Cylert, or pemoline, is a central nervous system stimulant but is not similar to amphetamines and methyphenidate. It is an oxazolidine compound that is chemically identified as 2-amino-5-pheny-2-oxazolin-4-one. Cylert has an action on the central nervous system similar to that of other stimulants. Although its effect on dopamine levels in animals is ascertained, the exact mechanism of action in humans has not been determined.

Cylert is supplied as tablets containing 18.75, 37.5, or 75 mg for oral administration. It is also available in 37.5-mg chewable tablets.

Because of the association with threatening hepatic or liver failure, Cylert has been withdrawn from the market. Since the marketing began in 1975, fifteen cases of acute hepatic failure have been reported to the FDA. Although the absolute number of reported cases is not large, the rate of reporting ranges from four to seventeen times the rate expected in the general population. This estimate may be conservation because of under reporting and because the long latency between initiation of Cylert treatment and the occurrence of the liver failure may limit recognition of the association. If only a portion of actual cases were recognized and reported, the risk could be substantially higher.

Of the fifteen cases reported as of December 1998, twelve resulted in death or liver transplantation, usually within four weeks of the onset of signs and symptoms of liver failure. The earliest onset of hepatic abnormalities occurred 6 months after initiation of Cylert. Although some reports describe dark urine and nonspecific prodromal or preoccurring symptoms, such as anorexia, malaise, and intestinal symptoms, in other reports it was not clear if any prodomal preceded the onset of jaundice. Pemoline was removed from the Canadian market in 1999 because of safety consideration; the U.S. FDA removed it from the market in 2005 because of liver toxicity.

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