苯丙胺

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安非他命(Amfetamine) (INN)
An image of the amphetamine compound
A 3d image of the D-amphetamine compound
系统(IUPAC)命名名称
(RS)-1-phenylpropan-2-amine
临床数据
读音 聆聽i/æmˈfɛtəmn/
Drugs.com英语Drugs.com amphetamine
License data
妊娠分级
  • US: C (不排除有风险的可能)
依赖性 生理依賴英语Physical dependence: 無
心理依賴英语Psychological dependence: 中等
成瘾性 中等
给药途径 醫用: 口服给药, 鼻腔給藥英语Nasal administration, 靜脈注射[1]
非醫療用(Recreational): 口服给药, 鼻腔給藥英语Nasal administration, Insufflation (medicine)英语Insufflation (medicine), 栓剂, 靜脈注射
合法狀態
合法状态
药代动力学数据
生物利用度 口服 75–100%[2]
蛋白结合度 15–40%[3]
代谢 Amphetamine only:
CYP2D6,[4] Dopamine β-hydroxylase,[5][6][7] Flavin-containing monooxygenase英语Flavin-containing monooxygenase[5][8][9]
代谢产物 4-hydroxyamphetamine英语4-hydroxyamphetamine, 4-hydroxynorephedrine英语4-hydroxynorephedrine, 4-hydroxyphenylacetone英语4-hydroxyphenylacetone, 苯甲酸, 馬尿酸, 苯丙醇胺, 苯基丙酮[4][10][11]
起效

IR dosing: 30–60 minutes[12]
XR dosing: 1.5–2 hours[13]

[14]
生物半衰期 D-amph:9–11 hours[4][15]
L-amph:11–14 hours[4][15]
PH值-dependent: 8–31 hours[16]
作用时间

IR dosing: 3–7 hours[13][17]
XR dosing: 12 hours[13] [14]

[17]
排泄 Primarily ;
PH值-dependent range: 1–75%[4]
识别信息
CAS注册号 300-62-9 ✓
ATC代码 N06BA01
PubChem CID 3007
IUPHAR/BPS英语IUPHAR/BPS 4804
DrugBank DB00182 ✓
ChemSpider 13852819 ✓
UNII CK833KGX7E ✓
KEGG D07445 ✓
ChEBI CHEBI:2679 ✓
ChEMBL英语ChEMBL CHEMBL405 ✓
NIAID ChemDB英语NIAID ChemDB 018564
其他名称 α-methylphenethylamine
PDB配体ID FRD (PDBe, RCSB PDB)
化学信息
化学式 C9H13N
摩尔质量 135.20622 g/mol[18]
物理性质
密度 0.9±0.1 g/cm3
熔点 11.3 °C(52.3 °F) (predicted)[19]
沸点 203 °C(397 °F) at 760 毫米汞柱[20]
  (verify)

安非他命(英文名稱:Amphetamine[note 1]为一种中樞神經興奮劑,用來治療注意力不足過動症嗜睡症、和肥胖症。“Amphetamine”一名擷取自 alphamethylphenethylamine

安非他命於西元1887年被發現,以兩種對映異構體的形式存在[note 2] ,分別是左旋安非他命英语levoamphetamine右旋安非他命英语dextroamphetamine

正確來說,安非他命指的是特定的化學物質-外消旋純胺類型態英语free base[24][25],這個物質等同於安非他命的的兩個對映異構體:左旋安非他命英语levoamphetamine右旋安非他命英语dextroamphetamine的等比化合物之純胺類型態。 然而,實際上安非他命一詞已被廣泛的用來表示任何由安非他命對映異構體構成的物質或安非他命對映異構體本身。[21][26][25]

歸類為中樞神經興奮劑的藥物:派醋甲酯(methylphenidate)和安非他命(amphetamine)。適度適量地使用它們能提升一個人整體的衝動控制能力英语inhibitory control(inhibitory control)。[27][28] 同理,中樞神經抑制劑英语depressants(depressants)(例如:酒精)由於會讓腦中神經傳導物質濃度降低、減少許多大腦區域的活性等,所以可能會造成專注力、神智清醒度等自我管理能力的下降。[29]

