Stimulant ‘rapid metabolizers’: wrong label, real phenomena

  • Margaret D. Weiss
  • Craig B.H. Surman
  • Dean Elbe
Short Communication
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Abstract

This is a review of the empirical literature regarding what has been described anecdotally as patients who are ‘rapid metabolizers’ of stimulant medication. The authors propose that this is a misnomer used to describe two types of atypical pharmacokinetic patterns of response: high-dose responders, short-duration responders and two types of atypical pharmacodynamics patterns of response: patients who develop either acute or chronic tolerance. The authors propose that use of more precise terminology should facilitate both patient education and research to better understand the physiology and clinical management of atypical response patterns to stimulant treatment. Presently, the understanding of the pharmacokinetics and pharmacodynamics of psychostimulants is still quite limited. Further scientific research is needed to understand unusual patterns of pharmacological response seen in the clinic. Careful identification and precise description of these patterns would facilitate understanding the pharmacokinetics and pharmacodynamics of stimulants impacts the atypical response patterns seen in the clinic.

Keywords

Stimulants Attention-deficit/hyperactivity disorder Dose–response Treatment resistance 
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Notes

Acknowledgements

We would like to acknowledge the support of Nicole McBride in preparing this manuscript.

Compliance with ethical standards

Conflict of interest

Dr. Margaret Weiss has the following disclosures: consulting and honorariums from Purdue Pharma, Rhodes Pharmaceuticals, Shire, and NLS Pharma. Dr. Weiss has received travel reimbursement from Rhodes, Shire, NLS Pharma, the Israeli Society for ADHD and the World Federation of ADHD. These disclosures listed are current since August 2016. Dr. Craig Surman has the following lifetime disclosures: consulting from Mcneil, Nutricia, Pfizer, Rhodes, Shire, Somaxon and Takeda; speaking fees from Alcobra, McNeil, Janssen, Janssen-Orth, Novartis, Shire, GME Psychiatry and Reed/MGH Academy; royalties from Berkeley/Penguin for 3FASTMINDS2: How to thrive if you have ADHD (or think you might)2 and from Humana/Springer for 3ADHD in Adults: A Practical Guide to Evaluation and Management2; research support from Abbott, Cephalon, Hilda and Preston Davis Foundation, Eli Lilly, Magceutics/Neurocentria, Johnson & Johnson/McNeil, Merch, Nordic Naturals, Pamlab/Nestle. Dr. Dean Elbe has no conflicts/disclosures to report.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

This article does not involve an informed consent process as it did not involve any participants.

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Copyright information

© Springer-Verlag GmbH Austria 2017

Authors and Affiliations

  1. 1.Division of Child and Adolescent Psychiatry, Department of PsychiatryUniversity of Arkansas for Medical Sciences (UAMS), Child Study Center, Arkansas Children’s HospitalLittle RockUSA
  2. 2.Adult ADHD Research ProgramMassachusetts General HospitalBostonUSA
  3. 3.Department of PsychiatryHarvard Medical SchoolBostonUSA
  4. 4.Child and Adolescent Mental Health ProgramsBC Children’s HospitalVancouverCanada
  5. 5.Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverCanada
  6. 6.Department of Psychiatry, Faculty of MedicineUniversity of British ColumbiaVancouverCanada

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