NOTE: Amphetamine derivatives are Note R (Schedule II).
Cautions and warnings.
(a) Patients taking amphetamine derivatives develop tolerance and
psychological dependence with chronic use.
(b) Amphetamine derivatives should be used cautiously with patients
who have arteriosclerosis, cardiovascular disease, glaucoma, hypertension, and
(4) Side effects. Side effects commonly seen in patients who take
amphetamine-like products are restlessness, tremor, hyperactive reflexes, irritability,
insomnia, euphoria, and confusion.
(1) Pharmacological effects. Ephedrine directly stimulates both alpha and
beta-receptors and indirectly stimulates Alpha-receptors by causing release of
norepinephrine. Ephedrine is similar to epinephrine; however, it is longer acting and
produces more effect on the central nervous system (CNS). Ephedrine produces
cardiovascular effects similar to those produced by epinephrine. Finally, the bronchial
muscle relaxation produced caused by ephedrine is less intense, but more sustained
than that caused by epinephrine.
(2) Indications. Ephedrine is most commonly used as a bronchodilator. It is
also used as a nasal decongestant, as a treatment for narcolepsy, and as agent to
control blood pressure in patients under the effects of spinal and epidural anesthesia.
(3) Caution and warning. Ephedrine is contraindicated in patients who have
severe hypertension and chronic heart disease.
(1) Pharmacological effects. Metaraminol produces alpha stimulation with
beta1 effects. The vasoconstriction produced by metaraminol is very pronounced. The
beta1 effects produced by metaraminol are similar to epinephrine. Overall, metaraminol
produces less potent and longer duration with more gradual onset than the effects
produced by norepinephrine.
(2) Indications. Metaraminol is indicated in the treatment of hypotensive
states (that is, shock); however, it must be used with caution because it increases the
myocardium's demand of oxygen.