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Stimulant 'rapid metabolizers': wrong label, real phenomena.

Margaret D Weiss1, Craig B H Surman2,3, Dean Elbe4,5,6

  • 1Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Arkansas for Medical Sciences (UAMS), Child Study Center, Arkansas Children's Hospital, 1210 Wolfe St., Little Rock, AR, 72202, USA. mdweiss@uams.edu.

Attention Deficit and Hyperactivity Disorders
|November 6, 2017
PubMed
Summary

The term "rapid metabolizers" for stimulant medication is inaccurate. This review clarifies atypical stimulant response patterns, including high-dose and short-duration responses, and acute or chronic tolerance, advocating for precise terminology.

Keywords:
Attention-deficit/hyperactivity disorderDose–responseStimulantsTreatment resistance

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Area of Science:

  • Pharmacology
  • Neuroscience
  • Clinical Pharmacy

Background:

  • Anecdotal reports describe 'rapid metabolizers' of stimulant medications.
  • Current understanding of psychostimulant pharmacokinetics and pharmacodynamics is limited.
  • Atypical response patterns to stimulant treatment require further investigation.

Purpose of the Study:

  • To review empirical literature on atypical stimulant response patterns.
  • To propose more precise terminology for describing these responses.
  • To facilitate better patient education and clinical management.

Main Methods:

  • Literature review of empirical studies on stimulant medication response.
  • Analysis of pharmacokinetic and pharmacodynamic patterns.
  • Categorization of atypical responses.

Main Results:

  • The term 'rapid metabolizers' is a misnomer.
  • Identified atypical pharmacokinetic patterns: high-dose responders and short-duration responders.
  • Identified atypical pharmacodynamic patterns: acute and chronic tolerance.

Conclusions:

  • Adopting precise terminology is crucial for understanding atypical stimulant response.
  • Further research is needed to elucidate the physiology and clinical management of these patterns.
  • Accurate identification and description of atypical responses will advance the field.