Nurses Compass
Drug Guide
Pemoline
Classification
Therapeutic: Central nervous system stimulant, treatment of ADHD and narcolepsy
Pharmacological: Nonamphetamine stimulant
FDA Approved Indications
- Attention deficit hyperactivity disorder (ADHD)
Mechanism of Action
Pemoline stimulates the central nervous system by increasing the release of norepinephrine and dopamine, leading to improved attention and focus.
Dosage and Administration
Adult: Initial dose of 37.5 mg once daily, titrated upward as needed; maximum dose 75 mg per day.
Pediatric: Usually started at 18.75 mg or 37.5 mg once daily, with careful monitoring.
Geriatric: Not specifically studied; use with caution due to potential for adverse effects and comorbidities.
Renal Impairment: Adjust dosage based on clinical response and tolerability.
Hepatic Impairment: Use with caution; no specific adjustment guidelines established.
Pharmacokinetics
Absorption: Well absorbed orally.
Distribution: Widely distributed including crossing the blood-brain barrier.
Metabolism: Partially metabolized in the liver.
Excretion: Primarily excreted in urine.
Half Life: Approximately 5-8 hours.
Contraindications
- History of tics or Tourette's syndrome.
- History of drug abuse.
- Previous hypersensitivity to pemoline.
Precautions
- Monitor for signs of liver toxicity, neurotoxicity, and tics.
- Use with caution in patients with hepatic impairment, cardiomyopathy, or hypertension.
Adverse Reactions - Common
- Insomnia (Common)
- Headaches (Common)
- Nausea (Common)
Adverse Reactions - Serious
- Hepatotoxicity (liver failure) (Rare but serious)
- Neurotoxicity (tics, hallucinations) (Rare)
- Cardiovascular events (hypertension, tachycardia) (Less common)
Drug-Drug Interactions
- MAO inhibitors (risk of hypertensive crisis)
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor liver function tests, blood pressure, heart rate, and signs of neurotoxicity and tics.
Diagnoses:
- Risk for liver toxicity
- Ineffective coping related to neurobehavioral side effects
Implementation: Administer as prescribed, monitor for adverse effects, counsel patient on signs of liver problems.
Evaluation: Assess for therapeutic effectiveness and adverse effects; perform regular liver function tests.
Patient/Family Teaching
- Report any signs of liver problems: jaundice, dark urine, abdominal pain.
- Do not abruptly stop medication.
- Be aware of potential neurobehavioral changes and report them.
Special Considerations
Black Box Warnings:
- Potential for hepatotoxicity leading to liver failure
Genetic Factors: None specifically noted
Lab Test Interference: No known interference
Overdose Management
Signs/Symptoms: Nausea, vomiting, agitation, tremors, hallucinations, seizures, liver failure signs such as jaundice, elevated liver enzymes.
Treatment: Supportive care, activated charcoal if ingestion was recent, liver function monitoring, and hospitalization as needed.
Storage and Handling
Storage: Store at room temperature, away from moisture and light.
Stability: Stable under recommended storage conditions.