Amphetamine

Absolute contraindication in patients with known structural cardiac abnormalities including cardiomyopathy, valvular disease, or congenital heart defects. Case literature documents irreversible ischemic cardiomyopathy with chronic use.

Relative contraindication. Therapeutic use requires baseline and ongoing blood pressure monitoring. Uncontrolled hypertension should be treated before initiating amphetamine therapy.

Relative contraindication. Patients with epilepsy or history of seizures require careful risk-benefit assessment. Seizure risk increases with dose.

Absolute contraindication in patients with active psychosis or history of psychotic disorders. Amphetamine psychosis is clinically indistinguishable from paranoid schizophrenia and can be precipitated even at therapeutic doses in vulnerable individuals.

Relative contraindication. Some bipolar patients with comorbid ADHD receive carefully monitored stimulant therapy with concurrent mood stabilization, but the risk of mania induction requires individualized assessment.

Relative contraindication. Amphetamine should be avoided in uncontrolled hyperthyroidism. Euthyroid patients on stable thyroid replacement may be considered with monitoring.

Absolute contraindication. Amphetamine use during pregnancy is associated with congenital anomalies, low birth weight, and adverse obstetric outcomes. Animal models show long-lasting epigenetic changes in DAT regulation.

Absolute contraindication. A minimum 14-day washout after MAOI discontinuation is required before amphetamine initiation. This is the most dangerous pharmacodynamic interaction for amphetamine.

Relative contraindication, primarily for narrow-angle glaucoma. Open-angle glaucoma may be manageable with monitoring.