Pemoline is a prescription medication commonly known as Cylert. As a central nervous system stimulant, pemoline is primarily used to treat children with attention-deficit hyperactivity disorder. It is also used to treat narcolepsy. Children taking pemoline are monitored for predicted growth rate, and breaks in therapy are sometimes needed. All patients require liver function monitoring due to possible liver toxicity.

Pemoline brand names

The primary pemoline brand name is Cylert.

What is pemoline prescribed for?

Pemoline is used in the treatment of attention-deficit hyperactivity disorder (ADHD) and narcolepsy.

It is a central nervous system (CNS) stimulant that, in ADHD, should be used as part of a holistic program. This means that treatment should include therapy (psychological treatment) and social and educational aids. Pemoline helps children living with ADHD to focus and be less hyperactive. It decreases restlessness, impulsivity, and emotional instability. Treatment allows the children to concentrate for longer and feel less distracted.

The treatment helps the ADHD child have an improved learning ability.

Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness that interferes with daily life. CNS stimulants improve alertness in patients suffering from narcolepsy, chronic lethargy, and prolonged depression that has been unresponsive to other treatments and therapies.

How does pemoline work?

Pemoline's exact mode of action and site of action are not known. Although it acts similarly to other known CNS stimulant medications, it generally tends to have different effects on the body.

Acting in the brain, pemoline improves alertness, focus, and behavior by raising levels of natural chemicals known as neurotransmitters.

Unlike other CNS stimulants, it has fewer sympathomimetic effects seen with other stimulants, e.g., increased heart rate. It is thought that the difference lies in its structure, which differs from the stimulants amphetamine and methylphenidate. This structural difference decreases the compound's affinity to noradrenaline receptors.

How is pemoline usually taken?

A mental health professional will guide you on the amount needed for you or your child. Different people will require a different dose, and it is up to your doctor to decide or find the correct dose. It is usually taken once a day in the morning via oral administration.

If using the chewable tablet, this should be chewed thoroughly before swallowing and should not be swallowed whole.

You should never change the amount prescribed by your doctor or the length of time they prescribed without discussing this with them. The average dosing for chewable tablets or oral tablets dosage forms is as follows:

  • Children six years and up: 37.5 mg to start, with a dose increase of up to 18.75 mg per week. The maximum dose is usually 112.5 mg per day. It may take up to three weeks to notice an effect after a dose increase. The amount is taken every day, once a day in the morning.
  • For children below six years: the dose must be determined by the mental health professional.

How long does pemoline stay in your system?

Pemoline is absorbed rapidly through the digestive system. The half-life of pemoline is twelve hours, meaning that half of the dose taken would be eliminated from the body after twelve hours.

It will be gone from the urine, blood, and saliva within two days, but traces of it will remain in the hair for up to 90 days.

Pemoline side effects

Common side effects can be mild and may go away within a few days or weeks. Continue to take pemoline but talk to your doctor if they become more severe and persistent:

  • Nervousness or anxiety
  • Headache
  • Drowsiness
  • Difficulty sleeping
  • Nausea
  • Decreased appetite or weight loss
  • Mild depression

Serious side effects can also occur. In this case, seek medical attention immediately and stop taking pemoline:

  • An allergic reaction with signs of swelling of the face, lips, tongue, or closing of the throat; difficulty breathing; hives
  • Seizures
  • Unusual and uncontrollable movements of the face, lips, tongue or arms and legs
  • Unusual behavior, including confusion and hallucinations (seeing things that are not there)
  • Liver damage as indicated by nausea, abdominal pain, vomiting, yellow eyes or skin, unexplained fatigue, itching, dark urine, or discolored feces)

Pemoline precautions

Before starting treatment with pemoline, your doctor will need to know whether you have any other conditions. This will determine if you need any dose adjustments or special monitoring during the treatment. The drug should never be given to those with impaired liver function. Tell your doctor if you currently have or have a history of:

  • Liver or kidney disease
  • Seizures or epilepsy
  • Tourette's syndrome
  • Drug/alcohol abuse

Always let your doctor know if you are pregnant, plan on trying for a baby, or are breastfeeding.

Pemoline can cause addiction. If you suspect that you, or someone you know, may have become physically or psychologically addicted to the medicine, you should speak to a healthcare professional.

