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amphetamine/dextroamphetamine (Rx)Brand and Other Names:Adderall XR, Adderall

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

amphetamine/dextroamphetamine

tablet, reg: Schedule II

  • 2.5mg/2.5mg
  • 3.75mg/3.75mg
  • 5mg/5mg
  • 6.25mg/6.25mg
  • 7.5mg/7.5mg
  • 10mg/10mg
  • 15mg/15mg

capsule, reg/extended-release: Schedule II

  • 2.5mg/2.5mg
  • 5mg/5mg
  • 7.5mg/7.5mg
  • 10mg/10mg
  • 12.5mg/12.5mg
  • 15mg/15mg
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ADHD

Amphetamine/dextroamphetamine

  • 5 mg PO qDay; may increase by 5-10 mg/day qWeek
  • Not to exceed 40 mg qDay or divided q8hr

Extended release

  • 20 mg PO qAM
  • Not to exceed 60 mg/day

Narcolepsy

Amphetamine/dextroamphetamine

  • 5-60 mg PO qDay; may increase by 10 mg/day qWeek
  • No more than 60 mg given qDay or divided doses with intervals of 4-6 hr between doses

Dosage Forms & Strengths

amphetamine/dextroamphetamine

tablet, reg: Schedule II

  • 2.5mg/2.5mg
  • 3.75mg/3.75mg
  • 5mg/5mg
  • 6.25mg/6.25mg
  • 7.5mg/7.5mg
  • 10mg/10mg
  • 15mg/15mg

capsule, reg/extended-release: Schedule II

  • 2.5mg/2.5mg
  • 5mg/5mg
  • 7.5mg/7.5mg
  • 10mg/10mg
  • 12.5mg/12.5mg
  • 15mg/15mg
more...

ADHD

<3 years: Not recommended

Age 3-6 years: 2.5 mg/day; may increase by 2.5 mg qWeek; not to exceed 40 mg qDay or divided q8hr; use intervals of 4-6 hr between additional doses

>6 years: 5 mg PO qDay or q12hr; may increase by 5 mg qWeek; not to exceed 40 mg qDay or divided q8hr; use intervals of 4-6 hr between additional doses

Extended release

  • >6 years: Initial, 5-10 mg PO qAM if needed; may increase by 5-10 mg/day qWeek; not to exceed 30 mg/day
  • 13-17 years: Initial, 10 mg PO qAM; may increase to 20 mg/day after 1 week if symptoms not controlled; doses up to 60 mg/day used but no evidence that higher doses increase effectiveness

Narcolepsy

<6 years: Safety and efficacy not established

6-12 years: 5mg/day PO initially in divided doses; may increase by 5 mg/day qWeek; not to exceed 60 mg qDay or divided doses with intervals of 4-6 hr between doses

>12 years: 10 mg/day PO initially; may increase by 10 mg/day qWeek; not to exceed 60 mg given qDay or divided doses with intervals of 4-6 hr between doses

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Interactions

Interaction Checker

amphetamine/dextroamphetamine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10% (Extended Release)

            Abdominal pain (11-14%)

            Headache (<26%)

            Insomnia (12-27%)

            Loss of appetite (22-36%)

            Weight loss (4-11%)

            1-10% (Extended Release)

            Anxiety (8%)

            Diarrhea (2-6%)

            Dizziness (2-7%)

            Dry mouth (2-4%)

            Dyspepsia (2-4%)

            Emotional lability (2-9%)

            Fatigue (2-4%)

            Fever (5%)

            Infection (4%)

            Nausea (5-2-8%)

            Nervousness (6%)

            Tachycardia (6%)

            Vomiting (7%)

            Weight loss (4-9%)

            Postmarketing Reports

            Cardiovascular: Palpitations; isolated reports of cardiomyopathy associated with chronic amphetamine use

            CNS: Psychotic episodes at recommended doses, overstimulation, restlessness, irritability, euphoria, dyskinesia, dysphoria, depression, tremor, tics, aggression, anger, logorrhea, dermatillomania, paresthesia (including formication), bruxism