在醫療用的劑量範圍內,安非他命能帶來情緒以及執行功能的變化,例如:欣快感性欲的改變、清醒度英语wakefulness的提升、大腦執行功能的進化。安非他命所改變的生理反應包含:減少反應時間、降低疲勞、以及肌耐力的增強。然而,若攝取劑量超越醫療用的劑量範圍過多,將會導致大腦執行功能的受損以及橫紋肌溶解症。 攝取過份超越醫療用劑量範圍的安非他命將產生嚴重的藥物成癮風險。然而長期攝取醫療劑量範圍的安非他命並不會產生上癮的風險。

服用嚴重超出醫療用劑量範圍的安非他命會引起精神疾病(例如:妄想[參 1]、偏執[參 2])。然而長期攝取醫療劑量範圍的安非他命並不會引起上述疾病。

娛樂用劑量遠超過醫療用劑量範圍且伴隨著非常嚴重甚至致命的副作用。 [sources 1]

安非他命可以也曾經被用來治療鼻塞(nasal congestion)和抑鬱

安非他命也被用來提升表現英语performance-enhancing substance、和促進大腦的認知功能及在助興時(非醫療用途情況下)被作為增強性慾[a]、和欣快感促進劑

安非他命在許多國家為合法的處方藥[參 3]。然而,私自散布和囤積安非他命被視為非法行為,因為安非他命被用於非醫療用途的助興英语recreational use可能性極高。[sources 2]

首個藥用安非他命的藥品名稱為Benzedrine。當今藥用安非他命英语#Pharmaceutical products[參 4]以下列幾種形式存在:外消旋安非他命[參 5]Adderall英语Adderall [note 3]。 、dextroamphetamine英语dextroamphetamine、或對人體無藥效的前驅藥物體[參 6]lisdexamfetamine英语lisdexamfetamine

安非他命藉著自身作用於兒茶酚胺神經傳導元素:正腎上腺素多巴胺的特點來活化trace amine receptor英语TAAR1 ,進而增加单胺类神经递质神经递质(excitatory neurotransmitter)在腦內的活動。[sources 3]

安非他命屬於替代性苯乙胺英语substituted phenethylamine類的物質。由安非他命衍伸出的物質被歸納在取代苯乙胺英语substituted phenethylamine[參 7]的分類中[note 4],比如說:安非他酮[參 8]cathinone英语cathinoneMDMA、 和 甲基苯丙胺[參 9]。安非他命也與人體內可自然生成的兩個屬於痕量胺的神經傳導物質--特別是 phenethylamineN-Methylphenethylamine英语N-Methylphenethylamine--有關。 Phenethylamine 是安非他命的原始化合物,而N-methylphenethylamine則是安非他命的位置異構體(只有在甲基族中才會區分出此位置異構體)。[sources 4]

醫療用途[编辑]

安非他命是用來治療注意力不足過動症(ADHD)、嗜睡症(一種睡眠疾病)、和肥胖症。有時候安非他命會以仿單標示外使用英语off-label use的方式處方來治療頑固性憂鬱症英语treatment-resistant depression頑固性強迫症[1][15] [44] [51]。 在動物試驗中,已知非常高劑量的安非他命會造成某些動物的多巴胺系統英语dopamine receptor和神經系統的受損。[52][53] 但是,在人體試驗中,注意力不足過動症患者在接受安非他命的治療後,則發現安非他命可促進大腦的發育及神經的成長。[54][55][56]

回顧許多核磁共振照影(MRI)的研究後發現,長期以安非他命治療注意力不足過動症患者能顯著降低患者大腦結構及大腦執行功能上的異常。並且優化大腦中數個部位,例如:基底神經節的右尾狀核[54][55][56]


眾多臨床研究的系統性及統合性回顧已確立長期使用安非他命治療注意力不足過動症的療效及安全。[57][58][59]

持續長達兩年的隨機對照試驗[參 10][b]結果顯示:長期使用安非他命治療注意力不足過動症,是有效且安全的。[57][59]

