Talk:Lisdexamfetamine

message: I changed wording of "indicated" to "can be prescribed"..."for treatment". Although use of the word indicated is generally understood by the medical profession to mean that it has been approved for use by the FDA, I'm concerned that use in this article implies to readers that "indicated" could mean the non-medical jargon use of the word which is defined as "suggest as a desirable or necessary course of action." with synonyms to the non-medical use of "indicated", being::	"advisable, recommended, suggested, desirable, preferable, best, sensible, wise, prudent, in someone's best interests"-----which is not always the case in drug use, although again, in medical jargon, "indicated" means something else.24.0.133.234 (talk) 14:13, 13 June 2014 (UTC)
replies: text: Thanks; I'll change this in all the high traffic amphetamine articles that use this language when I get a chance. Seppi333 (Insert 2¢ | Maintained) 17:23, 13 June 2014 (UTC)
thread_title:  "indicated" 

message: This entry looks very promotional and uncritical, which is a concern because many critics complain that Shire is been promoting its drugs heavily and inappropriately to the public. Here's a recent article in the New York Times:
http://www.nytimes.com/2015/02/25/business/shire-maker-of-binge-eating-drug-vyvanse-first-marketed-the-disease.html?
Shire, Maker of Binge-Eating Drug Vyvanse, First Marketed the Disease
By KATIE THOMAS
FEB. 24, 2015
(Vyvanse (Shire) is an amphetamine prodrug, $1.5 billion/year sales, recently new approval for binge eating. FDA granted priority approval, without advisory committee hearings or recommendations, because there was no other drug to treat binge eating. Shire hired retired tennis player Monica Seles to make the talk show circuit to promote awareness of binge eating. Shire similarly promoted Adderall and Vyvanse for ADHD. Lawrence H. Diller, behavioral pediatrician, Walnut Creek, CA, and critic of ADHD treatment, quoted. Shire web site on binge eating disorder offers printable symptom checklist and opening lines to start conversation with doctor, tells patients “don’t give up” if a doctor initially resists. Critics say "appeared to coach patients about how to receive a diagnosis for a relatively uncommon condition, or shop for a new doctor if they were not successful.")
This entry also seems to be quoting selectively from the Cochrane reviews. Here's one that I got with a search for lisdexafetamine:
http://www.aafp.org/afp/2012/0901/p413.html
Amphetamines for Attention-Deficit/Hyperactivity Disorder in Adults
Am Fam Physician. 2012 Sep 1;86(5):413-415.
Authors' Conclusions: Amphetamines improved short-term ADHD symptom severity. Mixed amphetamine salts also increased retention in treatment. Amphetamines were associated with higher attrition due to adverse events. The short study length and the restrictive inclusion criteria limit the external validity of these findings. Furthermore, the possibility that the results of the included studies were biased was high, which could have led to an overestimation of amphetamine efficacy.
--Nbauman (talk) 17:17, 25 February 2015 (UTC)
replies: text: If you'd like to add something on Shire and their promotion/marketing of the Vyvanse brand of lisdexamfetamine, please feel free to do so; this material would be appropriate for the Lisdexamfetamine#History, society, and culture section if you wish to add it.  As for the Cochrane reviews, that content is transcluded from amphetamine, which is a featured article; hence, that statement is unlikely to change due to the editorial consensus on its quality.  Personally, I don't think the omission of qualitative statistical information is misleading, especially when there is corroborating evidence of the underlying conclusion from other sources. Seppi333 (Insert 2¢ | Maintained) 23:06, 3 March 2015 (UTC)
thread_title:  Promotional and uncritical 

message: Why would anyone take a dextroamphetamine precursor when you can buy actual dextro?
Verdana♥Bøld 23:10, 22 November 2015 (UTC)
replies: text: What text in the article are you referring to? Seppi333 (Insert 2¢) 23:12, 22 November 2015 (UTC)
thread_title:  why precursor? 

message: Is there any reason to have this article and dextroamphetamine separate from amphetamine? Jytdog (talk) 22:36, 10 July 2017 (UTC)
replies: text: Amphetamine and dextroamphetamine are clearly very similar, but they're still distinct drugs. Lisdexamfetamine is an entirely different compound altogether though.  There have been several merge proposals over the years about combining these pages but it has never done for various reasons. Seppi333 (Insert 2¢) 22:50, 10 July 2017 (UTC)
replies: text: Yes they are but their actions are almost entirely the same.... we could have one article and just describe the different chemicals in the chemistry section, no? Jytdog (talk) 22:55, 10 July 2017 (UTC)
replies: text: The main differences between the articles are their medical indications (amphetamine has more than d-amph, LDX has one that neither amphetamine nor d-amph has) and their historical/cultural aspects.  That'd probably be a bit difficult to cleanly partition and cover in 1 article.  I agree that it's sort of redundant to have 3 pages on this, but I don't really see the harm in keeping them apart.  It's certainly simpler than trying to merge them into amphetamine and maintaining FA-quality prose in the process though.  FWIW, I don't actually remember any of the past arguments for/against keeping these pages separate. Seppi333 (Insert 2¢) 23:02, 10 July 2017 (UTC)
replies: text: Man these articles are incredibly intricately networked! Jytdog (talk) 23:30, 10 July 2017 (UTC)
replies: text: Lol.  A while back, I got really tired of updating Adderall, lisdexamfetamine, and dextroamphetamine every time I made a change to amphetamine that was relevant to those 3, so the simplest way to solve that problem was just to transclude to all of them. Seppi333 (Insert 2¢) 23:42, 10 July 2017 (UTC)
thread_title:  Merge? 

