Dosing & Uses
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)
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
Dosing Modifications
Extended release
- Severe renal impairment (GFR 15 to <30 mL/min/1.73m²): Reduce recommended dose to 15 mg PO qDay
- ESRD (GFR < 15 ml/min/1.73m²): Not recommended
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)
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
Dosing Modifications
Severe renal impairment
- <6 years: Not established
- 6-17 years: 5 mg once daily recommended; not to exceed 20 mg once daily for children 6 to 12 years of age
- End stage renal disease (GFR < 15 mL/min/1.73m²): Not recommended
End stage renal disease
- < 15 mL/min/1.73m²
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (10)
- iobenguane I 123
dextroamphetamine decreases effects of iobenguane I 123 by receptor binding competition. Contraindicated. If clinically appropriate, discontinue drugs that compete for NE receptor sites for at least 5 half-lives; may cause false-negative imaging results.
- isocarboxazid
isocarboxazid increases effects of dextroamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- linezolid
linezolid increases effects of dextroamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- phenelzine
phenelzine increases effects of dextroamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- procarbazine
procarbazine increases effects of dextroamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- rasagiline
rasagiline increases effects of dextroamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Coadministration is contraindicated during or within 14 days following the administration of MAOIs.
- safinamide
dextroamphetamine, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.
- selegiline
selegiline and dextroamphetamine both increase serotonin levels. Contraindicated. Amphetamines should not be administered during or within 14 days following the use of most MAOIs or drugs with MAO-inhibiting activity
selegiline increases effects of dextroamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Coadministration is contraindicated during or within 14 days following the administration of MAOIs. - selegiline transdermal
selegiline transdermal increases effects of dextroamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- tranylcypromine
tranylcypromine increases effects of dextroamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
Serious - Use Alternative (18)
- amitriptyline
amitriptyline, dextroamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- amoxapine
amoxapine, dextroamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- cabergoline
cabergoline, dextroamphetamine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- clomipramine
clomipramine, dextroamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- desflurane
desflurane increases toxicity of dextroamphetamine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- desipramine
desipramine, dextroamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- desvenlafaxine
dextroamphetamine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.
- dihydroergotamine
dihydroergotamine, dextroamphetamine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- dihydroergotamine intranasal
dihydroergotamine intranasal, dextroamphetamine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- doxapram
doxapram increases effects of dextroamphetamine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.
- doxepin
doxepin, dextroamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- ergoloid mesylates
ergoloid mesylates, dextroamphetamine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- ergotamine
ergotamine, dextroamphetamine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- ether
ether increases toxicity of dextroamphetamine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- imipramine
imipramine, dextroamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- iobenguane I 131
amphetamine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.
dextroamphetamine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose. - isocarboxazid
isocarboxazid and dextroamphetamine both increase serotonin levels. Avoid or Use Alternate Drug.
- ozanimod
ozanimod increases toxicity of amphetamine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.
Monitor Closely (201)
- 5-HTP
5-HTP and dextroamphetamine both increase serotonin levels. Use Caution/Monitor.
- acetazolamide
acetazolamide will increase the level or effect of dextroamphetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.
- albuterol
albuterol and dextroamphetamine both decrease sedation. Use Caution/Monitor.
albuterol and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - alfentanil
alfentanil increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- almotriptan
almotriptan and dextroamphetamine both increase serotonin levels. Use Caution/Monitor.
- alprazolam
alprazolam increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- aluminum hydroxide
aluminum hydroxide will increase the level or effect of dextroamphetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.
- amitriptyline
amitriptyline increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
amitriptyline and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
amitriptyline increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor. - ammonium chloride
ammonium chloride decreases levels of dextroamphetamine by increasing renal clearance. Use Caution/Monitor.
- amobarbital
amobarbital increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- amoxapine
amoxapine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
amoxapine and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
amoxapine increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor. - arformoterol
arformoterol and dextroamphetamine both decrease sedation. Use Caution/Monitor.
arformoterol and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - aripiprazole
aripiprazole increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- armodafinil
armodafinil and dextroamphetamine both decrease sedation. Use Caution/Monitor.
- artemether/lumefantrine
artemether/lumefantrine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- azelastine
azelastine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- belladonna and opium
belladonna and opium increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- benazepril
dextroamphetamine decreases effects of benazepril by pharmacodynamic antagonism. Use Caution/Monitor.
- benperidol
benperidol increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, amphetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
benzhydrocodone/acetaminophen, dextroamphetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment. - benzphetamine
dextroamphetamine and benzphetamine both decrease sedation. Use Caution/Monitor.
benzphetamine and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - buprenorphine, long-acting injection
amphetamine, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
- bromocriptine
bromocriptine, dextroamphetamine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Hypertension, V tach.
- brompheniramine
brompheniramine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- buprenorphine buccal
buprenorphine buccal increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- buprenorphine subdermal implant
dextroamphetamine, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
- buprenorphine, long-acting injection
dextroamphetamine, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
- bupropion
bupropion will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
dextroamphetamine increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible. - buspirone
buspirone and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
- butabarbital
butabarbital increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- butalbital
butalbital increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- butorphanol
butorphanol increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- caffeine
caffeine and dextroamphetamine both decrease sedation. Use Caution/Monitor.
- calcium carbonate
calcium carbonate will increase the level or effect of dextroamphetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.
- captopril
dextroamphetamine decreases effects of captopril by pharmacodynamic antagonism. Use Caution/Monitor. Dextroamphetamine may decrease the antihypertensive effects of ACE Inhibitors.
- carbinoxamine
carbinoxamine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cenobamate
cenobamate will decrease the level or effect of dextroamphetamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
- chloral hydrate
chloral hydrate increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorpromazine
chlorpromazine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
chlorpromazine, dextroamphetamine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - cinnarizine
cinnarizine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- citalopram
citalopram and dextroamphetamine both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
- clemastine
clemastine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clomipramine
clomipramine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
clomipramine and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
clomipramine increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor. - clonazepam
clonazepam increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clorazepate
clorazepate increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clozapine
clozapine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cocaine topical
cocaine topical and dextroamphetamine both increase serotonin levels. Use Caution/Monitor.
- codeine
codeine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cyclizine
cyclizine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cyproheptadine
cyproheptadine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- desipramine
desipramine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
desipramine and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
desipramine increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor. - desvenlafaxine
desvenlafaxine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mg
- dexchlorpheniramine
dexchlorpheniramine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexfenfluramine
dextroamphetamine and dexfenfluramine both decrease sedation. Use Caution/Monitor.
dexfenfluramine and dextroamphetamine both increase serotonin levels. Use Caution/Monitor.
dexfenfluramine and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dexlansoprazole
dexlansoprazole, dextroamphetamine. Other (see comment). Use Caution/Monitor. Comment: Reduced gastric acidity caused by proton pump inhibitors decreases time to Tmax for amphetamine and dextroamphetamine. AUC was unaffected. .
- dexmedetomidine
dexmedetomidine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexmethylphenidate
dexmethylphenidate and dextroamphetamine both decrease sedation. Use Caution/Monitor.
dexmethylphenidate and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dextromethorphan
amphetamine, dextromethorphan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when amphemtamines are coadministered with dextromethorphan. .
dextroamphetamine, dextromethorphan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when amphemtamines are coadministered with dextromethorphan. . - dextromoramide
dextromoramide increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine inhaled
amphetamine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- diamorphine
diamorphine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diethylpropion
dextroamphetamine and diethylpropion both decrease sedation. Use Caution/Monitor.
dextroamphetamine and diethylpropion both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - difenoxin hcl
difenoxin hcl increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dihydroergotamine
dextroamphetamine and dihydroergotamine both increase serotonin levels. Use Caution/Monitor.
- dihydroergotamine intranasal
dextroamphetamine and dihydroergotamine intranasal both increase serotonin levels. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diphenhydramine
diphenhydramine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diphenoxylate hcl
diphenoxylate hcl increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dipipanone
dipipanone increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dobutamine
dobutamine and dextroamphetamine both decrease sedation. Use Caution/Monitor.
dobutamine and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dopamine
dextroamphetamine and dopamine both decrease sedation. Use Caution/Monitor.
dextroamphetamine and dopamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dopexamine
dopexamine and dextroamphetamine both decrease sedation. Use Caution/Monitor.
dopexamine and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - doxepin
doxepin increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
doxepin and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
doxepin increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor. - droperidol
droperidol increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- droxidopa
dextroamphetamine and droxidopa both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. May increase risk for supine hypertension
- duloxetine
duloxetine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.
duloxetine and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely. - eletriptan
eletriptan and dextroamphetamine both increase serotonin levels. Use Caution/Monitor.
- ephedrine
ephedrine and dextroamphetamine both decrease sedation. Use Caution/Monitor.
ephedrine and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - epinephrine
epinephrine and dextroamphetamine both decrease sedation. Use Caution/Monitor.
epinephrine and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - epinephrine inhaled
dextroamphetamine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- epinephrine racemic
epinephrine racemic and dextroamphetamine both decrease sedation. Use Caution/Monitor.
epinephrine racemic and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - ergotamine
dextroamphetamine and ergotamine both increase serotonin levels. Use Caution/Monitor.
- escitalopram
escitalopram and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
- esketamine intranasal
esketamine intranasal, dextroamphetamine. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Closely monitor blood pressure with concomitant use of esketamine nasal with stimulants. .
esketamine intranasal, amphetamine. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Closely monitor blood pressure with concomitant use of esketamine nasal with stimulants. . - esomeprazole
esomeprazole, dextroamphetamine. Other (see comment). Use Caution/Monitor. Comment: Reduced gastric acidity caused by proton pump inhibitors decreases time to Tmax for amphetamine and dextroamphetamine. AUC was unaffected. .
- hydrocodone
hydrocodone, amphetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- estazolam
estazolam increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ethanol
ethanol increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fenfluramine
dextroamphetamine and fenfluramine both decrease sedation. Use Caution/Monitor.
dextroamphetamine and fenfluramine both increase serotonin levels. Use Caution/Monitor.
dextroamphetamine and fenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - fluoxetine
fluoxetine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
fluoxetine and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely. - fluphenazine
fluphenazine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
fluphenazine, dextroamphetamine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - flurazepam
flurazepam increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fluvoxamine
fluvoxamine and dextroamphetamine both decrease serotonin levels. Modify Therapy/Monitor Closely.
- formoterol
formoterol and dextroamphetamine both decrease sedation. Use Caution/Monitor.
formoterol and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - frovatriptan
frovatriptan and dextroamphetamine both increase serotonin levels. Use Caution/Monitor.
- gepirone
gepirone and dextroamphetamine both increase serotonin levels. Use Caution/Monitor. Monitor for symptoms of serotonin syndrome when gepirone is used gepirone with other drugs that may affect the serotonergic neurotransmitter systems. If serotonin syndrome occurs, consider discontinue gepirone and/or concomitant serotonergic drug.
- green tea
green tea, dextroamphetamine. Other (see comment). Use Caution/Monitor. Comment: Green tea may include caffeine. Caffeine is a CNS-stimulant and additive effects may be seen when coadministered with other CNS stimulants. Caffeine should be avoided or used cautiously.
- haloperidol
haloperidol increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hydralazine
hydralazine, dextroamphetamine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.
- hydrocodone
hydrocodone, dextroamphetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- hydromorphone
hydromorphone increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hydroxyzine
hydroxyzine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- iloperidone
iloperidone increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- imipramine
imipramine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
imipramine and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
imipramine increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor. - ioflupane I 123
dextroamphetamine decreases effects of ioflupane I 123 by receptor binding competition. Use Caution/Monitor. Drugs that bind to dopamine transporter receptor with high affinity may interfere with the image following ioflupane I 123 administration.
- isoniazid
dextroamphetamine and isoniazid both increase serotonin levels. Use Caution/Monitor.
- isoproterenol
isoproterenol and dextroamphetamine both decrease sedation. Use Caution/Monitor.
isoproterenol and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - ketotifen, ophthalmic
ketotifen, ophthalmic increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- L-tryptophan
dextroamphetamine and L-tryptophan both increase serotonin levels. Use Caution/Monitor.
- lansoprazole
lansoprazole, dextroamphetamine. Other (see comment). Use Caution/Monitor. Comment: Reduced gastric acidity caused by proton pump inhibitors decreases time to Tmax for amphetamine and dextroamphetamine. AUC was unaffected. .
- levalbuterol
levalbuterol and dextroamphetamine both decrease sedation. Use Caution/Monitor.
levalbuterol and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - levomilnacipran
levomilnacipran and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
- levorphanol
levorphanol increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lisdexamfetamine
dextroamphetamine and lisdexamfetamine both decrease sedation. Use Caution/Monitor.
dextroamphetamine and lisdexamfetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - lithium
dextroamphetamine and lithium both increase serotonin levels. Use Caution/Monitor.
- lofepramine
lofepramine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
lofepramine and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
lofepramine increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor. - lofexidine
lofexidine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- loprazolam
loprazolam increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lorazepam
lorazepam increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lormetazepam
lormetazepam increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- loxapine
loxapine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- loxapine inhaled
loxapine inhaled increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lsd
dextroamphetamine and lsd both increase serotonin levels. Use Caution/Monitor.
- lumefantrine
lumefantrine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- maprotiline
maprotiline increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
maprotiline and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
maprotiline increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor. - marijuana
marijuana increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- melatonin
melatonin increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- meperidine
meperidine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
dextroamphetamine and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely. - meprobamate
meprobamate increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaproterenol
metaproterenol and dextroamphetamine both decrease sedation. Use Caution/Monitor.
metaproterenol and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - methadone
methadone increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methamphetamine
dextroamphetamine and methamphetamine both decrease sedation. Use Caution/Monitor.
dextroamphetamine and methamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - methyldopa
methyldopa increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor.