            Eye disorders: Blurred vision, mydriasis

            Gastrointestinal: Unpleasant taste, constipation, other gastrointestinal disturbances

            Allergic: Urticaria, rash, hypersensitivity reactions (including angioedema and anaphylaxis); serious skin rashes (including Stevens-Johnson syndrome and toxic epidermal necrolysis)

            Endocrine: Impotence, changes in libido, frequent/prolonged erections

            Skin: Alopecia

            Vascular disorders: Raynaud phenomenon

            Musculoskeletal: Rhabdomyolysis

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            Warnings

            Contraindications

            Hypersensitivity

            Hyperthryroidism

            Glaucoma

            Hypertension, advanced arteriosclerosis, symptomatic CVD

            Symptomatic cardiovascular disease

            Moderate-to-severe hypertension

            Agitated states, history of drug abuse

            MAO inhibitors given within 14 days (risk of severe hypertensive reaction)

            Cautions

            Preexisting cardiac structural abnormalities associated with risk of sudden death (if abused)

            Time to maximum concentration decreased when coadministered with acid-suppressing drugs (eg, proton pump inhibitors)

            Associated with peripheral vasculopathy, including Raynaud phenomenon

            Difficulties with accommodation and blurring of vision have been reported with stimulant treatment

            May impair ability to engage in potentially hazardouse activities due to CNS effects

            Potential exists for drug dependency

            Use caution in hypertension, history of psychosis, seizure disorders, elderly, or Tourette's syndrome (may unmask tics)

            Abrupt discontinuation may result in symptoms for withdrawal

            Sudden deaths, stroke, and myocardial infarction reported in adults taking stimulants at usual doses

            Patients who develop symptoms such as exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease during stimulant treatment should undergo a prompt cardiac evaluation

            Particular care should be taken in using stimulants to treat ADHD patients with comorbid bipolar disorder because of concern for possible induction of mixed/manic episode in such patients

            Aggressive behavior or hostility is often observed in children and adolescents with ADHD; monitor for the appearance of or worsening of aggressive behavior or hostility

            Monitor growth of children ages 7 to 10 years during treatment with stimulants; may need to interrupt therapy in patients not growing or gaining weight as expected

            Stimulants may lower convulsive threshold in patients with prior history of seizure, patients with prior EEG abnormalities in absence of seizures, and very rarely, patients without a history of seizures and no prior EEG evidence of seizures; discontinue therapy in the presence of seizures

            Use with caution in patients who use other sympathomimetic drugs

            Amphetamines may exacerbate motor and phonic tics and Tourette’s syndrome; perform clinical evaluation for tics and Tourette’s syndrome in children and their families prior to treating with stimulant medications

            Rare instances of prolonged and sometimes painful erections (priapism), sometimes requiring surgical intervention, reported with methylphenidate products; typically not reported during initiation, but often subsequent to an increase in dose; seek immediate medical attention for abnormally sustained or frequent and painful erections

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Not recommended; found in breast milk; not recommended

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Sympathomimetic amine that promotes release of dopamine and norepinephrine from their storage sites in the presynaptic nerve terminals; may also block reuptake of catecholamines by competitive inhibition.

            Absorption

            Well absorbed

            Onset of action: 30-60 min

            Duration: 4-6 hr

            Vd: 3.5-4.6 L/kg (distributes into CNS; mean CSF concentrations are 80% of plasma)

            Peak plasma time: 3 hr (Adderall); 7 hr (Adderall XR)

            Metabolism

            Hepatic via glucuronidation and CYP450 mono-oxygenase

            Elimination

            Half-life elimination (children)

            • 6-12 years: 9 hr (d-amphetamine); 11 hr (l-amphetamine)
            • 12-18 years: 11 hr (d-amphetamine); 13-14 hr (l-amphetamine)

            Half-life elimination (adults)

            • d-amphetamine: 10 hr
            • l-amphetamine: 13 hr

            Excretion

            • Urine; dependent on urinary pH
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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Select a class to view formulary status for similar drugs

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