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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/11/13 22:39:46」(JST)

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"Adderall" redirects here. For amphetamine as a general drug or chemical, see amphetamine.

Amphetamine mixed salts (also known as amphetamine and dextroamphetamine mixed salts, amphetamine salt combo, or simply amphetamine salts, and sold under the brand name Adderall) is a pharmaceutical drug used in the treatment of attention deficit hyperactivity disorder (ADHD) and narcolepsy. The active ingredient contained in this medication is a mixture of multiple salts of the stimulant amphetamine. There is a single commercial formulation only as of 2013, which contains a 3:1 ratio of dextroamphetamine (the dextrorotary or "right-handed" enantiomer) to levoamphetamine (the levorotary or "left-handed" enantiomer^[1]). Amphetamine mixed salts are available in immediate release and extended release formulations.

1 Uses
- 1.1 Medical
  - 1.1.1 Attention deficit hyperactivity disorder
  - 1.1.2 Dosing and administration
- 1.2 Performance-enhancing
- 1.3 Recreational
2 Psychological effects
3 Side effects
- 3.1 Physical
- 3.2 Overdose
- 3.3 Dependence, addiction and withdrawal
- 3.4 Contraindications, interactions, and precautions
- 3.5 Psychosis
4 Mechanism of action
- 4.1 Pharmacokinetics
- 4.2 Detection of use
5 History
- 5.1 Patent disputes
6 Commercial formulations
- 6.1 Historical
- 6.2 Current
7 Legal status
8 References

Uses[edit]

Medical[edit]

Amphetamine mixed salt is generally used for the treatment of ADHD and narcolepsy, the two conditions for which the United States Food and Drug Administration has approved its use.^[2] However, it is sometimes prescribed off-label for other conditions such as depression. It has been used to treat obesity, but the American Society of Health-System Pharmacists does not recommend this use.^[3] Nearly 14 million monthly prescriptions for the condition were written for Americans ages 20 to 39 in 2011, two and a half times the 5.6 million just four years before, according to the data company I.M.S. Health.^[4]

In non-human primates, long-term exposure to amphetamine throughout adolescence has no discernible adverse effect on their physiology, behavior, or dopamine system development.^[5]^[6]

Attention deficit hyperactivity disorder[edit]

The comparative effectiveness of treatment options for children with ADHD, including different amphetamine medications, has been studied by the US Agency for Health Care Research and Quality,^[7] and summarized for parents.^[8] Amphetamines may improve ADHD symptoms in children over the age of six, but there is not enough evidence to be sure.^[7] Use for younger children and use for longer than a year in particular requires further study.^[7]

Amphetamine mixed salts have also been shown to reduce ADHD in adults, but research is limited.^[9] According to Millchap et al., "a multicenter, placebo-controlled trial of amphetamine treatment for ADHD in Sweden found significant improvements in attention, hyperactivity, and disruptive behaviors and a mean change in IQ of +4.5 after more than 9 months of amphetamine [use];" however, the authors note that the population in the study had a remarkably high incidence of comorbid disorders associated with ADHD.^[10] Consequently, they asserted that other long-term trials of stimulants in ADHD with less comorbidity would be expected to show greater functional improvements and fewer side effects.^[11]

Dosing and administration[edit]

Amphetamine mixed salts is available as immediate release form or extended-release form.^[12] The extended release capsule is generally used in the morning.^[13] Generic forms are available in some doses.^[8] The extended release formulation available under the brand Adderall XR is designed to provide therapeutic effect and plasma concentrations identical to taking two doses 4 hours apart.^[14]

Performance-enhancing[edit]

Therapeutic doses of psychostimulants, like amphetamine and methylphenidate, improve performance on working memory tests both in normal functioning individuals and those with ADHD; moreover, these stimulants also act on general levels of arousal and, within the nucleus accumbens, improve task saliency.^[15] Thus, stimulants improve performance on effortful and tedious tasks as well.^[15] Consequently, Adderall, an amphetamine mixture, is used by some college and high-school students as a study and test-taking aid.^[16] In contrast, at abused (much higher) doses, stimulants can interfere with working memory and cognitive control.^[15]

