Amphetamine-Dextroamphetamine

Generic Name: Amphetamine-Dextroamphetamine

Brand Names: Adderall, Adderall XR

Amphetamine-dextroamphetamine is a central nervous system stimulant used to treat ADHD and narcolepsy. It increases dopamine and norepinephrine levels in the brain.

PsychiatryADHDCNS StimulantsControlled Substances

Drug Class

Central Nervous System (CNS) Stimulant — Mixed Amphetamine Salts

DEA Schedule

Schedule Schedule II

Pregnancy

Category C — Animal reproduction studies have shown adverse effects, and there are no adequate well-controlled studies in pregnant women. Use during pregnancy is associated with risk of premature birth, low birthweight, and neonatal withdrawal symptoms. Use only if the potential benefit clearly justifies the potential risk to the fetus.

Available Forms

Immediate-release oral tablet (5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg), Extended-release oral capsule (5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg), Oral disintegrating tablet (5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg), Oral solution (1.25 mg/mL)

What It's Used For

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.

Dosage Quick Reference

These are general dosage guidelines. Your doctor will determine the appropriate dose for your specific situation.

Condition	Starting Dose	Maintenance Dose
ADHD (adults, immediate-release)	5 mg once or twice daily	Increase by 5 mg weekly; typical 5–40 mg/day in divided doses
ADHD (children 6–12, immediate-release)	5 mg once or twice daily	Increase by 5 mg weekly; max 40 mg/day
ADHD (extended-release, adults and children >= 6)	10 mg once daily in the morning	Increase by 5–10 mg weekly; typical 20–30 mg/day, max 30 mg (children) or 40 mg (adults)
Narcolepsy (adults)	10 mg daily in divided doses	Increase by 10 mg weekly; typical 5–60 mg/day in divided doses

Side Effects

Common side effects may include:

• Loss of appetite and weight loss • Dry mouth • Insomnia • Headache • Stomach upset • Nervousness • Dizziness • Increased heart rate and blood pressure

Serious side effects (seek immediate medical attention):

• Chest pain • Shortness of breath • Fainting • Seizures.com/what-is-epilepsy/seizure-types) • Hallucinations or psychosis • Prolonged erection (priapism) • Severe allergic reactions • Circulation problems • Serotonin syndrome

Drug Interactions

Amphetamine-dextroamphetamine increases catecholamine activity and has multiple clinically significant interactions.

Monoamine oxidase inhibitors (MAOIs — e.g., phenelzine, tranylcypromine, selegiline, linezolid): Concurrent use can precipitate hypertensive crisis. Do not administer amphetamines during or within 14 days of MAOI therapy.
Serotonergic agents (SSRIs, SNRIs, triptans, tramadol, fentanyl): Increased risk of serotonin syndrome, characterized by agitation, hyperthermia, tachycardia, clonus, and altered mental status. Monitor closely and discontinue if suspected.
Acidifying agents (ascorbic acid, fruit juices, ammonium chloride): Decrease amphetamine absorption and accelerate urinary excretion, reducing efficacy. Avoid co-administration.
Alkalinizing agents (sodium bicarbonate, antacids, acetazolamide): Increase amphetamine absorption and reduce urinary excretion, raising plasma levels and risk of toxicity. Monitor for excess stimulant effects.
Sympathomimetics and decongestants (pseudoephedrine, phenylephrine): Additive cardiovascular and CNS stimulation, increasing the risk of hypertension, tachycardia, and arrhythmia. Avoid concurrent use.
Tricyclic antidepressants (e.g., amitriptyline, nortriptyline): May enhance amphetamine effects, leading to sustained increases in blood pressure and risk of arrhythmias. Monitor cardiovascular status.

Additional Information

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

Frequently Asked Questions

Immediate-release formulations typically begin working within 30 to 60 minutes, with peak effects at about 3 hours and a duration of 4 to 6 hours. Extended-release capsules also begin working within about an hour but provide effects for 10 to 12 hours, allowing once-daily morning dosing for school or workday coverage.