message: Can you restore this statement with clarification? I don't know what this means and I imagine neither do our readers.  In what context and by whom is this less preferred? E.g., by British adults for the treatment of ADHD? By American children for the same purpose? "It is usually less preferred than methylphenidate."
Seppi333 (Insert 2¢) 06:58, 17 April 2019 (UTC)
replies: text: Sure added that this is in the UK Doc James (talk · contribs · email) 14:40, 17 April 2019 (UTC)
thread_title:  Ambiguous statement 

message: "Chemically, lisdexamfetamine belongs to the class of substituted amphetamines." 
Not saying it is incorrect. But if not source makes the claim it makes one wonder how notable it is? Probably best to go in the body of the text regardless.
Doc James (talk · contribs · email) 14:40, 17 April 2019 (UTC)
replies: text: That’s literally the only chemistry statement in a paragraph you’ve marked as “mechanism and chemistry”, so I’m not sure why you want to remove it.  I don’t have a source on-hand, but I don’t think a source is necessary for a statement like this given that the amphetamine backbone in lisdexamfetamine’s structure diagram is clearly visible.  It’s almost a “sky is blue” statement. Seppi333 (Insert 2¢) 03:35, 18 April 2019 (UTC)
replies: text: No it is not a "sky is blue" statement. Please provide a source. It is not something that is obvious by just looking at it... Doc James (talk · contribs · email) 17:49, 18 April 2019 (UTC)
replies: text: The first sentence in https://www.ncbi.nlm.nih.gov/pubmed/17407369 implies that it is a substituted amphetamine; however, since I am sure you are going to take that statement at face value instead of what it implies, I will opt to use the more technical language of the source and state that "Chemically, lisdexamfetamine is composed of the amino acid l-lysine covalently bonded to dextroamphetamine". Seppi333 (Insert 2¢) 07:53, 19 April 2019 (UTC)
replies: text: Okay have simplified a bit. Doc James (talk · contribs · email) 17:39, 19 April 2019 (UTC)
thread_title: Which ref supports this

message: May occur not just in overdose but when this is used in combination with other medications per the source. Doc James (talk · contribs · email) 14:45, 17 April 2019 (UTC)
replies: text: Then that's not a side effect; it's a drug interaction. Seppi333 (Insert 2¢) 20:48, 17 April 2019 (UTC)
replies: text: Okay clarified. Doc James (talk · contribs · email) 17:53, 18 April 2019 (UTC)
thread_title: Serotonin syndrome

message: These are two different conditions within psychiatry and the reference deals with them separately. Ref says "Manic symptoms may occur with usual dosages in children and adolescents without prior history of mania." Doc James (talk · contribs · email) 14:48, 17 April 2019 (UTC)
replies: text: Fair enough. Seppi333 (Insert 2¢) 20:48, 17 April 2019 (UTC)
thread_title: Mania versus psychosis

message: Lisdexamfetamine is classified as a CNS stimulant. This is despite the fact that it is converted into dextroamphetamine first. Just because something requires metabolism in the body does not mean it is not in that class of medications. Stating that it "works after being converted by the body" is how one says in common English that it is a prodrug. Technical terminology can generally go in the body. Doc James (talk · contribs · email) 14:53, 17 April 2019 (UTC)
replies: text: Sigh. I suppose that'll do for now. Seppi333 (Insert 2¢) 20:49, 17 April 2019 (UTC)
thread_title: CNS stimulant

message: Appears we have decent sources saying there is no physical dependence or that their is physical dependence at high doses. 
For example see  Doc James (talk · contribs · email) 17:40, 19 April 2019 (UTC)
replies: text: The symptoms they list under physical dependence reflect psychological dependence. Seppi333 (Insert 2¢) 20:52, 19 April 2019 (UTC)

text: Re your other ref: https://books.google.ca/books?id=VuhGDQAAQBAJ&pg=PA374#v=onepage&q=physical%20dependence&f=false. This doesn't list any symptoms; however, see on page xiii: "Dependence as used in this book refers to physical dependence: the body' adaption to a drug upon cessation or reduction of the drug, the manifestation of withdrawal symptoms."  Physical dependence is conflated with dependence in this book. Seppi333 (Insert 2¢) 21:00, 19 April 2019 (UTC)
replies: text: The ref says "Chronic amphetamine use produces physical dependence". Prolonged sleep is physical withdrawal not psychological. Doc James (talk · contribs · email) 01:01, 20 April 2019 (UTC)
replies: text: No, it’s not; physical dependence entails visible somatic withdrawal symptoms such as seizures, tremors, or sweating.  Even if it were though, why would we refer to insomnia and wakefulness as psychological side effects of this drug and hypersomnia as a physical withdrawal symptom? Seppi333 (Insert 2¢) 01:34, 20 April 2019 (UTC)
replies: text: Ah the physical withdrawal symptoms are typically the opposite of the effects of the drug. So yes for depressants you have described the physical withdrawal symptoms. However for stimulants the state of physical withdrawal is a state of depressed functioning. Doc James (talk · contribs · email) 02:50, 20 April 2019 (UTC)
thread_title: Physical dependence