兩個系統性/統合性回顧的結果顯示長期且持續地使用中樞神經興奮劑治療注意力不足過動症能有效地減少注意力不足過動症的核心症狀(核心症狀即為:過動、衝動和分心/無法專心)、增進生活品質、提升學業成就、廣泛地強化大腦的執行功能。[note 5] 這些執行功能分別與下列項目有關:學業、反社會行為、駕駛習慣、藥物濫用、肥胖、職業、日常活動、自尊心、服務使用(例如:學習、職業、健康、財金、和法律等)、社交功能。[58][59]

一篇系統性/統合性回顧標誌了一個重要發現:一個為期九個月的隨機雙盲試驗中,持續以安非他命治療的ADHD患者,其智力商數平均增加4.5單位[註 1],且在專注力、衝動、過動的改善皆呈現持續進步的態勢。[57] 另一篇系統性/統合性回顧則指出:根據迄今為止為時最長的數個臨床追蹤研究英语prospective cohort study[參 11],可以得到一個結論:即便從兒童時期開始以中樞神經興奮劑治療直到老年,中樞神經興奮劑都能持續有效地控制ADHD的症狀並且減少物質濫用的風險。[59] 研究表明,ADHD與大腦的執行功能受損有關。而這些受損的執行功能分別與大腦中部分的神經傳導系統英语neurostransmitter systems有關[參 12][60] ;又此部分受損的神經傳導系統和中腦皮質激素英语mesocorticolimbic projection-多巴胺[參 13]的傳導及藍斑核[參 14]前額葉[參 15]中的正腎上腺素[參 16]的傳導相關。[60]

中樞神經興奮劑,例如:methylphenidate和安非他命對於治療ADHD都是有效的,因為中樞神經興奮劑刺激了上述神經系統中的神經傳導物質活動。[30][60] [61]

至少超過80%的ADHD患者在使用中樞神經興奮劑治療後,其ADHD的症狀可以獲得改善。[62]

使用中樞神經興奮劑治療的ADHD患者相較之下,普遍與同儕及家庭成員的關係較佳並且在學校擁有較好的表現。興奮劑能使ADHD患者較不易分心、衝動、且擁有較長的專注力時間和範圍。[63] [64]

根據考科藍協作組織[參 17]所提供的文獻回顧結果[note 6]指出:使用中樞神經興奮劑治療的ADHD患者即便其症狀改善,相較於使用非中樞神經興奮劑,仍因副作用而有較高的停藥率。[66] [67]

回顧結果也發現,中樞神經興奮劑並不會惡化抽動綜合症的症狀,例如:妥瑞氏症,除非服用dextroamphetamine英语dextroamphetamine[c]的劑量過高才有可能在部分妥瑞氏症合併注意力不足過動症患者身上觀察到抽動綜合症的症狀惡化。[68]

中樞神經興奮劑只要依照醫師指示用藥,都是相當安全的。[69][70][70][71] 中樞神經興奮劑,例如:利他能與專思達,可能導致:心悸、頭痛、胃痛、喪失食慾、失眠、因相對專注而變得冷淡(面無表情)等副作用,因此6歲以下的兒童不適宜服用。(副作用產生與否因人而異) [72]

隨著時間推進與各方的努力,中樞神經興奮劑的相關副作用已可藉由包括但不限於劑量調整、服藥時間、飯前飯後服用、服藥頻率等服藥模式之改變以及改變藥物組合等方式獲得相當程度的減少。[73] [74] [75] [70] [76]

醫療上的禁忌[编辑]

根據International Programme on Chemical Safety英语International Programme on Chemical Safety (IPCS)和美國食品藥物管理局 (USFDA), [note 7]

安非他命不建議處方給有藥物濫用心血管疾病、對於各種刺激嚴重反應過度、和嚴重焦慮歷史的人。 [note 8][78][79]

安非他命也不被建議處方給正經歷動脈血管硬化英语arteriosclerosis(血管硬化)、中度到重度高血壓青光眼(眼壓過高)、或甲狀腺機能亢進(身體在體內製造出過量的甲狀腺 賀爾蒙/激素)的人。 [78][79][80]

