label/2003/016832s022_017703s018lbl.pdf
5. Mayo Clinic: http://www.mayoclinic.com/health/drug-information/DR601863
6. Dr Robert Hsiung: http://www.dr-bob.org/tips/split/Pemoline-for-ADD.html