Addiction experts in psychiatry, chemistry, pharmacology, forensic science, epidemiology, and the police and legal services engaged in delphic analysis regarding 20 popular recreational drugs.<unk>  was ranked 13th in dependence, 12th in physical harm, and 18th in social harm. Overall, adverse events associated with long-acting<unk> H formulations are similar with the most common adverse effects including appetite loss, dry mouth, anxiety/nervousness, nausea, and insomnia. Gastrointestinal adverse effects may include abdominal pain and weight loss. Nervous system adverse effects may include akathisia (agitation/restlessness), irritability, dyskinesia (tics), oromandibular dystonia, lethargy (drowsiness/fatigue), and dizziness. Cardiac adverse effects may include palpitations, changes in blood pressure and heart rate (typically mild), and tachycardia (rapid heart rate). Smokers with ADHD who take<unk>  may increase their nicotine dependence, and smoke more often than before they began using<unk> , with increased nicotine cravings and an average increase of 1.3 cigarettes per day. Ophthalmologic adverse effects may include blurred vision caused by pupil dilatation and dry eyes, with less frequent reports of diplopia and mydriasis. There is some evidence of mild reductions in height with prolonged treatment in children. This has been estimated at or less per year during the first three years with a total decrease of over 10 years. Hypersensitivity (including skin rash, urticaria, and fever) is sometimes reported when using transdermal<unk> . The Daytrana patch has a much higher rate of skin reactions than oral<unk> .<unk>  can worsen psychosis in people who are psychotic, and in very rare cases it has been associated with the emergence of new psychotic symptoms. It should be used with extreme caution in people with bipolar disorder due to the potential induction of mania or hypomania. There have been very rare reports of suicidal ideation, but some authors claim that evidence does not support a link. Logorrhea is occasionally reported. Libido disorders, disorientation, and visual hallucinations are very rarely reported. Priapism is a very rare adverse event that can be potentially serious. US Food and Drug Administration-commissioned studies in 2011, indicate that in children, young adults, and adults there is no association between serious adverse cardiovascular events (sudden death, heart attack, and stroke) and the medical use of<unk>  or other ADHD stimulants.• • • Because some adverse effects may only emerge during chronic use of<unk> , a constant watch for adverse effects is recommended. A 2018 Cochrane review found that<unk>  might be associated with serious side effects such as heart problems, psychosis, and death. The certainty of the evidence was stated as very low. A 2018 review found tentative evidence that it may cause both serious and non-serious adverse effects in children. Overdose The symptoms of a moderate acute overdose on<unk>  primarily arise from central nervous system overstimulation; these symptoms include: vomiting, nausea, agitation, tremors, hyperreflexia, muscle twitching, euphoria, confusion, hallucinations, delirium, hyperthermia, sweating, flushing, headache, tachycardia, heart palpitations, cardiac arrhythmias, hypertension, mydriasis, and dryness of mucous membranes. A severe overdose may involve symptoms such as hyperpyrexia, sympathomimetic toxidrome, convulsions, paranoia, stereotypy (a repetitive movement disorder), rhabdomyolysis, coma, and circulatory collapse. A<unk>  overdose is rarely fatal with appropriate care. Following injection of<unk>  tablets into an artery, severe toxic reactions involving abscess formation and necrosis have been reported. Treatment of a<unk>  overdose typically involves the administration of benzodiazepines, with antipsychotics, α-adrenoceptor agonists and propofol serving as second-line therapies. Packaging of a formulation of<unk>  advises against crushing the tablets. It is placed under Schedule X of the Indian drug scheduling system. Schedule X medications typically hold abusable medications such as barbiturates or stimulants such as amphetamines. Addiction and dependence<unk>  is a stimulant with an addiction liability and dependence liability similar to amphetamine. It has moderate liability among addictive drugs; accordingly, addiction and psychological dependence are possible and likely when<unk>  is used at high doses as a recreational drug. When used above the medical dose range, stimulants are associated with the development of stimulant psychosis. As with all addictive drugs, the overexpression of ΔFosB in D1-type medium spiny neurons in the nucleus accumbens is implicated in<unk>  addiction. Biomolecular mechanisms<unk>  has the potential to induce euphoria due to its pharmacodynamic effect (i.e., dopamine reuptake inhibition) in the brain's reward system. At therapeutic doses, ADHD stimulants do not sufficiently activate the reward system, or the reward pathway in particular, to the extent necessary to cause persistent increases in ΔFosB gene expression in the D1-type medium spiny neurons of the nucleus accumbens; consequently, when taken as directed in doses that are commonly prescribed for the treatment of ADHD,<unk>  use lacks the capacity to cause an addiction. However, when<unk>  is used at sufficiently high recreational doses through a bioavailable route of administration (e.g., insufflation or intravenous administration), particularly for use of the drug as a euphoriant, ΔFosB accumulates in the nucleus accumbens. Hence, like any other addictive drug, regular recreational use of<unk>  at high doses eventually gives rise to ΔFosB overexpression in D1-type neurons which subsequently triggers a series of gene transcription-mediated signaling cascades that induce an addiction.
Methylphenidate
Dexmethylphenidate
Ethylphenidate
Atomoxetine
Guanfacine
Psychotherapy
Imipramine
Fluoxetine