曾對中樞神經刺激劑藥物過敏的人以及正在服用單胺氧化酶抑制劑 (MAOI)或單胺氧化酶抑制劑類藥物 (MAOIs),可能不適合使用安非他命。即便曾有合併使用安非他命和單胺氧化酶抑制劑後仍一切平安的案例。 [78][79] [81][82] IPCS和美國食品藥物管理局也同意患有神經性厭食症(anorexia nervosa)、雙極性情感疾患(bipolar disorder)、憂鬱高血壓mania英语mania思覺失調症Raynaud's phenomenon英语Raynaud's phenomenon心臟病發(seizures)、抽動綜合症(tics)、妥瑞氏症(Tourette's disease)、和有甲狀腺問題、問題的人在使用安非他命時應密切追蹤上述疾病的變化。 [78][79]

人體試驗證明,醫療用劑量下的安非他命並不會導致胎兒或新生兒畸形(i.e., it is not a human teratogen英语Teratology)。然而超越醫療用劑量甚多的安非他命確實會增加胎兒或新生兒畸形的機會。 [79]

研究觀察發現,安非他命會進入母親的母乳中,因此不建議授乳中的母親避免在授乳期間使用安非他命。 [78][79]

由於安非他命可能影響食慾繼而導致可反轉的身高及體重的成長遲緩, [note 9] ,因此建議兒童或青少年在用藥期間定期測量自己的身高及體重。 [78]

副作用[编辑]

生理[编辑]

心理[编辑]

嚴重過量[编辑]

成癮[编辑]

依賴和戒斷症狀[编辑]

交互作用[编辑]

藥學(Pharmacology)[编辑]

作用[编辑]

認知方面(Cognitive)[编辑]

西元2015年中,一篇系統性回顧[參 18]和一篇元分析/整合分析[參 19]回顧了數篇優秀的臨床試驗[參 20]報告後發現, 低劑量(醫療用劑量)的安非他命能適度但不強烈地促進一個人的認知功能,包含工作記憶(working memory)、長期的情節記憶(episodic memory)、衝動控制英语inhibitory control以及在一些方面的注意力(attention)。 [27] [28] 安非他命強化認知功能的效果已知是部分透過間接活化英语indirect agonist在大腦前額葉(prefrontal cortex)的dopamine receptor D1英语dopamine receptor D1adrenoceptor α2英语Alpha-2 adrenergic receptor[30] [27] 一篇2014年的系統性回顧發現低劑量(醫療用劑量)的安非他命能促進memory consolidation英语memory consolidation,進而提升一個人的recall of information英语Recall (memory)[84] 低劑量(醫療用劑量)的安非他命也可增加大腦皮層(質)區的效率,這能讓一個人的工作記憶(working memory)獲得進步。 [30] [85] 安非他命和其他用於治療ADHD的中樞神經刺激劑能透過提升task saliency英语Incentive salience來增加一個人去做事情的動機、並強化一個人的警覺心(清醒度),因而能刺激一個人開始做「以目標為導向」的行為。 [30] [86] [87] 中樞神經興奮劑(例如:安非他命)能提升一個人在困難且枯燥的任務中的表現。 [30] [87] [88] 超過醫療用劑量範圍(包含其誤差範圍及容許最大上限)的安非他命劑量將不利於工作記憶(working memory)和其他的認知功能。 [30][87]

生理(physical)[编辑]

雖然安非他命可以提升速度、耐力英语endurance(延遲疲勞的發生)、肌耐力、身體素質和警覺心並減少心理反應時間[31][35] [31] [89] [90] 然而,「非因醫療需求使用安非他命」在各種運動場合都是被嚴格禁止的。[91] [92]

安非他命藉由抑制多巴胺在中樞神經系統中的回收及外流來促進耐力和反應時間的提升。 [89][90] [93] 安非他命和其他作用於多巴胺系統的藥物一樣,都能增加在固定施力(levels of perceived exertion英语rating of perceived exertion)下的動力(能)輸出。這是因為安非他命能奪取(override)體溫的「安全開關」的控制權並將身體核心溫度(core temperature limit)的上限提高以取得在體溫安全上限提高前被身體保留的能量。 [90] [94] [95] 於醫療用劑量範圍(包含其誤差範圍),安非他命的副作用不至於影響運動員的運動表現; [31][89] 然而,當攝取的劑量過多時,安非他命可能會引起嚴重的後果,例如:橫紋肌溶解症體溫過高[32][34] [89]

