CNS stimulants: Uses, common brands, and safety info

Central nervous system (CNS) stimulants are a class of drugs that can help promote focus, increase alertness, and decrease appetite. They are often used to treat mental health disorders like ADHD and sleep disorders like narcolepsy. CNS stimulants cover a broad range of natural substances and prescription medications, from caffeine to dextroamphetamine. Prescription CNS stimulants work directly on the central nervous system to increase the levels of certain chemicals, or neurotransmitters, such as dopamine and norepinephrine.  

Continue reading to learn more about CNS stimulants, their therapeutic uses, and side effects.

What are CNS stimulants?

CNS stimulants are prescription drugs that increase the activity of the central nervous system. These medications can have different therapeutic effects, including increased alertness and attention. These effects can be beneficial for the treatment of different mental health disorders. However, CNS stimulants are also controlled substances that can have addictive properties.  

CNS stimulants are often used to treat symptoms of attention deficit hyperactivity disorder (ADHD), such as inattention, restlessness, and impulsive behavior. They may also be used to treat excessive sleepiness associated with narcolepsy or other sleep disorders. Prescription stimulants used for ADHD or narcolepsy (excessive sleepiness) include amphetamines, methylphenidate, and modafinil. Some CNS stimulants, such as cocaine, ecstasy, and MDMA (methylenedioxymethamphetamine), are not prescribed, because they have a high potential for abuse. 

CNS stimulant tablets can vary in formulation, such as oral tablets, capsules, solutions, and transdermal patches. They may also have different durations of action. Long-acting or extended-release tablets can be taken once daily and may be preferred for people taking multiple medications. Immediate-release formulations may be more suitable for people who prefer a flexible dosing schedule. 

How do CNS stimulants work?

Central nervous system stimulants generally work by increasing catecholamine levels in the brain. Catecholamines are a group of neurotransmitters that include norepinephrine and dopamine. CNS stimulants work by blocking the reuptake of norepinephrine and dopamine in the brain. They may also directly increase the release of these neurotransmitters in the brain. Norepinephrine and dopamine are believed to be involved with different physical and mental processes like attention, mood, and motivation. 

Clinical controlled trials have shown that amphetamines are effective stimulants for treating conditions like ADHD and narcolepsy. Some trials found that amphetamines, including methylphenidate, relieve symptoms in 55 to 70% of patients with ADHD and 65 to 85% of patients with narcolepsy. Stimulants may be beneficial for children, adolescents, and adults with ADHD; according to a meta-analysis, methylphenidate is the preferred choice in children while amphetamines are the preferred choice in adults. 

CNS stimulants, like dextroamphetamine and methylphenidate, can help stimulate increased activity in the brain. However, they can also have other effects in the body. Catecholamines are involved with the body’s fight-or-flight response during stressful situations. CNS stimulants can increase norepinephrine levels, which can lead to increased blood pressure, increased heart rate, and narrowed blood vessels. 

What are CNS stimulants used for?

CNS stimulants may be prescribed to treat various physical and mental health disorders, including obesity, sleep disorders, and neurological disorders. FDA approved indications include the treatment of ADHD, narcolepsy, and obesity. However, CNS stimulants may also be used off-label for different conditions like postural orthostatic tachycardia syndrome (POTS) and treatment-resistant depression. 

• ADHD (attention deficit hyperactivity disorder)

• Narcolepsy

• Shift work disorder 

• Chronic lethargy

• Neonatal apnea

• Obstructive sleep apnea

• Obesity

• Postural orthostatic tachycardia syndrome (POTS)

• Treatment-resistant depression

Prescription stimulants, like amphetamines or methylphenidate, are a first-choice option for treating ADHD. Other stimulants, like modafinil, are preferred for sleep disorders, including narcolepsy, shift work disorder, and obstructive sleep apnea. Phentermine has stimulant effects and is used as an appetite suppressant for treating obesity. 

Who can take CNS stimulants?

Adults

CNS stimulants are approved for treating adults with mental health and sleep disorders, among other conditions. They may be prescribed for short-term or long-term treatment, and they may also be combined with other forms of treatment, such as talk therapy. Adults should use CNS stimulants as prescribed to avoid the risk of side effects. 