In addition, amphetamine is also used by some professional, collegiate and high school athletes for its strong stimulant effects;^[17]^[18]^[19] in competitive sports, this form of use is prohibited by anti-doping regulations.^[19] At moderate therapeutic doses, amphetamine has been shown to increase physical strength,^[19] acceleration,^[19] stamina,^[19]^[20] and endurance,^[19]^[20] while reducing reaction time.^[19] Like methylphenidate and bupropion, amphetamine increases stamina and endurance in humans primarily through reuptake inhibition and effluxion of dopamine in the central nervous system.^[20]

Recreational[edit]

Amphetamine is considered to have a high potential for misuse and a high liability for dependence and listed as Schedule II in the US,^[21]^[22] Schedule II in the UN Convention of Psychotropic Substances and Schedule I in Canada (CSA).^[23] Amphetamine mixed salts is a drug of abuse.^[24] Amphetamine salts can be crushed, and snorted or dissolved in water and injected.^[25] Injection into the bloodstream can be dangerous because insoluble fillers within the tablets can block small blood vessels.^[25]

Recreational use of amphetamines is exceedingly dangerous, especially when used at very high doses. Research has shown that amphetamine binges in lab animals cause neurotoxicity in dopaminergic pathways, resulting in permanent but not irreversible cognitive impairments.^[26] Moreover, extremely high doses of amphetamine can induce rapid muscle breakdown, repetitive or stereotyped behaviors, catecholaminergic/adrenergic storm, and coma.^[27]^[28] An amphetamine overdose is rarely fatal with appropriate care.^[29]

In 2012, the US National Institute on Drug Abuse (NIDA) published the following prevalence statistics for adolescent use of prescription amphetamine and Adderall within the past year:^[30]

	Amphetamine	Adderall
8th-graders	2.90%	1.70%
10th-graders	6.50%	4.50%
12th-graders	7.90%	7.60%

Psychological effects[edit]

Psychological effects can include euphoria, anxiety, increased libido, alertness, concentration, energy, self-esteem, self-confidence, sociability, irritability, psychosomatic disorders, psychomotor agitation, grandiosity, repetitive and obsessive behaviors, and paranoia. With chronic and/or high doses, amphetamine psychosis can occur. Occasionally this psychosis can occur at therapeutic doses during chronic therapy as a treatment emergent side effect.^[31]^[32] According to the US FDA, "there is no systematic evidence that stimulants cause aggressive behavior or hostility."^[33]

Side effects[edit]

Physical[edit]

At normal therapeutic doses, the physical side effects of amphetamine vary widely by age and among individuals;^[33] these side effects can include abdominal pain, acne, arrhythmias, blood shot eyes, blurred vision, bruxism, constipation, diaphoresis, diarrhea, dilated pupils, dizziness, dry and/or itchy skin, dry mouth, erectile dysfunction, fever, flushing, headache, hypertension or hypotension, indigestion, insomnia, loss of appetite, mood swings, nausea, nervousness, numbness, pallor, palpitations, Raynaud's phenomenon (secondary), reduced seizure threshold, restlessness, tachycardia, tachypnea, tics, vasoconstriction or vasodilation, vomiting, and weight loss.^[33]^[34] Dangerous physical side effects are exceedingly rare in typical pharmaceutical doses.^[35] Amphetamines stimulate the medullary respiratory centers, which increases the rate of respiration and produces deeper breaths.^[36] In a normal individual, amphetamines do not noticeably increase the rate of respiration or produce deeper breaths, but when respiration is already compromised, amphetamines may stimulate respiration.^[36]

Recent studies by the FDA indicate that, in children, young adults, and adults, there is no association between serious adverse cardiovascular events (sudden death, myocardial infarction, and stroke) and the medical use of amphetamines or other ADHD stimulants.^[37]^[38]^[39]

Amphetamine mixed salts is in FDA pregnancy category C.^[2] This means that detriments to the fetus have been observed in animal studies, that adequate human studies have not been conducted, and that it may still be prescribed to pregnant women in some circumstances.^[40] Studies on rats show long-term neurological and behavioral changes resulting from prenatal and early postnatal exposure to amphetamines.^[41]^[42]

A study on comparative effects between amphetamine mixed salts and methylphenidate in children who have been treated for a year or more have shown a temporary decrease in growth rate that does not affect final adult height. Change in weight was reported as slightly greater for amphetamine mixed salts and authors concluded that the result may be clinically insignificant.^[43]

Overdose[edit]