藥效動力學(Pharmacodynamics)[编辑]

藥物代謝動力學(Pharmacokinetics)[编辑]

安非他命的口服生體可利用率[參 21]pH值連動; [96] 安非他命非常容易在腸道被吸收,dextroampetamine的生體可利用率在多數的情況下高於75%。 [2] 安非他命呈弱鹼性,其pKa值介於9–10之間;[4] 因此,當pH值呈鹼性時,多數的安非他命會以其易溶於脂類free base英语free base形式存在。在此情況下,身體會通過腸道上表皮富含脂類的細胞膜[參 22]來吸收安非他命。 [4] [96] 相反地,酸性的pH值表示安非他命主要以易溶於水的離子[參 23](鹽)形式存在,因此較少能被吸收。 [4] 大約15–40%循環於血管中的安非他命與血漿蛋白[參 24]相連接。 [3] 安非他命的對映異構物的半衰期會隨著尿液的pH值而有所不同。 [4] 當尿液的酸鹼值落在正常範圍中,dextroamphetamine和levoamphetamine的半衰期分別為9–11 小時及 11–14 小時。 [4] 酸性飲食會導致安非他命的對映異構物的半衰期降低至8–11 小時;鹼性飲食則會使安非他命的對映異構物的半衰期增加到16–31 小時。 [10][16]

成分為安非他命或其衍生物的短效藥品大約在口服後三小時在體內達到最高血漿濃度英语plasma concentration;而成分為安非他命或其衍生物的長效藥品則在口服後大約七小時在體內達到最高血漿濃度。 [4]

安非他命主要透過腎臟來代謝,大約30–40%的藥物以藥物本身原始的型態從酸鹼度正常的尿液中排出。 [4] 當尿液是鹼性時,安非他命傾向以其free base英语free base型態存在,因此較少被排泄。 [4]

當尿液的pH值失常時,各種安非他命的分解物在尿液中重新結合的程度將從最低1%到最高75%。該程度的高低大多取決於於尿液的酸鹼值,尿液越酸,結合率越高;尿液愈鹼,結合率越低。 [4] 安非他命通常於口服後兩天內自體內完全代謝完畢。 [10] 安非他命確切的半衰期及藥效作用期隨著(小於兩天的)重複服用導致的血漿內安非他命濃度(plasma concentration of amphetamine)的增加而延長。[97]

對人體無藥效的前驅藥物體(prodrug):lisdexamfetamine並不若安非他命一樣容易受腸胃道環境的pH值影響; [98] lisdexamfetamine在腸道被吸收進入血管的血液後很快就會透過水解(hydrolysis)的方式轉化為dextroamphetamine。而參與這水解反應的酶(enzymes)與紅血球有關。 [98]

Lisdexamfetamine的半衰期通常小於一個小時。 [98]

細胞色素 P450 2D6(Cytochrome P450 2D6、或CYP2D6)、多巴胺β羥化酶(Dopamine β-hydroxylase、或DBH)、flavin-containing monooxygenase 3英语flavin-containing monooxygenase 3butyrate-CoA ligase英语butyrate-CoA ligase、和 glycine N-acyltransferase英语glycine N-acyltransferase為已知在人體中參與[註 2]「安非他命」及「安非他命代謝後之產物」的代謝反應的(enzyme)。 [sources 5]

「安非他命代謝後之產物」包含:4-hydroxyamphetamine英语4-hydroxyamphetamine4-hydroxynorephedrine英语4-hydroxynorephedrine4-hydroxyphenylacetone英语4-hydroxyphenylacetone苯甲酸(benzoic acid)、馬尿酸(hippuric acid)、苯丙醇胺(norephedrine)、苯基丙酮(phenylacetone)[註 3] [4] [10] [11]

在這些「安非他命代謝後之產物」之中,有實際藥效的產物(sympathomimetics)為:4‑hydroxyamphetamine[101]4‑hydroxynorephedrine[102]、和norephedrine[103]

安非他命的主要代謝途徑包含:aromatic para-hydroxylation、aliphatic alpha- 、beta-hydroxylation、N-oxidation、N-dealkylation、和 deamination。 [4][10]

