title: Rebound effects with long-acting amphetamine or methylphenidate stimulant medication preparations among adolescent male drivers with attention-deficit/hyperactivity disorder.
abstract: This study investigated whether OROS methylphenidate (OROS MPH, Concerta) or extended-release mixed amphetamine salts (se-AMPH ER, Adderall XR) were associated with worsening of driving performance, or drug rebound, relative to placebo 16-17 hours post-ingestion. Nineteen male adolescent drivers aged 17-19 with attention-deficit/hyperactivity disorder (ADHD) were compared on a virtual reality driving simulator and an on-road drive after taking 72 mg of OROS MPH, 30 mg of se-AMPH ER, or placebo. Medication was taken at 08:00 in a randomized, double-blind, placebo-controlled, crossover study. Participants drove a simulator at 17:00, 20:00, 23:00, and 01:00, and drove their own cars over a 16-mile road course at 24:00. The main outcome measures were composite scores of driving performance. Neither OROS MPH nor se-AMPH ER was associated with significant worsening of simulator performance relative to placebo 17 hours post-ingestion in group comparisons. However, inattentive on-road driving errors were significantly more common on se-AMPH ER relative to placebo at midnight (p = 0.04), suggesting possible rebound. During both late simulator and on-road testing, driving performance variance was approximately 300% greater during the se-AMPH ER compared to the OROS MPH condition.
authors.affiliation: Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA 22908, USA. djc4f@virginia.edu
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Cox
authors.forename: Melissa
authors.initials: M
authors.lastname: Moore
authors.forename: Roger
authors.initials: R
authors.lastname: Burket
authors.forename: R Lawrence
authors.initials: RL
authors.lastname: Merkel
authors.forename: Amori Yee
authors.initials: AY
authors.lastname: Mikami
authors.forename: Boris
authors.initials: B
authors.lastname: Kovatchev
mesh_terms: D000293:Adolescent; D000328:Adult; D000661:Amphetamine / Q000008:administration & dosage / Q000009:adverse effects*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D001334:Automobile Driving; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D018592:Cross-Over Studies; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000009:adverse effects*; D013997:Time Factors
chemical_list: D000697:Central Nervous System Stimulants; D003692:Delayed-Action Preparations; D008774:Methylphenidate; D000661:Amphetamine