For ADHD, long-term use is well-studied and considered safe under medical supervision. Periodic re-evaluation — typically at least annually — is recommended to assess continued need, monitor blood pressure and heart rate, track growth in children, and screen for misuse or diversion. Some clinicians use planned drug holidays during weekends or school breaks, though this is individualized.

Take the missed dose as soon as you remember if it is still early in the day. Skip the missed dose if it is late afternoon or evening, since taking a stimulant late can cause significant insomnia. Do not double up to make up for a missed dose. Resume your normal schedule the next morning.

Stimulants modestly increase heart rate (typically 3 to 6 beats per minute) and blood pressure (about 2 to 4 mmHg). While usually well-tolerated, these effects can be problematic in patients with underlying cardiovascular disease. Monitoring at each visit allows your provider to detect significant changes early and adjust therapy if needed.

Caffeine is itself a stimulant and can compound the cardiovascular and CNS effects of amphetamines, leading to jitteriness, palpitations, anxiety, and disrupted sleep. Most clinicians recommend limiting caffeine to small-to-moderate amounts and avoiding it later in the day. Discuss your specific intake with your prescriber.

Warning signs include using more than prescribed, running out of medication early, craving doses, using to stay awake for non-medical reasons, or experiencing withdrawal-like fatigue and depression between doses. Report any of these patterns to your prescriber. Stimulants are Schedule II controlled substances and require careful adherence to the prescribed regimen.

Related Health Conditions

This medication is commonly used to treat or manage the following conditions:

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is a neurodevelopmental disorder marked by inattention, hyperactivity, and/or impulsivity, stemming from complex interactions between genetics, brain differences, and environmental factors, not poor parenting.

Learn More

Bipolar Disorder

Bipolar disorder, characterized by alternating manic/hypomanic and depressive episodes impacting mood, energy, and daily function, is likely caused by a mix of genetics, brain factors, and triggers.

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Cardiomyopathy

Cardiomyopathy encompasses diseases weakening the heart muscle, impairing its ability to pump blood efficiently, potentially leading to heart failure, arrhythmias, and other complications.

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Coronary Artery Disease (CAD)

Coronary Artery Disease (CAD) results from plaque buildup in coronary arteries (atherosclerosis), restricting blood flow and potentially causing angina, heart attack, or heart failure, influenced by factors like high blood pressure and cholesterol.

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Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder (GAD) involves persistent, excessive worry about everyday things, impacting daily life, and likely stemming from genetics, brain chemistry, personality, and environmental factors.

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Glaucoma

Glaucoma encompasses eye conditions damaging the optic nerve, often due to elevated eye pressure, leading to irreversible vision loss if untreated; early detection is crucial.

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Heart Failure Due to Coronary Artery Disease

Heart failure stemming from coronary artery disease arises from narrowed arteries restricting blood flow, weakening or stiffening the heart muscle and reducing its pumping efficiency.

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Hyperthyroidism

Hyperthyroidism, characterized by excessive thyroid hormone production, accelerates metabolism and can result from Graves' disease, toxic goiter, thyroiditis, or excessive iodine intake.

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Lupus Anticoagulant

Lupus anticoagulant is an antibody causing paradoxical prolonged clotting tests yet increasing thrombosis risk, linked to antiphospholipid syndrome and autoimmune diseases, despite not always requiring lupus diagnosis.

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Osteoarthritis

Osteoarthritis, a common degenerative joint disease, causes pain, stiffness, and reduced motion due to cartilage breakdown from aging, genetics, obesity, injuries, or repetitive stress.

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Seizures

Seizures are sudden brain disturbances caused by abnormal electrical activity, manifesting in various symptoms and linked to conditions like epilepsy, injury, infection, or imbalances.

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Vertigo

Vertigo, a spinning sensation distinct from dizziness, often stems from inner ear or brain issues like BPPV or Meniere's, sometimes triggered by head trauma or medication.

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Medical Disclaimer: This information is for educational purposes only and should not be considered medical advice. Always consult with your healthcare provider before starting, stopping, or changing any medication. Your doctor can provide personalized recommendations based on your specific health condition and medical history.