下圖為已知的「安非他命」代謝途徑和「安非他命代謝後之產物」: [4][8][11]

苯丙胺的代謝途徑
Graphic of several routes of amphetamine metabolism
Para-
Hydroxylation
Para-
Hydroxylation
Para-
Hydroxylation
Beta-
Hydroxylation
Beta-
Hydroxylation
Oxidative
Deamination
Oxidation
Glycine
Conjugation
在這些「安非他命代謝後之產物」之中,主要的且有實際藥效的產物為:4-hydroxyamphetamine去甲麻黃鹼(norephedrine)[11]

從酸鹼度正常的尿液中可發現,大約30–40%的「安非他命」以本身原始的型態排出;大約50%的安非他命以不具藥效的「安非他命代謝後之產物」(即為圖片中最下列的產物)的型態排出。 [4]

剩下的10–20%則為「安非他命代謝後之產物」之中,有實際藥效的產物。 [4]

苯甲酸(Benzoic acid)被butyrate-CoA連接酶(butyrate-CoA ligase)代謝後成為一個中介物質/中間產物(intermediate product):benzoyl-CoA英语benzoyl-CoA [99]

隨後透過glycine N-acyltransferase代謝並轉化為馬尿酸(hippuric acid)。[100]

相關的內部生成化合物/混和物(endogenous compound)[编辑]

歷史、社會與文化[编辑]

合法狀態與條件[编辑]

藥品[编辑]

備註A[编辑]

  1. ^ 别名有:1-phenylpropan-2-amine (IUPAC name), α-methylbenzeneethanamine, α-methylphenethylamine, amfetamine (International Nonproprietary Name [INN]), β-phenylisopropylamine, desoxynorephedrine, and speed.[18][21][22]
  2. ^ 對映異構體指的是兩個形狀相同但方向相反的兩個分子,他們又稱為彼此的鏡中影像。[23] Levoamphetamine 和 dextroamphetamine 分別被簡稱為 L-amph 或 levamfetamine (INN) 和 D-amph 或 dexamfetamine (INN) [18]
  3. ^ "Adderall"是一個品牌名稱。因為以下幾個安非他命的異構物的英文名稱太長了:("dextroamphetamine sulfate, dextroamphetamine saccharate, amphetamine sulfate, and amphetamine aspartate"),因此本文單獨以此名稱來表示此安非他命的此種混合物。
    原文對照:"Adderall" is a brand name as opposed to a nonproprietary name; because the latter ("dextroamphetamine sulfate, dextroamphetamine saccharate, amphetamine sulfate, and amphetamine aspartate" [45]) is excessively long, this article exclusively refers to this amphetamine mixture by the brand name.
  4. ^ 「安非他命」一詞也意指一個化學分類,但與「替代性安非他命」這個化學分類不同的是,「安非他命」類在學術上並無標準的定義。 [5][25] 有一個「安非他命」類的定義嚴格限定分類中僅有:安非他命的racemate and enantiomers 和 甲基安非他命methamphetamine的racemate and enantiomers。 [25] 大多數「安非他命」類的定義為那些在藥理學上以及結構上與安非他命相關的化合物。 [25]
    為避免讓amphetamine 和 amphetamines 把讀者給弄糊塗了,本條目中僅會使用amphetamine、amphetamines來表示racemic amphetamine, levoamphetamine, and dextroamphetamine;‘替代性安非他命(substituted amphetamines)’來表示安非他命的結構分類。
    原文對照: Due to confusion that may arise from use of the plural form, this article will only use the terms "amphetamine" and "amphetamines" to refer to racemic amphetamine, levoamphetamine, and dextroamphetamine and reserve the term "substituted amphetamines" for its structural class.
  5. ^ 研究證實,長期以中樞神經興奮劑治療ADHD能在下列這些方面產生大幅的進步:學業、駕駛、降低藥物濫用、降低肥胖、自尊、和社交功能等。 [58]

