0767 Analysis Of The Effect On Blood Pressure And Heart Rate When Adding Solriamfetol (Sunosi) To Stimulant Therapy

Introduction Solriamfetol is a non-stimulant wakefulness-promoting agent (WPA) indicated for the treatment of excessive daytime sleepiness in adult patients with obstructive sleep apnea or narcolepsy. It acts by inhibiting reuptake of dopamine and norepinephrine. Since many patients with excessive daytime sleepiness take stimulants, clinicians commonly ponder the safety of adding solriamfetol in this population due to concern of increased blood pressure and/or heart rate (HR). Methods We conducted a retrospective chart review and identified 18 patients who had solriamfetol added to their stimulant therapy. Of those, 7 to date have had a follow-up appointment after the addition of solriamfetol (6 on 150mg, 1 on 75mg). We collected the blood pressure and HR readings at the appointment immediately prior to and following the addition of solriamfetol and conducted a paired t-test. Results The systolic blood pressure (SBP) had a mean difference of -0.57 (95% CI -9.6 to 8.5, p=0.88), diastolic blood pressure (DBP) 1.7 (95% CI -4.4 to 7.9, p=0.52), mean arterial pressure (MAP) 0.95 (95% CI -5.6 to 7.5, p=0.73), and HR 6.6 (95% CI -0.07 to 13.2, p=0.052). Conclusion The addition of solriamfetol to stimulant therapy did not lead to a significant increase in SBP, DBP, MAP, or HR. Support none

Stimulant Therapy in Acute Traumatic Brain Injury: Prescribing Patterns and Adverse Event Rates at 2 Level 1 Trauma Centers

Background/Objective: Pharmacological stimulant therapies are routinely administered to promote recovery in patients with subacute and chronic disorders of consciousness (DoC). However, utilization rates and adverse drug event (ADE) rates of stimulant therapies in patients with acute DoC are unknown. We aimed to determine the frequency of stimulant use and associated ADEs in intensive care unit (ICU) patients with acute DoC caused by traumatic brain injury (TBI). Methods: We retrospectively identified patients with TBI admitted to the ICU at 2 level 1 trauma centers between 2015 and 2018. Patients were included if they were stimulant naive at baseline and received amantadine, methylphenidate, or modafinil during ICU admission. Stimulant dose reduction or discontinuation during ICU admission was considered a surrogate marker of an ADE. Targeted chart review was performed to identify reasons for dose reduction or discontinuation. Results: Forty-eight of 608 patients with TBI received pharmacological stimulant therapy (7.9%) during the study period. Most patients were diagnosed with severe TBI at presentation (60.4%), although stimulants were also administered to patients with moderate (14.6%) and mild (25.0%) TBI. The median time of stimulant initiation was 11 days post-injury (range: 2-28 days). Median Glasgow Coma Scale score at the time of stimulant initiation was 9 (range: 4-15). Amantadine was the most commonly prescribed stimulant (85.4%) followed by modafinil (14.6%). Seven (14.6%) patients required stimulant dose reduction or discontinuation during ICU admission. The most common ADE resulting in therapy modification was delirium/agitation (n = 2), followed by insomnia (n = 1), anxiety (n = 1), and rash (n = 1); the reason for therapy modification was undocumented in 2 patients. Conclusions: Pharmacological stimulant therapy is infrequently prescribed but well tolerated in ICU patients with acute TBI at level 1 trauma centers. These retrospective observations provide the basis for prospective studies to evaluate the safety, optimal dose range, and efficacy of stimulant therapies in this population.

A Controlled Trial of Extended-Release Guanfacine and Psychostimulants on Executive Function and ADHD

Objective: To evaluate the effectiveness of guanfacine extended-release (GXR) versus placebo as adjunct therapy to usual care stimulant therapy in improving executive function in children aged 6 to 12 years diagnosed with ADHD. Method: In this single center, double-blind placebo-controlled crossover trial, subjects continued to take their psychostimulant and were randomly assigned at baseline to receive active treatment or placebo first. Efficacy measures included Behavioural Rating Inventory of Executive Function (BRIEF-P), ADHD Rating Scale IV (ADHD-RS IV), and Clinical Global Impressions of Severity of Illness (CGI-S) and Improvement (CGI-I) scales. Safety measures included adverse events and vital signs. Results: Significant benefits of GXR plus psychostimulant were observed on BRIEF-P ( p value = .0392), ADHD-RS-IV ( p < .0001), CGI-S ( p = .0007), and CGI-I ( p = .003). There were no serious adverse events and no new safety signals. Conclusion: Use of GXR as adjunctive therapy to stimulant therapy significantly improves executive function in children with ADHD.