Antidepressant Medications Anti-depressant Drugs Antidepressant: pemoline, Cylert

Antidepressant: pemoline, Cylert

Generic Name: pemoline
Brand Name(s): Cylert
Common Use: Psychostimulant
Potentiates antidepressants

Pemoline is a CNS stimulant, which, although structurally different from the amphetamines and methylphenidate, possesses pharmacological activity similar to that of other known stimulants. It has minimal sympathomimetic effects. Although studies indicate that pemoline may act in animals through dopaminergic mechanisms, the exact mechanism and site of action of the drug in man is not known.

As an integral part of a total treatment program which typically includes other remedial measures (psychological, educational, social) for a stabilizing effect in children with a behavioral syndrome characterized by the following group of developmentally inappropriate symptoms: moderate to severe distractibility, short attention span, hyperactivity, emotional lability, and impulsivity. The diagnosis of this syndrome should not be made with finality when these symptoms are only of comparatively recent origin. Nonlocalizing (soft) neurological signs, learning disability, and abnormal EEG may or may not be present, and a diagnosis of CNS dysfunction may or may not be warranted.

Attention deficit disorder and hyperkinetic syndrome are among the terms being used to describe the above signs and symptoms. In the past, a variety of terms have been associated with these signs and symptoms including: minimal brain dysfunction, hyperkinetic reaction of childhood, hyperkinetic syndrome, hyperactive child syndrome, minimal brain damage, minimal cerebral dysfunction, and minor cerebral dysfunction.

Contraindications

In patients with known hypersensitivity or idiosyncrasy to the drug.
Pemoline is not recommended for children less than 6 years since its safety and efficacy in this age group have not been established.
Clinical experience suggests that in psychotic children, administration of pemoline may exacerbate symptoms of behavior disturbance and thought disorder.
Data are inadequate to determine whether chronic administration of pemoline may be associated with growth inhibition; therefore, growth should be monitored during treatment.

Adverse Side Effects

Insomnia is the most frequently reported side effect; it usually occurs early in therapy, prior to an optimum therapeutic response. In the majority of cases it is transient in nature or responds to a reduction in dosage.
Anorexia with weight loss may occur during the first weeks of therapy. In the majority of cases it is transient in nature; weight gain usually resumes within 3 to 6 months. Stomach ache, skin rashes, increased irritability, mild depression, nausea, dizziness, headache, drowsiness, and hallucinations have been reported.

Elevations of AST (SGOT), ALT (SGPT), and serum LDH have occurred in patients taking pemoline, usually after several months of therapy. These effects appear to be reversible upon withdrawal of the drug, and are thought to be manifestations of a delayed hypersensitivity reaction. There have also been a few reports of jaundice occurring in patients taking pemoline; a causal relationship between the drug and this clinical finding has not been established.
The following CNS effects have been reported with the use of pemoline:
Dyskinetic movements of the tongue, lips, face and extremities, nystagmus and nystagmoid eye movements, and convulsive seizures. CNS stimulants have been reported to precipitate attacks of Gilles de la Tourette syndrome. Mild adverse reactions appearing early during the course of treatment with pemoline often remit with continuing therapy. If adverse reactions are of a significant or protracted nature, dosage should be reduced or the drug discontinued.

Overdose

Signs and symptoms of acute pemoline overdosage may include agitation, restlessness, hallucinations, dyskinetic movements and tachycardia.

The treatment for an acute overdosage of pemoline is essentially the same as that for an overdosage of any CNS stimulant. Management is primarily symptomatic and may include induction of emesis or gastric lavage, sedation, and other appropriate supportive measures.

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