An amphetamine overdose is rarely fatal with appropriate care,^[29] but can lead to a number of different symptoms that vary widely among individuals.^[33] A moderate overdose may induce symptoms including: agitation, arrhythmia, confusion, dysuria, hypertension or hypotension, hyperreflexia, myalgia, tachypnea, tremor, urinary hesitancy, and urinary retention.^[33]^[36] An extremely large overdose may produce symptoms such as adrenergic storm, anuria, cardiogenic shock, circulatory collapse, hyperthermia, psychosis, pulmonary hypertension, renal failure, rhabdomyolysis, serotonin syndrome, and stereotypy.^[27]^[28]^[32]^[33]^[36]^[44]^[45] Fatal amphetamine poisoning usually also involves convulsions and coma.^[33]

Dependence, addiction and withdrawal[edit]

Tolerance is developed rapidly in amphetamine abuse; therefore, periods of extended use require increasing amounts of the drug in order to achieve the same effect.^[46] According to a Cochrane Collaboration review on the topic, "when chronic heavy users abruptly discontinue amphetamine use, many report a time-limited withdrawal syndrome that occurs within 24 hours of their last dose."^[47] This review noted that withdrawal symptoms in chronic, heavy users are frequent, occurring in up to 87.6% of cases, and persists for three to four weeks with a marked "crash" phase occurring during the first week.^[47] Amphetamine withdrawal symptoms can include fatigue, dysphoric mood, increased appetite, vivid or lucid dreams, hypersomnia or insomnia, suicidal ideation, increased movement or decreased movement, anxiety, and drug craving.^[47]

Contraindications, interactions, and precautions[edit]

MAOIs (monoamine oxidase inhibitors, e.g., phenelzine, selegiline, iproniazid, etc.) —There is a high risk of a hypertensive crisis if amphetamine is administered within two weeks after last use of an MAOI type drug. Preliminary trials of low-dose amphetamine and MAOIs being administered together are in progress. However, this is to be done only under strict supervision of the prescribing parties.
SSRIs (selective serotonin reuptake inhibitors, e.g., fluvoxamine, citalopram, paroxetine, etc.) — While a common combination, and although rare, the risk for serotonin syndrome exists. (Use only when directed)
NRIs (norepinephrine reuptake inhibitors, e.g., atomoxetine, etc.) — NRI medications and amphetamine both enhance noradrenergic activity. Possible augmentation/potentiation of effects. (Use only when directed)
SNRIs (selective serotonin-norepinephrine reuptake inhibitors) — See SSRIs and NRIs.
Bupropion — Both bupropion and amphetamine have noradrenergic and dopaminergic activity. Bupropion is a potent CYP2D6 inhibitor. Bupropion has pro-convulsant properties that may be enhanced or cumulatively potentiated by amphetamine.^[48] (Use only when directed)
Monoaminergic tricyclic antidepressant — See NRIs, SNRIs, and SSRIs. Possible potentiation of serotonin-, dopamine-, and/or norepinephrine-related drug effects. The combination of monoaminergic tricyclics and amphetamine compounds has been associated with increased sympathomimetic effects. The exceptions to this class (i.e. non-monoaminergic tricyclic antidepressants) include the glutamatergic tricyclic tianeptine and sigmaergic tricyclic opipramol.
CYP2D6 (liver enzyme) inhibitors, e.g., Bupropion and most SSRIs such as fluoxetine, citalopram, paroxetine, etc. Some anti-psychotics such as thioridazine, haloperidol, and levomepromazine, as well as cocaine, the opioid agonist methadone, and others. It is important to determine if any medication or drug taken is a CYP2D6 inhibitor. Taking a CYP2D6-inhibiting drug along with amphetamine will lead to an elevated level of amphetamine in the system, resulting in the drug's remaining in the body for a longer period, which can lead to undesirable and possibly serious side effects.
Individuals with pre-existing cardiac conditions or mental illnesses.
Individuals with a history of drug abuse

Psychosis[edit]

Main article: Stimulant psychosis

Abuse of amphetamines can result in a stimulant psychosis which may present with a variety of symptoms (e.g. paranoia, hallucinations, delusions). A Cochrane Collaboration review on treatment for amphetamine, dextroamphetamine, and methamphetamine induced psychosis^[49] states that about 5-15% of users fail to recover completely.^[50] The same review asserts that, based upon at least one trial, antipsychotic medications effectively resolve the symptoms of acute amphetamine psychosis.^[49] An amphetamine psychosis may also develop occasionally as a treatment-emergent side effect.^[31]

