Amphetamine-Dextroamphetamine

Amphetamine-dextroamphetamine is prescribed to treat:

• Attention-deficit/hyperactivity disorder (ADHD) in children (3+) and adults • Narcolepsy

It helps improve attention, focus, and behavior control while reducing hyperactivity and impulsiveness.

What is Amphetamine-Dextroamphetamine?

Amphetamine-dextroamphetamine (commonly known as Adderall) is a Schedule II controlled substance containing a combination of amphetamine salts. It's one of the most prescribed medications for ADHD.

How Does It Work?

This medication affects brain neurotransmitters:

• Increases dopamine and norepinephrine release
• Blocks reuptake of these neurotransmitters
• Enhances focus and attention
• Reduces impulsivity and hyperactivity
• Effects begin within 30-60 minutes

Common Uses

• ADHD: First-line treatment for children (3+) and adults
• Narcolepsy: Improves wakefulness and reduces sleep attacks

Dosage Forms

Immediate-Release (IR) - Adderall:

• Lasts 4-6 hours
• Dosed 1-3 times daily
• Tablets: 5, 7.5, 10, 12.5, 15, 20, 30 mg

Extended-Release (XR) - Adderall XR:

• Lasts 10-12 hours
• Once-daily dosing
• Capsules: 5, 10, 15, 20, 25, 30 mg
• Can open capsule and sprinkle on food

Dosage and Administration

Children (3-5 years):

• Start: 2.5 mg daily
• Increase by 2.5 mg weekly
• Maximum: Based on response

Children (6+ years) and Adults:

• Start: 5 mg once or twice daily (IR)
• Increase by 5 mg weekly
• Typical: 20-30 mg/day
• Maximum: 40 mg/day (children), 60 mg/day (adults)

Administration Tips:

• Take in morning (avoid late doses - insomnia)
• Can take with or without food
• XR: Swallow whole or sprinkle contents on applesauce
• Avoid vitamin C around dose time (reduces absorption)

Important Safety Information

Black Box Warning

⚠️ ABUSE AND DEPENDENCE:

• High potential for abuse and addiction
• Schedule II controlled substance
• Chronic use can lead to physical and psychological dependence
• Misuse can cause sudden death and serious cardiovascular problems
• Assess abuse risk before prescribing
• Monitor for signs of abuse or diversion

Cardiovascular Risks

Sudden Death and Serious Events:

• Reported in children/adolescents with heart defects
• Reported in adults with cardiomyopathy
• Screen for cardiac disease before starting
• Obtain detailed cardiac history
• Consider ECG in high-risk patients

Monitor:

• Blood pressure and heart rate regularly
• Can increase BP and heart rate
• May need to reduce dose or discontinue

Who Should Not Take This Medication?

• Advanced arteriosclerosis
• Symptomatic cardiovascular disease
• Moderate to severe hypertension
• Hyperthyroidism
• Glaucoma
• Agitated states
• History of drug abuse
• During or within 14 days of MAO inhibitor

Psychiatric Side Effects

Can cause or unmask:

• Psychotic symptoms (hallucinations, delusions)
• Mania in bipolar patients
• Aggression or hostility
• Depression
• Suicidal ideation

Before starting:

• Screen for bipolar disorder, depression, psychosis
• Obtain family psychiatric history
• Monitor for psychiatric symptoms

Growth Suppression

In children:

• May slow growth rate and weight gain
• Monitor height and weight regularly (plot on growth charts)
• May need treatment interruptions
• Most children eventually reach expected adult height

Seizures

• May lower seizure threshold
• Use cautiously in patients with seizure history
• Discontinue if seizures occur

Peripheral Vasculopathy

• Can cause Raynaud's phenomenon
• Fingers/toes may become painful, numb, or change color
• More common in cold weather
• Report symptoms immediately

Serotonin Syndrome Risk

When combined with:

• SSRIs, SNRIs
• MAO inhibitors
• Triptans
• Other serotonergic drugs

Symptoms:

• Agitation, hallucinations
• Fast heart rate
• Fever, sweating
• Muscle rigidity
• Nausea, vomiting

