You have great sections on here describing how to changes meds given renal impairment — however there isn’t a section regarding stimulants.
For a 70 year old female with ADHD, GFR: 39 (BUN: 13, Creat: 1.37) , any concerns that a low-dose stimulant (like methylphenidate) would make kidney function worse? Stahl says no need to change dose of methylphenidate based on renal function, but I’m just wondering if those with renal function impairment could have worsening of renal function with stimulant use. Thx!
The “low dose” use of stimulants is safe in the elderly. I will stay cautious in patients with end-stage renal disease (by using lower doses) and not in patients with mild, moderate, or severe renal impairment. Read this study to learn more on this: PubMed.
Overall, low dose stimulants have shown efficacy in the following disorders in elderly:
Geriatric depression secondary to medical illness: Dextroamphetamine (average maximal daily dose of 8.2 mg/day) and methylphenidate (maximal daily dose averaging 9mg/day).
Post-stroke depression: Methylphenidate (mean dose of 17mg daily). read more on this topic here: Chapter
Major depression resistant to other treatment: Methylphenidate (ranged between 5 and 20 mg daily)
Apathy, Negative symptoms with dementia: Methylphenidate (ranging from 10 to 20 mg/day)
Improving falls: Methylphenidate (10mg single dose)
The list is long. Let me know if you want me to post a chapter with a summary on this topic.