Amfetamine mixed salts/lisdexamfetamine
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Chorea: 2 case reports Two boys, a child and an infant, developed chorea after ingesting lisdexamfetamine and amfetamine mixed salts [dose not stated], respectively. A 10-year-old boy, who had attention deficit hyperactivity disorder, presented to an emergency department with acute-onset abnormal body movements. His usual dose of lisdexamfetamine was 70mg and he had been taking the drug for several months. He had received his morning dose of lisdexamfetamine and had then gone to school. He developed rapid, uncontrollable movements of his legs, arms, and trunk, approximately 2 hours later. He was treated with lorazepam, diphenhydramine, and fentanyl but there was no improvement. He was transferred to an ICU. Further investigation revealed he had mistakenly received an extra dose of lisdexamfetamine the night before his symptoms. His stepfather reported that he had been more ‘fidgety’ than normal and had difficulty falling asleep. He received haloperidol and showed significant improvement. Approximately 48 hours after onset, his signs returned to baseline. It was concluded that his signs were caused by lisdexamfetamine. His dose of lisdexamfetamine was reduced to 30 mg/day and he was discharged on hospital day 6. An 8-month-old boy developed sudden onset abnormal movements [duration of treatment to reaction onset not stated]. Approximately 4 hours later he was taken to an emergency department. A neurological examination revealed rapid, continuous, uncontrollable movements of his arms and legs. He initially received midazolam, diphenhydramine, benzatropine, morphine, and lorazepam but there was no improvement. A urine drug screen then tested positive for amphetamines. Investigation revealed that his stepbrother was taking amfetamine mixed salts [Adderall XR] at an unknown dose. The infant was transferred to an ICU. His symptoms resolved approximately 72 hours later and he was discharged. Author comment: "We describe two children who developed chorea after ingesting amphetamine-derived medications". Ford JB, et al. Acute, sustained chorea in children after supratherapeutic dosing of amphetamine-derived medications. Pediatric Neurology 47: 216-218, No. 3, Sep 2012. Available from: URL: http://dx.doi.org/10.1016/j.pediatrneurol.2012.05.013 803078481 USA
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Reactions 13 Oct 2012 No. 1423
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