Auret, K. A., Schug, S. A., Bremner, A. P., & Bulsara, M. (2009). A randomized, double-blind, placebo-controlled trial assessing the impact of dexamphetamine on fatigue in patients with advanced cancer. Journal of Pain and Symptom Management, 37, 613–621.
To test the hypothesis that use of dexamphetamine in fatigued patients with advanced cancer would produce a clinically significant improvement with minimal side effects.
Patients with a prognosis of more than two months and fatigue rated at least 4 out of 10 were randomized to receive either dexamphetamine or lactose placebo. Patients were given a daily dose of 20 mg in two doses daily at 8 am and noon. Patients were contacted daily by telephone if at home to record acceptability and improve compliance. If the dose was not tolerated, it was reduced by 50%. The trial was conducted for eight days, and measurement was repeated every two days.
Single multisite study in a palliatve care service in Australia
The study was a randomized, double-blind, placebo-controlled trial.
A transient improvement was observed in fatigue in the dexamphetamine arm (p = 0.039) only on day 2 of the trial. No other significant differences existed between groups. Age and sex were significant predictors of severity of fatigue; those who were younger (p = 0.03) and male (p = 0.047) had more severe fatigue. Both groups had nonsignificant improvement in quality of life measures on some subscales, indicating a potential overall placebo effect. Medication was associated with an increased pulse rate, suggesting that the dosage given had a physiologic effect.
Although well tolerated, 20 mg of dexamphetamine does not improve fatigue or quality of life in patients with advanced cancer. This study agreed with null effects reported by others. Short-term results seen may indicate a response to initiation of a psychostimulant, and changing the dosage over time may have more effect.
Optimum dosage across studies has not been defined.