Risks of high-dose stimulants in the treatment of disorders of excessive somnolence: a case-control study.
OBJECTIVE
To ascertain complications associated with high-dose stimulant therapy in patients with narcolepsy or idiopathic hypersomnia.


METHODS
Case-control, retrospective chart review.


METHODS
Sleep center in an academic hospital.


METHODS
116 patients with narcolepsy or idiopathic hypersomnia were individually matched by sex, diagnosis, age of onset, and duration of follow-up from both onset and diagnosis. Members of the high-dose group (n = 58) had received at least 1 stimulant at a dosage > or = 120% of the maximum recommended by the American Academy of Sleep Medicine Standards of Practice Committee. The standard-dose control group (n = 58) had received stimulants at a dosage < or = 100% of the American Academy of Sleep Medicine guidelines.


METHODS
N/A.


RESULTS
The prevalence of psychosis (odds ratio = 12.0 [1.6-92.0]), alcohol or polysubstance misuse (odds ratio = 4.3 [1.2-15.2]), and psychiatric hospitalization (odds ratio = 3.2 [1.1-10.0]) was significantly increased in the high-dose group. More high-dose patients also experienced tachyarrhythmias (odds ratio = 3.3 [0.92-12.1] and anorexia or weight loss (odds ratio = 11.0 [1.4-85.2]). The frequency of physician-diagnosed depression, drug-seeking and suicide-related behaviors, hypertension, and cardiovascular disease did not differ significantly between the groups.


CONCLUSIONS
This study demonstrated a significantly higher occurrence of psychosis, substance misuse, and psychiatric hospitalizations in patients using high-dose stimulants compared to those using standard doses. Tachyarrhythmias and anorexia or weight loss were also more common in this group as compared with controls. Clinicians should be very cautious in prescribing dosages that exceed maximum guidelines.
Sleep Disorders Center, Mayo Clinic College of Medicine, Rochester, MN, USA.
R Robert
RR
Auger
Scott H
SH
Goodman
Michael H
MH
Silber
Lois E
LE
Krahn
V Shane
VS
Pankratz
Nancy L
NL
Slocumb
D000328:Adult; D000855:Anorexia / Q000139:chemically induced / Q000453:epidemiology; D016022:Case-Control Studies; D000697:Central Nervous System Stimulants / Q000009:adverse effects* / Q000627:therapeutic use; D006970:Disorders of Excessive Somnolence / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors; D012720:Severity of Illness Index
D000697:Central Nervous System Stimulants; D008774:Methylphenidate