    在上述領域中,最為突出的領域為: 學業(例如:GPA分數 grade point average、成果測驗分數 achievement test scores、受教育的時間長度 length of education、和教育程度 education level) 、自尊(例如:自尊心測驗分數 self-esteem questionnaire assessments、嘗試自殺的次數、自殺率等) 和社交功能(例如:peer nomination scores、社交技巧、家庭關係 quality of family、同儕關係 quality of peer、和浪漫關係/情侶關係 romantic relationships) [58]

    長期以「藥物治療合併行為治療」的模式來治療ADHD,能夠比單獨以藥物治療,產生更全面且更長足的進步。 [58]
  6. ^ 考科藍協作組織對於歷年眾多的「隨機對照試驗」的系統性回顧數據統整分析後所得出的總結,基本上都是非常有水準且深具參考價值的。 [65]
  7. ^ 美國食品藥物管理局核准的藥品使用指引及醫療上的禁忌(放在藥盒中的仿單/說明書)並非為了限制醫師的決策而是為了避免藥商恣意宣稱藥物的作用。醫師可以此為參考,並依照每位病人的實際情況做出獨立的判斷。 [77]
  8. ^ 然而根據一篇回顧性論文,安非他命可以處方給曾有藥物濫用歷史的人,不過需要有對患者適度的藥品控管,例如:每天由醫護人員配給處方劑量。[1]
  9. ^ 曾受此副作用的用藥者,身高及體重在在短暫停藥後恢復至應有水準是可以被預期的。[57][59][83] 根據追蹤,持續三年過程不停歇的安非他命治療(沒有合併任何積極減少安非他命副作用的療法的情況下)平均會減少 2公分的最終身高。 [83]

備註B[编辑]

  1. ^ 智力測驗結果與專注力有關,詳見注意力不足過動症#智力
  2. ^ 酶做為反應的催化劑catalyst,並不實際參與反應。
  3. ^ 不是苯丙酮

注释[编辑]

  1. ^ 安非他命乃春藥的其中一種
  2. ^ 又稱為「隨機分配且包含控制組的臨床試驗」,是臨床試驗的一種
  3. ^ 中樞神經興奮劑的一種

英文名稱對照[编辑]

  1. ^ 英文名稱為:delusions
  2. ^ 英文名稱為:paranoia
  3. ^ 英文名稱為:Prescription drug
  4. ^ 英文名稱為:Pharmaceutical amphetamine
  5. ^ 英文名稱為:racemic amphetamine
  6. ^ 英文名稱為:Prodrug
  7. ^ 英文名稱為:substituted amphetamine
  8. ^ 英文名稱為:Bupropion
  9. ^ 英文名稱為:meth-amphetamine
  10. ^ 英文名稱為:Randomized controlled trials
  11. ^ 英文名稱為:follow-up studies
  12. ^ 英文名稱為:neurotransmitter systems
  13. ^ 英文名稱為:dopamine
  14. ^ 英文名稱為:locus coeruleus
  15. ^ 英文名稱為:prefrontal cortex
  16. ^ 英文名稱為:nor-epinephrine或nor-adrenaline
  17. ^ 英文名稱為:Cochrane Collaboration
  18. ^ 英文名稱為:systematic review
  19. ^ 英文名稱為:meta-analysis
  20. ^ 英文名稱為:臨床試驗
  21. ^ 英文名稱為:bioavailability
  22. ^ 英文名稱為:cell membrane
  23. ^ 英文名稱為:cation
  24. ^ 英文名稱為:plasma protein

引用[编辑]

來源[编辑]

  1. ^ 1.0 1.1 1.2 1.3 1.4 引用错误:没有为名为Amph_Uses的参考文献提供内容
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    "Table 5: N-containing drugs and xenobiotics oxygenated by FMO"
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  12. ^ Pharmacology. amphetamine/dextroamphetamine. Medscape. WebMD. [21 January 2016]. Onset of action: 30–60 min 
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    Table 9.2 Dextroamphetamine formulations of stimulant medication
    Dexedrine [Peak:2–3 h] [Duration:5–6 h] ...
    Adderall [Peak:2–3 h] [Duration:5–7 h]
    Dexedrine spansules [Peak:7–8 h] [Duration:12 h] ...
    Adderall XR [Peak:7–8 h] [Duration:12 h]
    Vyvanse [Peak:3–4 h] [Duration:12 h]
     