Pemoline interactions

Always discuss concurrent diseases or medications with your doctor before starting pemoline. In particular, note the following:

Pemoline vs. epilepsy medications

A decreased seizure threshold has been reported when pemoline is given simultaneously with anti-epilepsy drugs. This means that the dose of either pemoline or the anti-epilepsy medicine needs to be adjusted to avoid seizures.

Pemoline vs. CNS stimulants

When pemoline is given simultaneously with another CNS stimulant, there is a high chance of increased agitation and/or anxiety. Other symptoms, such as behavior disturbance or hypertension, may also occur. This interaction can also lead to liver disease and dysfunction.

Pemoline vs. heart medications

There is a major potential hazard when giving pemoline together with heart medications. This can result in heart failure, stroke, chest pain, heart attack, severe hypertension, serious arrhythmias, and sudden death.

Pemoline storage

Pemoline should be stored in the container it came in, in a cool and dry place at room temperature. It should be kept from intense heat, moisture, and light sources. Do not freeze.

Any unwanted or expired medication should be safely disposed of. Contact your pharmacy or www.DEA.gov for information about National Prescription Drug Take Back Day.

Always keep medications out of sight and reach of children. This drug has the potential for abuse, so it should be accounted for carefully, especially around those with a history of drug addiction or abuse.

What to do if you overdose on pemoline

If you have taken an overdose or suspect someone you know may have done so, seek immediate medical attention. If possible, take the patient to a poison control center.

The signs of overdose include, but are not limited to:

  • Tremors or muscle twitches
  • Seizures
  • Agitation and nervousness
  • Vomiting
  • Hallucinations
  • Profuse and unexplained sweating
  • Fast or irregular heartbeat
  • Dilated pupils
  • Dry mouth or eyes

Overdose may result in severe, permanent, and life-threatening side effects.

Following an overdose, the patient may need to undergo gastric emptying or other means of detoxifying the gut, such as using activated charcoal. Sometimes other drugs are given to counteract the effects of the stimulant.

Frequently asked questions about pemoline

What should I do if I miss a dose of Cylert?

If you miss a dose, you should take/give the dose as soon as you remember unless it is almost time for another dose. If it is time for another dose, then you should skip the missed dose and take/give the next scheduled dose.

How long does it take for pemoline to work?

Unlike some other medicines used as stimulants, it may take pemoline (Cylert) around three to four weeks to exert its full effect. Therefore, you mustn't stop taking this medication or alter your dose without consulting your doctor. However, you should stop taking pemoline if you experience severe side effects, as listed on the patient information leaflet, or if a healthcare professional tells you to do so.

Resources:

  1.  Pemoline (Oral Route). (2022, February 14). Retrieved October 25, 2022, from https://www.mayoclinic.org/drugs-supplements/pemoline-oral-route/before-using/drg-20068359
  2.  Pemoline (Oral Route) Description and Brand Names. (2022b, February 14). Retrieved October 25, 2022, from https://www.mayoclinic.org/drugs-supplements/pemoline-oral-route/description/drg-20068359
  3. CNS stimulants. (n.d.). Drugs.com. Retrieved October 25, 2022, from https://www.drugs.com/drug-class/cns-stimulants.html
  4. Cylert (Pemoline): Uses, Dosage, Side Effects, Interactions, Warning. (2022, August 9). RxList. Retrieved October 25, 2022, from https://www.rxlist.com/cylert-drug.htm
  5.  Cylert (Pemoline): Uses, Dosage, Side Effects, Interactions, Warning. (2022b, August 9). RxList. Retrieved October 25, 2022, from https://www.rxlist.com/cylert-drug.htm
  6.  How Long Each Drug Stays In your Body: Drug Use Chart. (n.d.). Retrieved October 25, 2022, from http://www.passyourdrugtest.com/timetable.htm
  7.  Pemoline Uses, Side Effects & Warnings. (n.d.). Drugs.com. Retrieved October 26, 2022, from https://www.drugs.com/mtm/pemoline.html
  8. Cylert (Pemoline): Uses, Dosage, Side Effects, Interactions, Warning. (2022c, August 9). RxList. Retrieved October 26, 2022, from https://www.rxlist.com/cylert-drug.htm Pemoline Disease Interactions. (n.d.). Drugs.com. Retrieved October 26, 2022, from https://www.drugs.com/disease-interactions/pemoline.html