Simtriyo/Centanafadine

[u/last_1left]

Hi! I'm a pediatric social worker and one of the medical students doing a rotation in my program mentioned this new medication coming to the market for ADHD. I'm curious what prescribers have heard about this medication and what non-medical people should know as it gets rolled out. Open to any and all thoughts and opinions, or suggestions on where to look for more information!

[u/theongreyjoy96]

Not the best effect size at .24-.4, especially compared to the stimulants. It might have a place for patients with concomitant mood issues in theory given its serotonergic and dopaminergic activity, though I don’t think the med was evaluated for its effect on mood.

[u/police-ical]

Prediction: Very expensive weak-sauce drug whose claimed advantages will fall flat.

Triple reuptake inhibitors have been pursued for a long time, often falling flat for safety and/or addiction concerns. Manufacturer will claim low misuse potential, we've all heard that one before. Note that cocaine is the original triple reuptake inhibitor, and follow cautiously for reports of misuse. It has a black box warning for addiction and will be controlled, hasn't been scheduled yet.

Effect size in ADHD appears to be smaller than stimulants and atomoxetine, so hard to justify a controlled substance at what will surely be an exorbitant price. Adverse effects appear stimulant-like, plus a surprising rate of rash in child/adolescent which is unusual for reuptake inhibitors. Also has a black box warning for suicidality, which rather than the blanket one for antidepressants is based on specific clinical data for this drug, also a bit concerning that the signal popped up that easily and soon. I have no reason to believe this is a safer, better-tolerated, or less-addictive drug than methylphenidate, but I do have reason to believe it's less effective.

So, how would you sell a crappy drug for way more money? Even before approval the manufacturer was clearly preparing a massive campaign (see the "All of ADHD" ads with feckless shill Rakesh Jain already clogging Reddit) which will likely imply that this drug will be a panacea for peripheral anxious and depressive symptoms in addition to core symptoms. This will likely be based on preclinical and marginal secondary analyses, despite a total lack of head-to-head comparisons that would actually establish such a claim.

There is zero evidence this is a better option than existing cheap drugs for any indication. Atomoxetine and guanfacine are good anxiolytics, bupropion and nortriptyline good antidepressants, and even classical stimulants can improve anxious and depressive symptoms (especially subthreshold or when closely tied to core inattentive/hyperactive symptoms.)

[u/cafermed]

It's similar to methylphenidate. Compared to amphetamine and methylphenidate stimulants: potential for rash and severe hypersensitivity reactions, less effective, boxed warning for suicidal thoughts and behaviors, more expensive, more potential drug-drug interactions, doubles caffeine, dose-dumping with alcohol. Plenty of downside and no upside.

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[u/Tendersituation00]

Understand that "this new medication"(s) are rarely game changers and that 1) it takes years to find out if they actually deliver what the manufacturers monkey with data to show and 2) If it ever can get paid for.

Honestly, when there is discussion social workers and therapist trying to stay on top of new psychiatric medication info it me ITchY! (sorry bot got me last time) because that's really a prelude to a misinformed clinician not staying in their lane and making medication recommendations about medicines they don't really understand nor will they ever be in a position to prescribe. "MYthe rap!st told me about this new medication" is the same thing as "MYthe rap!st told me you are supposed to give me a blood test which shows which medications work for me" I've heard that only a thousand times in the last 12 years. Edit: Bot got me bad. Had to go to the Method One school of acting on this one with the word therapist

[u/KimJong_Bill → u/Tendersituation00]

Oh the irony