message: *Support as proposer. The withdrawal syndrome seen with a substance is generally the opposite of the effects it causes. Thus stimulants result in a withdrawal syndrome that is associated with exhaution and prolonged sleep. Well depressants like alcohol result in an agitated withdrawal state. Doc James (talk · contribs · email) 04:49, 22 April 2019 (UTC)
thread_title: Option 1: Use "disputed"

message: * Support as the sources provided are crap as I've explained above. Moreover, I'm baffled as to why Doc James is arguing that modulation of circadian cycles is a physical drug effect. Seppi333 (Insert 2¢) 08:23, 22 April 2019 (UTC)
thread_title: Option 2: Use "none"

message: *Support Happy with this aswell. Agree it is controversial and likely best to reflect this in the body of the text. Doc James (talk · contribs · email) 16:53, 22 April 2019 (UTC)
thread_title: Option 3: Leave out physical dependence from the infobox

message: *Support - Maybe I'm confusing this, but it seems like this is a debate over what is "physical" versus "psychological" dependence. I'm obviously no expert, but my initial sentiment is that the infobox doesn't really distinguish different kind of dependencies and we ought to list any kind of dependence as just dependence. NickCT (talk) 20:46, 25 April 2019 (UTC)
thread_title: Option 4: Leave as "high"

message: Not seeing it here. Not seeing it at WP:MEDMOS. I oppose this. Doc James (talk · contribs · email) 11:14, 23 May 2019 (UTC)
thread_title: Consensus to add a second "side effects" section

message: This IMO does not belong in the first sentence "codrug composed of the amino acid L-lysine, attached to dextroamphetamin"
Doc James (talk · contribs · email) 16:09, 29 November 2019 (UTC)
thread_title: First sentence

message: This article has a surprisingly bad noise/data ratio. Too much is transcluded or just pasted from [amphetamine] or similar articles, not directly specific to Lisdexamfetamine. The result is an essentially useless article that looks very detailed and authoritative, but requires too much effort to find out what is actually relevant to the subject matter. It might be relevant to have links to amphetamine data when there is none available that is specific to Lisdexamfetamine, but not pretend it should simply be pasted here. YamaPlos talk 19:19, 10 July 2020 (UTC)
replies: text: If anything, the Pharmacology and Adverse effects sections can just link to amphetamines. Those sections just draw away from the main subject at hand. – The Grid (talk)  01:48, 12 July 2020 (UTC)
thread_title:  Major rewrite cleanup needed 

message: I have revised the dependence liability of lisdexamfetamine to moderate to align with the growing body of evidence and current expert consensus that lisdexamfetamine has an appreciably lower potential for dependence compared to that of dextroamphetamine (Dexedrine) or mixed amphetamine salts (Adderall). RiMediaN (talk) 01:20, 30 March 2021 (UTC)
replies: text: Drugs.com not really appropriate, but what's the relevant quote in the former article? ProcrastinatingReader (talk) 01:36, 30 March 2021 (UTC)
thread_title:  Changing “dependence liability” from “high” to “moderate” 

message: On this edit,  reversed my edit mentioning cognitive disengagement syndrome (CDS) as a treatable condition by lisdexamfetamine on the basis of the secondary source being an "advocacy study" thus not gaining sufficient recognition. This criticism is unfounded. CDS has reached the threshold of recognition as a distinct syndrome as established by the International Consensus Statement on CDS, which I cited as part of my edit, in addition to the primary research it reviews. It is not a promotive idea, but rather a statement of fact, as the scientific consensus makes plain. It is not an "advocacy study". To claim it has not reached the recognition threshold is to contradict the international scientific consensus.
Please note that the current status of diagnostic manuals are quite irreverent as they are not leading the research, but follows it and often a decade or two behind where the research is at the time. And the decisions made by the APA for instance are also political, not just scientifically-based so its hard to know where this will go in the subsequent DSM version. Thus the condition not being recognised in diagnostic manuals does not preclude it from being a distinct syndrome.
Therefore, this edit should not have been redacted on this article. Please discuss/refute/or attest if my understanding of the guidelines here are misled. Димитрий Улянов Иванов (talk) 19:59, 18 February 2024 (UTC)
replies: text: Responded to it here. --WikiLinuz (talk) 22:08, 18 February 2024 (UTC)

text: Please gain consensus here before restoring. Until then the article must be in WP:STATUSQUO. --WikiLinuz (talk) 01:10, 20 February 2024 (UTC)
thread_title:  CDS & Lisdexamfetamine