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Table 2. Centrally Acting Stimulants for Adult Cancer Patients

Drug Dosage Comments/Primary Side Effects 
AUC = area under the curve; MAOI = monoamine oxidase inhibitor; SSRI = selective serotonin reuptake inhibitor.
Dextroamphetamine (Dexedrine)2.5 mg/d (start)Schedule II. Major potential interactions with citalopram and venlafaxine.
5–30 mg/d in 2 to 3 divided doses
Methylphenidate (Ritalin)2.5 mg/d (start)Schedule II. High-fat meals may increase AUC. Peak concentration 102 hours after ingestion. Do not use with MAOIs as it can precipitate hypertensive crisis. Antidepressants that increase norepinephrine can cause increased amphetamine side effects. Concomitant use with SSRI can result in increased SSRI concentrations.
Titrate up to 54 mg/d (27 mg D-isomer)
Modafinil (Provigil)50–100 mg (start)Schedule IV. Avoid driving/operation of machinery until effects are known. Do not take at bedtime. Peak concentration in 2–4 hours. Food slows absorption by about 1 hour but does not affect bioavailability. Decreases efficacy of birth control pills.
100–200 mg every morning
Armodafinil (Nuvigil)50 mg (start)Schedule IV. Avoid driving/operation of machinery until effects are known. Do not take at bedtime. Peak concentration in 2 hours if fasting, slowed to as many as 4 hours if fed, but food does not affect bioavailability. Decreases efficacy of birth control pills.
25–250 mg every morning