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Show your face!

 Editorial  Are there any amphetamine derivatives still on the market? Yes, and healthcare professionals would do well to be able to spot them in order to anticipate their effects, in particular their adverse effects, and especially their cardiovascular adverse effects.

International nonproprietary names (INNs) are helpful in this regard, since the INNs for amphetamine derivatives contain the stem “orex” (as in benfluorex, formerly marketed as Mediator° for example) or “amfe” (extensively used in the INNs of amphetamine derivatives, even though it is not listed as an official stem).

An INN stem may only be a few letters long, but it conveys very useful information. Information that can, on occasion, prevent healthcare professionals being misled by statements from drug companies and even drug regulatory agencies. Solriamfetol, for example, has been authorised under the brand name Sunosi° for use in certain patients with narcolepsy or obstructive sleep apnoea, and its INN contains the stem "amfe" because it is an amphetamine derivative (see "Solriamfetol and sleepiness due to narcolepsy or sleep apnoea" > Pdf, Subscribers only). Yet none of the documents we consulted, whether from drug regulatory agencies or the pharmaceutical company, clearly state that solriamfetol is an amphetamine-like drug. Aspects of its mechanism of action that differ from amfetamine are emphasised, yet its chemical structure and its effects in animals are indeed those of amphetamines.

The adverse effects of solriamfetol in humans include the known adverse effects of amphetamines, in the short term. It is therefore important to demand robust evidence of its benefits (if any) and to evaluate the consequences of its long-term use before exposing patients to this drug in routine practice.

We must draw lessons from France’s Mediator° disaster, where the amphetamine-like effects of benfluorex were too long ignored, denied or concealed (see "Mediator° – the criminal trial. A special section from Prescrire International" > HERE).

©Prescrire 1 July 2021

Source: "Show your face!" Prescrire International 2020; 29 (228): 171. Free

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For more information:

"Solriamfetol (Sunosi°)
and sleepiness due to
narcolepsy or sleep apnoea:
an amphetamine with poorly
documented cardiovascular harms"
Prescrire International 2021;
29 (228): 171.
Pdf, subscribers only

"The INN, a drug's real name"
Advancing healthcare policy

"Mediator° – the criminal trial.
A special section from
Prescrire International"

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