Drug Interactions

Contraindicated:

• MAO inhibitors (wait 14 days after stopping MAO inhibitor)

Significant Interactions:

• Antacids/alkalinizing agents (increase absorption)
• Acidifying agents/vitamin C (decrease absorption)
• Antihypertensives (reduced effectiveness)
• TCAs (increased cardiovascular effects)
• Proton pump inhibitors (may reduce effect)
• Anticonvulsants (monitor seizure control)
• SSRIs/SNRIs (serotonin syndrome risk)

Avoid:

• Fruit juices high in vitamin C around dose time
• St. John's Wort

Monitoring

Regular monitoring required:

• Height and weight (children/adolescents)
• Blood pressure and heart rate (each visit)
• Cardiovascular symptoms
• Psychiatric symptoms
• Sleep patterns
• Appetite and nutrition
• Signs of abuse or misuse
• Academic/occupational performance

Tolerance and Dependence

Long-term use:

• Tolerance can develop (higher doses needed for same effect)
• Physical and psychological dependence possible
• Withdrawal symptoms upon discontinuation:
  • Extreme fatigue
  • Depression
  • Increased appetite
  • Sleep disturbances
• Taper gradually if discontinuing

Abuse Potential

High risk of misuse:

• Sought for euphoria, weight loss, or performance enhancement
• Can be crushed and snorted
• Keep medication secure
• Monitor pill counts
• Watch for signs of abuse:
  • Running out early
  • Requesting early refills
  • Doctor shopping
  • Mood swings
  • Weight loss

Supply Chain Issues

Frequent shortages:

• Due to DEA manufacturing quotas
• May need to try multiple pharmacies
• Plan refills in advance
• Consider alternative formulations if needed

Managing Side Effects

Loss of appetite:

• Take after meals
• High-calorie/protein snacks when appetite returns
• Monitor weight regularly
• Nutritionist consultation if significant weight loss

Insomnia:

• Take early in day
• Avoid afternoon/evening doses
• Good sleep hygiene
• May need dose reduction or sleep aid

Anxiety/irritability:

• May need dose reduction
• Ensure adequate sleep and nutrition
• Consider switching to XR formulation
• Rule out anxiety disorder

Drug Holidays

Considerations:

• Some patients take breaks on weekends/holidays
• Pros: Reduces side effects, allows appetite recovery
• Cons: Symptom return, impact on daily functioning
• Discuss with doctor - individualized decision

Special Populations

Children:

• Approved for age 3+
• Lower doses for younger children
• Monitor growth carefully
• Regular follow-up essential

Adolescents:

• Higher abuse/diversion risk
• Address misuse concerns
• Long-acting formulations may improve compliance
• Driving concerns when starting treatment

Adults:

• Growing population of adults with ADHD
• May prefer long-acting for work
• Screen for substance abuse history
• Cardiovascular screening important

Pregnancy:

• Category C
• Limited human data
• Risk of premature birth and low birth weight
• Use only if benefit outweighs risk
• Not recommended during breastfeeding

Elderly:

• Higher cardiovascular risk
• Start with lower doses
• Monitor carefully for side effects

Non-Stimulant Alternatives

If stimulants not appropriate:

• Atomoxetine (Strattera)
• Guanfacine (Intuniv)
• Clonidine (Kapvay)
• Bupropion (off-label)

When to Contact Your Doctor

• Chest pain or palpitations
• Fainting or severe dizziness
• Shortness of breath
• Seizures
• Hallucinations or psychosis
• Severe mood changes or depression
• Thoughts of self-harm
• Prolonged erection
• Painful fingers or toes
• Tics developing
• Significant weight loss
• Signs of abuse or addiction

Storage and Disposal

• Store at room temperature
• Keep in secure, locked location
• Count pills periodically
• Don't share with others
• Dispose through drug take-back programs
• Never flush (environmental concerns)

Legal Considerations

• Schedule II controlled substance
• Requires new prescription each month (no refills)
• Pharmacies may require ID to pick up
• Traveling with medication: keep in original bottle
• Possession without prescription is illegal