Mechanism of action[edit]

Main article: Amphetamine#Pharmacology

Amphetamine has been identified as a potent agonist of trace amine-associated receptor 1 (TAAR1) (aka "TAAR1"), a GPCR, discovered in 2001, that is important for regulation of monoaminergic systems in the brain.^[51] Activation of TAAR1 increases cAMP production via adenylyl cyclase activation and inhibits the function of the dopamine transporter, norepinephrine transporter, and serotonin transporter, as well as induce effluxion of these neurotransmitters.^[51]^[52]^[53]^[54]^[55] Amphetamine is a substrate for a specific neuronal synaptic vesicle uptake transporter called VMAT2.^[56] When amphetamine is taken up by VMAT2, the vesicle releases (effluxes) dopamine, norepinephrine, and serotonin, among other monoamines, into the cytosol in exchange.^[56]

Dextroamphetamine (the dextrorotary enantiomer) and levoamphetamine (the levorotary enantiomer) have different pharmacological properties.^[57] Dextroamphetamine is several times more potent in the central nervous system than levoamphetamine, but the two isomers have comparable activity in the peripheral nervous system.^[58] The overall greater potency of dextroamphetamine to central actions suggests that this form may have a higher potential for abuse.^[59]

Levoamphetamine provides mixed amphetamine salts quicker onset and longer-lasting effects than dextroamphetamine alone.^[60] It has been reported that certain children have a better clinical response to levoamphetamine.^[61]

Pharmacokinetics[edit]

The half-lives of amphetamines vary with age and stereochemistry, with dextroamphetamine being processed faster than levoamphetamine.^[33] The half life for dextroamphetamine is 9 hours for children of ages 6–12, 11 hours in adolescents aged 13–17, and 10 hours in adults.^[33] For levoamphetamine, the half-life is 11 hours for children of ages 6–12, 13–14 hours in adolescents aged 13–17, and 13 hours in adults.^[33] Both isomers reach peak plasma concentrations at 3 hours post-dose.^[33] Amphetamine is eliminated renally with a fraction of the drug being excreted unchanged (30–40%) at normal urinary pH.^[33] Amphetamine is a weak base with a pKa of 9–10; consequently, when the urinary pH is basic, more of the drug is in its free base form and less is excreted.^[33] When urine pH is abnormal, the urinary recovery of amphetamine may range from 1–75%, depending on whether urine is too alkaline or acidic respectively.^[33] Amphetamine is usually eliminated within two days of the last oral dose.^[62] Apparent half-life and duration of effect increase with repeated use and accumulation of drug.^[63]^[64]

Metabolism occurs mostly in the liver by the cytochrome P450 (CYP) detoxification system; CYP2D6 and FMO are the only enzymes currently known to metabolize amphetamine in humans.^[33]^[65]^[66] Amphetamine has a variety of excreted metabolic products, including 4‑hydroxyamfetamine, 4‑hydroxynorephedrine, 4‑hydroxyphenylacetone, α‑hydroxy‑amphetamine, benzoic acid, hippuric acid, norephedrine, phenylacetone, and phenylisopropanol.^[33]^[62]^[67] Among these metabolites, the active sympathomimetics are 4‑hydroxyamphetamine,^[68] 4‑hydroxynorephedrine,^[69] and norephedrine.^[70]

The main metabolic pathways involve aromatic para-hydroxylation, aliphatic alpha- and beta-hydroxylation, N-oxidation, N-dealkylation, and deamination.^[33]^[62] The known pathways include:^[33]^[67]

Much of amphetamine is excreted unchanged in the urine; however, the main metabolites, by percent recoverable, are 4‑hydroxyamphetamine, and norephedrine.^[67]

Detection of use[edit]

Techniques such as immunoassay may cross-react with a number of sympathomimetics drugs, so chromatographic methods specific for amphetamine should be employed to prevent false-positive results. Chiral techniques may be employed to help distinguish the source of the drug, whether obtained legally (by prescription) or illegally or possibly as a result of formation from a prodrug such as lisdexamfetamine or selegiline. Chiral separation can be used to differentiate amphetamine mixed salts use from use of another prescription form of amphetamine or from use of illicit amphetamine^[71]^[72]^[73]

