Pemoline

A to Z Drug Facts

 Action Acts as a CNS stimulant but with minimal sympathomimetic effects; exact mechanism of action unknown.

 Indications Treatment of attention-deficit hyperactivity disorder. Unlabeled use(s): Treatment of narcolepsy and excessive daytime sedation.

 Contraindications Hepatic insufficiency.

 Route/Dosage

ADULTS AND CHILDREN 6 YR AND OLDER: PO 37.5 mg/day as a single dose in the morning initially; increase by increments of 18.75 mg weekly until desired response is obtained (max daily dose 112.5 mg/day).

 Interactions None well documented.

 Lab Test Interferences None well documented.

 Adverse Reactions

CNS: Insomnia; Tourette syndrome; hallucinations; dyskinetic movements of tongue, lips, face, and extremities; abnormal oculomotor function (eg, nystagmus, oculogyric crisis); depression; dizziness; irritability; headache; drowsiness; seizures. DERM: Rash. GI: Anorexia; transient weight loss; stomach ache; nausea. HEPA: Elevated liver enzymes; hepatitis; jaundice. OTHER: Growth suppression.

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children: Safety and efficacy in children younger than 6 yr not established. Drug abuse and dependence: Can occur; use with caution in emotionally unstable patients who may increase the dosage on their own initiative. Hepatic failure: Life-threatening hepatic failure has been associated with pemoline use; therefore, pemoline is not usually considered first-line therapy. Renal impairment: Use with caution in patients with significantly impaired renal function.

 Administration/Storage

• Do not administer if LFTs are abnormal.
• Administer as a single dose each morning and ensure that chewable tablets are completely chewed and swallowed.
• Administer with caution to emotionally unstable patients. Administration may intensify symptoms of behavior disturbance and thought disorder.
• Administer with caution to patients with impaired renal function.
• Store at controlled room temperature (56° to 86°F) in a tight, dry container.

 Assessment/Interventions

• Obtain patient history.
• Clinically assess for tics and Tourette syndrome in children and their families before use of this drug.
• Monitor growth of children during treatment, as long-term administration is associated with growth inhibition.
• Ensure LFTs are performed prior to and periodically during therapy.
• Assess therapeutic effects of medication. Medication is often interrupted at intervals to determine therapeutic effects and to ascertain if there are sufficient behavioral symptoms present to require continued therapy.
• Ensure that dosage is decreased gradually following long-term therapy to prevent withdrawal symptoms.

 Patient/Family Education

• Advise patient that clinical improvement is gradual and benefits may not occur until wk 3 or 4 of administration.
• Instruct patient to take pemoline as prescribed and not to make up missed doses.
• Caution patient to avoid taking large doses of caffeine or using other stimulants that could adversely potentiate the effects of pemoline.
• Instruct patient to take medication in the morning to avoid sleep disturbance. Notify health care provider if problems with sleeping occur.
• Instruct patient to notify health care provider of adverse reactions; the dosage may need to be reduced or the drug discontinued.
• Advise patient that medication can cause dizziness or drowsiness and to avoid driving and other tasks requiring mental alertness.
• Instruct patient not to increase the dose amount or take the medication more frequently because of a high dependence and abuse potential. In addition, psychotic symptoms could occur following long-term misuse of excessive oral doses.
• Instruct caregiver, patient, or family to be aware of the symptoms of overdose and take immediate and appropriate action, such as notifying a poison control center.
• Instruct patient to take daily dose in the morning.
• Advise patient to follow health care provider instructions for LFTs.
• Advise patient to be alert for signs and symptoms of liver dysfunction (eg, jaundice, anorexia, malaise, GI complaints) and to report them immediately to the health care provider.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts