amphetamine/dextroamphetamine (Rx)

Brand and Other Names:Adderall XR, Mydayis
  • Print

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

Each tab/cap contains equal portions of the following: amphetamine aspartate, amphetamine sulfate, dextroamphetamine saccharate, and dextroamphetamine sulfate

tablet: Schedule II

  • 5mg (1.25mg/1.25mg/1.25mg/1.25mg)
  • 10mg (2.5mg/2.5mg/2.5mg/2.5mg)
  • 20mg (5mg/5mg/5mg/5mg)
  • 30mg (7.5mg/7.5mg/7.5mg/7.5mg)

capsule, extended-release: Schedule II

  • 5mg (1.25mg/1.25mg/1.25mg/1.25mg) (Adderall XR)
  • 10mg (2.5mg/2.5mg/2.5mg/2.5mg) (Adderall XR)
  • 12.5mg (3.125mg/3.125mg/3.125mg/3.125mg) (Mydayis)
  • 15mg (3.75mg/3.75mg/3.75mg/3.75mg) (Adderall XR)
  • 20mg (5mg/5mg/5mg/5mg) (Adderall XR)
  • 25mg (6.25mg/6.25mg/6.25mg/6.25mg) (Adderall XR, Mydayis)
  • 30mg (7.5mg/7.5mg/7.5mg/7.5mg) (Adderall XR)
  • 37.5mg (9.375mg/9.375mg/9.375mg/9.375mg) (Mydayis)
  • 50mg (12.5mg/12.5mg/12.5mg/12.5mg) (Mydayis)
more...

Attention Deficit Hyperactivity Disorder (ADHD)

Tablet: 5 mg PO qDay initially; may increase by 5-10 mg/day qWeek; administer daily dose in 2-3 doses; not to exceed 40 mg/day

Extended-release capsule

  • Adderall XR
    • 20 mg PO qAM initially or switching from another medication
    • May increase by increments of 5-10 mg/week; not to exceed 60 mg/day
  • Mydayis
    • 18-55 years: 12.5 mg qAM initially
    • May increase by increments of 12.5 mg/week; not to exceed 50 mg/day
    • Note: 25 mg qAM may be considered as an initial dose for some patients

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

Each tab/cap contains equal portions of the following: amphetamine aspartate, amphetamine sulfate, dextroamphetamine saccharate, and dextroamphetamine sulfate

tablet: Schedule II

  • 5mg (1.25mg/1.25mg/1.25mg/1.25mg)
  • 10mg (2.5mg/2.5mg/2.5mg/2.5mg)
  • 20mg (5mg/5mg/5mg/5mg)
  • 30mg (7.5mg/7.5mg/7.5mg/7.5mg)

capsule, extended-release: Schedule II

  • 5mg (1.25mg/1.25mg/1.25mg/1.25mg) (Adderall XR)
  • 10mg (2.5mg/2.5mg/2.5mg/2.5mg) (Adderall XR)
  • 12.5mg (3.125mg/3.125mg/3.125mg/3.125mg) (Mydayis)
  • 15mg (3.75mg/3.75mg/3.75mg/3.75mg) (Adderall XR)
  • 20mg (5mg/5mg/5mg/5mg) (Adderall XR)
  • 25mg (6.25mg/6.25mg/6.25mg/6.25mg) (Adderall XR, Mydayis)
  • 30mg (7.5mg/7.5mg/7.5mg/7.5mg) (Adderall XR)
  • 37.5mg (9.375mg/9.375mg/9.375mg/9.375mg) (Mydayis)
  • 50mg (12.5mg/12.5mg/12.5mg/12.5mg) (Mydayis)
more...

Attention Deficit Hyperactivity Disorder (ADHD)

Tablet

  • <3 years: Safety and efficacy not established
  • 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

Capsule, extended-release

  • (Adderall XR)
    • <6 years: Safety and efficacy not established
    • ≥6 years to <13 years: 5-10 mg PO qAM initially; may increase by 5-10 mg/day qWeek; not to exceed 30 mg/day
    • 13-17 years: 10 mg PO qAM initially; may increase to 20 mg/day after 1 week if symptoms not controlled; doses up to 60 mg/day have been used, but there is no evidence that higher doses increase effectiveness
  • Mydayis
    • <13 years: Safety and efficacy not established; younger children experienced higher plasma exposure than those aged ≥13 yr at the same dose, and experienced higher rates of adverse reactions, mainly insomnia and decreased appetite
    • ≥13-17 years: 12.5 mg qAM initially
    • May increase by increments of 12.5 mg/week; not to exceed 50 mg/day

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

Next:

Interactions

Interaction Checker

and amphetamine/dextroamphetamine

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 
            Previous
            Next:

            Adverse Effects

            >10% (Extended Release)

            Loss of appetite (22-36%)

            Headache (<26%)

            Insomnia (12-27%)

            Abdominal pain (11-14%)

            Weight loss (4-11%)

            1-10% (Extended Release)

            Anxiety (8%)

            Vomiting (7%)

            Nervousness (6%)

            Tachycardia (6%)

            Fever (5%)

            Nausea (5-8%)

            Infection (4%)

            Emotional lability (2-9%)

            Dizziness (2-7%)

            Diarrhea (2-6%)

            Fatigue (2-4%)

            Dry mouth (2-4%)

            Dyspepsia (2-4%)

            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

            Previous
            Next:

            Warnings

            Black Box Warnings

            Amphetamines have a high potential for abuse

            Administration for prolonged periods may lead to dependence and must be avoided

            Assess the possibility of persons obtaining amphetamines for nontherapeutic use or distribution to others

            Prescribed or dispensed sparingly

            Misuse of amphetamines may cause sudden death and serious cardiovascular adverse events

            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

            Drug interaction overview

            • Serotonin syndrome, a potentially life-threatening reaction, may occur when amphetamines are used in combination with other drugs that affect the serotonergic neurotransmitter systems such as monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, and St. John’s Wort
            • Amphetamines and amphetamine derivatives are known to be metabolized, to some degree, by cytochrome P450 2D6 (CYP2D6) and display minor inhibition of CYP2D6 metabolism; potential for a pharmacokinetic interaction exists with coadministration of CYP2D6 inhibitors which may increase risk with increased exposure to amphetamines and derivatives; in these situations, consider alternative non-serotonergic drug or alternative drug that does not inhibit CYP2D6
            • If concomitant use with other serotonergic drugs or CYP2D6 inhibitors is clinically warranted, initiate therapy with lower doses, monitor patients for emergence of serotonin syndrome during drug initiation or titration, and inform patients of increased risk for serotonin syndrome
            Previous
            Next:

            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...
            Previous
            Next:

            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
            Previous
            Next:

            Administration

            Oral Administration

            Tablet

            • May take with or without food
            • Give first dose on awakening; give additional doses (1 or 2) at intervals of 4-6 hr
            • Avoid late evening doses owing to potential insomnia

            Extended-release capsule

            • May take with or without food
            • Take in morning upon awakening; avoid afternoon doses owing to potential insomnia
            • Swallow capsule whole, OR
            • Open capsule and sprinkle the entire content over a spoonful of applesauce and consume immediately without chewing (do not store)
            • Do not divide content of a single capsule
            Previous
            Next:

            Images

            Previous
            Next:

            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            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.
            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.