History[edit]

Adderall is available as an instant-release (IR) and an extended-release (XR) drug. Adderall instant-release is manufactured today by Teva and Barr Pharmaceuticals. Shire Pharmaceuticals, the creator of Adderall IR, no longer produces it. However, Shire does continue to manufacture the extended-release version of Adderall ("Adderall XR"). Richwood Pharmaceuticals (later merged with Shire) introduced the Adderall brand in 1996 in the form of a multi-dose, instant-release tablet derived from an original formula of the weight management drug Obetrol. In 2006, Shire agreed to sell rights to the Adderall name for this instant-release medication to Duramed Pharmaceuticals^[74] DuraMed Pharmaceuticals was acquired by Teva Pharmaceuticals in 2008 when Teva completed its acquisition of Barr Pharmaceuticals (including Barr's Duramed division).^[75] Therefore, following its acquisition of Duramed, Teva is in the somewhat unusual position of manufacturing both a generic formulation of Adderall instant-release (under its Barr Division) as well as "brand name" Adderall (under its DuraMed division.)

In 2001, Shire introduced an extended-release preparation of these ingredients in a variety of dosages under the brand name "Adderall XR," on which Shire retains exclusive patent rights until the patent expires, expected in 2018.^[76] Shire was unable to extend patents by evergreening and generic version of Adderall XR became available in 2009.^[77] In 2009, Barr and Shire reached a settlement agreement permitting Barr to offer a generic form of the drug beginning April 1, 2009.^[78]

Patent disputes[edit]

Manufacturer's claims of instant release have been disputed. A US patent granted for Adderall^[79] was a pharmaceutical composition patent listing a rapid immediate-release oral dosage form. No claim of increased or smooth drug delivery was made. A study by James and colleague as published in the November 2001 issue of the Journal of the American Academy of Child and Adolescent Psychiatry, placebo-controlled crossover study conducted among 35 children ages 5–12 indicated that patients behaved similarly to those having taken other immediate-release amphetamines. The authors found that sustained-release dextro-amphetamine (the main isomeric-amphetamine component of Adderall) had a longer duration of action; however, D-amphetamine was less effective in the first few hours.^[80]

Commercial formulations[edit]

Historical[edit]

Rexar, a pharmaceutical company, reformulated another drug, branded as Obetrol, to exclude methamphetamine and continued to sell this new formulation under the same brand name. This new unapproved formulation was later rebranded and sold as Adderall by Richwood after it acquired Rexar resulting in FDA warning in 1994. Richwood submitted this formulation as NDA 11-522 and Adderall gained FDA approval for the treatment of attention-deficit/hyperactivity disorder therapy on February 13, 1996.^[81]

Current[edit]

Amphetamine mixed salts is a psychostimulant medication used primarily for the treatment of ADHD and narcolepsy.^[3]

It is a mixture of amphetamine salts consisting of equal amounts by mass of:^[14]

amphetamine aspartate monohydrate (racemic)
amphetamine sulfate (racemic)
dextroamphetamine sulfate
dextroamphetamine saccharate

This mixture acts as a dopamine releasing agent, dopamine reuptake inhibitor, norepinephrine releasing agent, norepinephrine reuptake inhibitor and can be mildly serotonergic.^[41]

Amphetamine mixed salts are available in immediate release and extended release formulations. The immediate release formulation is indicated for use in ADHD and narcolepsy,.^[12] The extended release formulation only approved for the treatment of ADHD.^[41]

Legal status[edit]

In Canada, amphetamines are in Schedule I of the Controlled Drugs and Substances Act, and can only be obtained by prescription.^[82]
In Japan, the use, production, and import of any medicine containing amphetamine are prohibited.^[83]^[84]
In South Korea, amphetamines are prohibited.^[85]
In Thailand, Amphetamines are classified as Type 1 Narcotics.^[86]
In the United Kingdom, amphetamines are regarded as Class B drugs. The maximum penalty for unauthorized possession is five years in prison and an unlimited fine. The maximum penalty for illegal supply is 14 years in prison and an unlimited fine.^[87]
In the United States, amphetamine is a Schedule II prescription drug, classified as a CNS (central nervous system) stimulant.^[88]
Internationally (United Nations), amphetamine is in Schedule II of the Convention on Psychotropic Substances^[89]^[90]

