Central serous chorioretinopathy associated with Adderall (dextroamphetamine-amphetamine) and topical steroid use

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Abstract

Purpose

To report a case of central serous chorioretinopathy (CSC) associated with Adderall (dextroamphetamine-amphetamine) and topical steroid use.

Observations

A 34-year-old man presented for evaluation of a “cloud” in his vision for three months. He was taking Adderall for attention deficit hyperactivity disorder and mometasone 0.1% topical cream for eczema. He was found to have subretinal fluid in the left eye consistent with CSC. The subretinal fluid persisted despite cessation of the steroid cream but resolved after cessation of the Adderall. The subretinal fluid returned when the patient restarted Adderall and again resolved after he stopped it for a second time.

Conclusions

Though we cannot prove causality, the course of events was suggestive of a direct relationship between Adderall use and CSC in this patient, with exogenous steroid as a possible modifying factor.

Related collections

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Amphetamine was discovered over 100 years ago. Since then, it has transformed from a drug that was freely available without prescription as a panacea for a broad range of disorders into a highly restricted Controlled Drug with therapeutic applications restricted to attention deficit hyperactivity disorder (ADHD) and narcolepsy. This review describes the relationship between chemical structure and pharmacology of amphetamine and its congeners. Amphetamine’s diverse pharmacological actions translate not only into therapeutic efficacy, but also into the production of adverse events and liability for recreational abuse. Accordingly, the balance of benefit/risk is the key challenge for its clinical use. The review charts advances in pharmaceutical development from the introduction of once-daily formulations of amphetamine through to lisdexamfetamine, which is the first d-amphetamine prodrug approved for the management of ADHD in children, adolescents and adults. The unusual metabolic route for lisdexamfetamine to deliver d-amphetamine makes an important contribution to its pharmacology. How lisdexamfetamine’s distinctive pharmacokinetic/pharmacodynamic profile translates into sustained efficacy as a treatment for ADHD and its reduced potential for recreational abuse is also discussed.

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Author and article information

Contributors

Joseph B. Alsberge

Journal

Journal ID (nlm-ta): Am J Ophthalmol Case Rep

Journal ID (iso-abbrev): Am J Ophthalmol Case Rep

Title: American Journal of Ophthalmology Case Reports

Publisher: Elsevier

ISSN (Electronic): 2451-9936

Publication date PMC-release: 09 March 2022

Publication date Collection: June 2022

Publication date (Electronic): 09 March 2022

Volume: 26

Electronic Location Identifier: 101482

Affiliations

[a ]Department of Ophthalmology, Northwest Permanente, Portland, OR, USA

[b ]West Coast Retina Medical Group, San Francisco, CA, USA

[c ]Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA

Author notes

[∗ ]Corresponding author. Department of Ophthalmology, Northwest Permanente, 14406 NE 20th Ave., Vancouver, WA, 98686, USA. joseph.b.alsberge@ 123456kp.org

Article

Publisher Item ID: S2451-9936(22)00228-6 Publisher ID: 101482

DOI: 10.1016/j.ajoc.2022.101482

PMC ID: 8924628

SO-VID: cabce3e4-b6aa-42bd-b1fa-850aef1f4e39

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 11 November 2021

Date revision received : 6 March 2022

Date accepted : 7 March 2022

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