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  23. ^ Enantiomer. IUPAC Goldbook. International Union of Pure and Applied Chemistry. [14 March 2014]. doi:10.1351/goldbook.E02069. (原始内容存档于17 March 2013). One of a pair of molecular entities which are mirror images of each other and non-superposable. 
  24. ^ 24.0 24.1 Guidelines on the Use of International Nonproprietary Names (INNS) for Pharmaceutical Substances. World Health Organization. 1997 [1 December 2014]. In principle, INNs are selected only for the active part of the molecule which is usually the base, acid or alcohol. In some cases, however, the active molecules need to be expanded for various reasons, such as formulation purposes, bioavailability or absorption rate. In 1975 the experts designated for the selection of INN decided to adopt a new policy for naming such molecules. In future, names for different salts or esters of the same active substance should differ only with regard to the inactive moiety of the molecule. ... The latter are called modified INNs (INNMs). 
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  27. ^ 27.0 27.1 27.2 Spencer RC, Devilbiss DM, Berridge CW. The Cognition-Enhancing Effects of Psychostimulants Involve Direct Action in the Prefrontal Cortex. Biol. Psychiatry. June 2015, 77 (11): 940–950. doi:10.1016/j.biopsych.2014.09.013. PMID 25499957. The procognitive actions of psychostimulants are only associated with low doses. Surprisingly, despite nearly 80 years of clinical use, the neurobiology of the procognitive actions of psychostimulants has only recently been systematically investigated. Findings from this research unambiguously demonstrate that the cognition-enhancing effects of psychostimulants involve the preferential elevation of catecholamines in the PFC and the subsequent activation of norepinephrine α2 and dopamine D1 receptors. ... This differential modulation of PFC-dependent processes across dose appears to be associated with the differential involvement of noradrenergic α2 versus α1 receptors. Collectively, this evidence indicates that at low, clinically relevant doses, psychostimulants are devoid of the behavioral and neurochemical actions that define this class of drugs and instead act largely as cognitive enhancers (improving PFC-dependent function). This information has potentially important clinical implications as well as relevance for public health policy regarding the widespread clinical use of psychostimulants and for the development of novel pharmacologic treatments for attention-deficit/hyperactivity disorder and other conditions associated with PFC dysregulation. ... In particular, in both animals and humans, lower doses maximally improve performance in tests of working memory and response inhibition, whereas maximal suppression of overt behavior and facilitation of attentional processes occurs at higher doses.  引用错误:带有name属性“Unambiguous_PFC_D1_A2”的<ref>标签用不同内容定义了多次
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  29. ^ Long-term & Short-term effects, depressants, brand names: Foundation for a drug free work. 
  30. ^ 30.0 30.1 30.2 30.3 30.4 30.5 30.6 30.7 30.8 Malenka RC, Nestler EJ, Hyman SE. Chapter 13: Higher Cognitive Function and Behavioral Control. (编) Sydor A, Brown RY. Molecular Neuropharmacology: A Foundation for Clinical Neuroscience 2nd. New York, USA: McGraw-Hill Medical. 2009: 318, 321. ISBN 9780071481274. Therapeutic (relatively low) doses of psychostimulants, such as methylphenidate and amphetamine, improve performance on working memory tasks both in normal subjects and those with ADHD. ... stimulants act not only on working memory function, but also on general levels of arousal and, within the nucleus accumbens, improve the saliency of tasks. Thus, stimulants improve performance on effortful but tedious tasks ... through indirect stimulation of dopamine and norepinephrine receptors. ...
    Beyond these general permissive effects, dopamine (acting via D1 receptors) and norepinephrine (acting at several receptors) can, at optimal levels, enhance working memory and aspects of attention.
     
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    Physiologic and performance effects
     · Amphetamines increase dopamine/norepinephrine release and inhibit their reuptake, leading to central nervous system (CNS) stimulation
     · Amphetamines seem to enhance athletic performance in anaerobic conditions 39 40
     · Improved reaction time
     · Increased muscle strength and delayed muscle fatigue
     · Increased acceleration
     · Increased alertness and attention to task
     
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