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^ Enantiomers are molecules that are "mirror images" of one another; they are structurally identical but of the opposite orientation, like left and right hands
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UpToDate Contents

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1. 小児および思春期における注意欠陥多動性障害：薬物治療 attention deficit hyperactivity disorder in children and adolescents treatment with medications
2. 小児および思春期における注意欠陥多動性障害治療薬の薬理学 pharmacology of drugs used to treat attention deficit hyperactivity disorder in children and adolescents
3. 注意欠陥多動性障害に対する薬物療法を受けた患者の心臓評価 cardiac evaluation of patients receiving pharmacotherapy for attention deficit hyperactivity disorder
4. 成人の注意欠陥多動性障害 adult attention deficit hyperactivity disorder
5. 小児および思春期における自閉症スペクトラム障害：薬理学的介入 autism spectrum disorders in children and adolescents pharmacologic interventions

English Journal

Prescription stimulant medication misuse: Where are we and where do we go from here?

Weyandt LL1, Oster DR1, Marraccini ME2, Gudmundsdottir BG1, Munro BA1, Rathkey ES1, McCallum A1.
Experimental and clinical psychopharmacology.Exp Clin Psychopharmacol.2016 Oct;24(5):400-414.
Prescription stimulants, including methylphenidate (e.g., Ritalin) and amphetamine compounds (e.g., dextroamphetamine; Adderall), have been approved by the U.S. Food and Drug Administration for the treatment of attention-deficit/hyperactivity disorder (ADHD) and are classified by the United States D
PMID 27690507

Impact of alcohol and alcohol mixed with energy drinks on non-medical prescription stimulant use in a nationally representative sample of 12th-grade students.

Housman JM1, Williams RD Jr1, Woolsey CL2.
The American journal on addictions.Am J Addict.2016 Aug;25(5):378-84. doi: 10.1111/ajad.12390. Epub 2016 Jun 24.
BACKGROUND AND OBJECTIVES: Approximately 30% of high school students use energy drinks. Alcohol use and alcohol mixed with energy drink use (AmED) is associated with risky behavior, including non-medical prescription stimulant use. We assessed alcohol-only, AmED and non-medical prescription stimulan
PMID 27341690

Counterfeit Adderall Containing Aceclofenac from Internet Pharmacies.

Gaudiano MC1, Borioni A1, Antoniella E1, Valvo L1.
Journal of forensic sciences.J Forensic Sci.2016 Jul;61(4):1126-1130. doi: 10.1111/1556-4029.13095. Epub 2016 Apr 6.
A nontargeted approach based on liquid chromatography equipped with a quadrupole time-of-flight mass detector (LC-MS Q-TOF) joined to nuclear magnetic resonance (NMR) analysis allowed rapid identification and quantification of the anti-inflammatory drug aceclofenac in illegal Adderall tablets. The l
PMID 27364297

Related Pictures

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★リンクテーブル★

リンク元	「デキストロアンフェタミン」

「デキストロアンフェタミン」

Amphetamine mixed salts
Combination of
amphetamine aspartate	(25%) psychostimulant
amphetamine sulfate	(25%) psychostimulant
dextroamphetamine saccharate	(25%) psychostimulant
dextroamphetamine sulfate	(25%) psychostimulant
Clinical data
Trade names	Adderall; Adderall ER; Adderall XR
AHFS/Drugs.com	monograph
MedlinePlus	a601234
Licence data	US Daily Med:link
Pregnancy cat.	C (US)
Legal status	Schedule I (CA) Schedule II (US)
Dependence liability	High
Routes	Oral, insufflation, rectal, sublingual
Identifiers
CAS number	300-62-9 51-64-9
ATC code	N06BA02 N06BA01
PubChem	CID 3007
DrugBank	DB00182
ChemSpider	13852819
KEGG	D03740
ChEBI	CHEBI:2679
ChEMBL	CHEMBL405
(what is this?) (verify);

　　[★]

英: dextroamphetamine
商: Adderall, Dexedrine, Dextrostat
関: d-アンフェタミン d-amphetamine、デキサンフェタミン。薬物濫用

[1] Enantiomers are molecules that are "mirror images" of one another; they are structurally identical but of the opposite orientation, like left and right hands

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