Children

CNS stimulants are often prescribed to children with ADHD. Treatment with stimulants is usually combined with behavioral therapy to improve symptoms like inattention and learning difficulties. There may be different age restrictions depending on the stimulant prescribed. For example, regular Adderall is not approved for children under the age of three years old, and Ritalin is not approved for children under the age of six years old. 

Seniors

CNS stimulants are not usually prescribed for the elderly (aged 65 and older) due to an increased risk of adverse effects. These medications may be effective and safe in the elderly for certain conditions, such as treatment-resistant depression. However, stimulants can increase blood pressure and heart rate. Older adults are at an increased risk of cardiovascular events, like heart attack and stroke, when using CNS stimulants. 

Can you take CNS stimulants while pregnant or breastfeeding?

There is not enough available research on whether CNS stimulants are safe in women who are pregnant or breastfeeding. If you are pregnant or breastfeeding, you should weigh the benefits and risks of taking stimulants and seek medical advice from a healthcare provider. CNS stimulants may cause adverse effects during pregnancy or breastfeeding. 

Are CNS stimulants safe?

CNS stimulants are safe and effective when used as directed by a doctor. These medications carry a risk of misuse, abuse, and dependence, and they should only be used with a prescription.

Tell your doctor if you have a history of any of the following before taking a CNS stimulant.

• Heart problems, including heart defects and heart rhythm problems

• High blood pressure

• Heart attack or stroke

• Glaucoma

• Thyroid problems

• Kidney or liver disease

• Seizures

• Tourette’s syndrome

• Agitation

• Depression or other mental health disorders

• Drug abuse or alcohol addiction

Black Box Warnings

Yes, CNS stimulants have a black box warning. CNS stimulants carry an FDA warning for abuse and dependence. Monitor for signs of abuse and dependence during treatment with a CNS stimulant. 

CNS stimulant recalls

There are no current CNS stimulant drug recalls.

CNS stimulant restrictions

CNS stimulants should be avoided in individuals who have a history of drug abuse and dependence. Misuse of this medication can increase the risk of overdose and other complications. 

People who are allergic to any ingredients in CNS stimulants should not take these medications. People who are taking or have taken a monoamine oxidase inhibitor (MAOI) during the last 14 days should not start treatment with a CNS stimulant. 

Certain drugs can interact with prescription stimulants. Use caution or avoid taking CNS stimulants if you are also taking antidepressants, blood pressure medications, or opioids. Before taking a stimulant, tell your doctor if you are also taking other medications, including prescription drugs, over-the-counter medicine, and herbal supplements. 

Are CNS stimulant controlled substances?

Yes, CNS stimulants are controlled substances due to their risk of abuse and dependence. Stimulants may be placed under different schedules depending on their level of risk. Those widely used for ADHD and narcolepsy are classified as Schedule II drugs while stimulant medications for the treatment of obesity are placed in Schedule III or Schedule IV.  

Common CNS stimulants side effects

CNS stimulants can cause different side effects. Different factors, such as dosage, age of the treated person, and the specific medication prescribed can affect the occurrence of side effects. Common CNS stimulant side effects include:

• Headache

• Restlessness

• Insomnia

• Anxiety or nervousness

• Loss of appetite 

• Weight loss

• Dry mouth 

• Upset stomach

• Increased sweating or itching

Severe CNS stimulant side effects may include:

• Abnormal heart rhythm (arrhythmia)

• Rapid heartbeat (tachycardia)

• Heart palpitations

• Chest pain 

• High blood pressure

• Seizures

• Shortness of breath

• Psychosis

• Paranoia

• Blurred vision

• Cardiac arrest

Long-term CNS stimulant use may result in tolerance, abuse, and dependence. These medications may also increase the risk of a stroke or heart attack, especially in people with a history of cardiovascular disease. 

Most side effects of stimulants are mild and temporary, and severe side effects are usually attributed to incorrect dosing and misuse. Stimulants are often started at a low dose to assess any side effects that may arise. A healthcare provider will monitor a person through regular office visits as stimulant side effects can vary by individual. 

How much do CNS stimulants cost?

Prescription stimulants are available in brand name and generic versions. Most prescription insurance plans help cover the cost of stimulant medications. However, the costs of the medications with insurance will depend on the insurance plan, drug, and quantity of the drug prescribed. Talk to your pharmacist or insurance provider to determine the costs of your prescription. Using a prescription discount card from SingleCare may help reduce the cost of CNS stimulants at participating pharmacies.