- methylenedioxymethamphetamine
dextroamphetamine and methylenedioxymethamphetamine both decrease sedation. Use Caution/Monitor.
dextroamphetamine and methylenedioxymethamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - methylphenidate
dextroamphetamine increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.
- midazolam
midazolam increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- midodrine
dextroamphetamine and midodrine both decrease sedation. Use Caution/Monitor.
dextroamphetamine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - milnacipran
milnacipran and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
- mirtazapine
mirtazapine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
dextroamphetamine and mirtazapine both increase serotonin levels. Use Caution/Monitor. - modafinil
dextroamphetamine and modafinil both decrease sedation. Use Caution/Monitor.
- morphine
morphine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
dextroamphetamine and morphine both increase serotonin levels. Use Caution/Monitor. - motherwort
motherwort increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- moxonidine
moxonidine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nabilone
nabilone increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nalbuphine
nalbuphine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- naratriptan
naratriptan and dextroamphetamine both increase serotonin levels. Use Caution/Monitor.
- nefazodone
nefazodone and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
- norepinephrine
norepinephrine and dextroamphetamine both decrease sedation. Use Caution/Monitor.
norepinephrine and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - nortriptyline
nortriptyline increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
nortriptyline and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
nortriptyline increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor. - olanzapine
olanzapine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- omeprazole
omeprazole, dextroamphetamine. Other (see comment). Use Caution/Monitor. Comment: Reduced gastric acidity caused by proton pump inhibitors decreases time to Tmax for amphetamine and dextroamphetamine. AUC was unaffected. .
- opium tincture
opium tincture increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxazepam
oxazepam increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxycodone
oxycodone increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxymorphone
oxymorphone increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxytocin
oxytocin increases effects of dextroamphetamine by pharmacodynamic synergism. Use Caution/Monitor.
- paliperidone
paliperidone increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pantoprazole
pantoprazole, dextroamphetamine. Other (see comment). Use Caution/Monitor. Comment: Reduced gastric acidity caused by proton pump inhibitors decreases time to Tmax for amphetamine and dextroamphetamine. AUC was unaffected. .
- papaveretum
papaveretum increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- paroxetine
paroxetine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
paroxetine and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely. - pentazocine
pentazocine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
dextroamphetamine and pentazocine both increase serotonin levels. Use Caution/Monitor. - pentobarbital
pentobarbital increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- perphenazine
perphenazine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
perphenazine, dextroamphetamine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - phendimetrazine
dextroamphetamine and phendimetrazine both decrease sedation. Use Caution/Monitor.
dextroamphetamine and phendimetrazine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - phenobarbital
phenobarbital increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phentermine
dextroamphetamine and phentermine both decrease sedation. Use Caution/Monitor.
dextroamphetamine and phentermine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - phenylephrine
dextroamphetamine and phenylephrine both decrease sedation. Use Caution/Monitor.
dextroamphetamine and phenylephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - phenylephrine PO
dextroamphetamine and phenylephrine PO both decrease sedation. Use Caution/Monitor.
dextroamphetamine and phenylephrine PO both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - pholcodine
pholcodine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pimozide
pimozide increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pirbuterol
pirbuterol and dextroamphetamine both decrease sedation. Use Caution/Monitor.
pirbuterol and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - primidone
primidone increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- prochlorperazine
prochlorperazine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
prochlorperazine, dextroamphetamine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - promazine
promazine, dextroamphetamine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.
- promethazine
promethazine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
promethazine, dextroamphetamine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - propylhexedrine
dextroamphetamine and propylhexedrine both decrease sedation. Use Caution/Monitor.
dextroamphetamine and propylhexedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - protriptyline
protriptyline increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
protriptyline and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
protriptyline increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor. - pseudoephedrine
dextroamphetamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- quazepam
quazepam increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- quetiapine
quetiapine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- quinidine
quinidine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- rabeprazole
rabeprazole, dextroamphetamine. Other (see comment). Use Caution/Monitor. Comment: Reduced gastric acidity caused by proton pump inhibitors decreases time to Tmax for amphetamine and dextroamphetamine. AUC was unaffected. .
- risperidone
risperidone increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- rizatriptan
rizatriptan and dextroamphetamine both increase serotonin levels. Use Caution/Monitor.
- salmeterol
salmeterol and dextroamphetamine both decrease sedation. Use Caution/Monitor.
salmeterol and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - SAMe
dextroamphetamine and SAMe both increase serotonin levels. Use Caution/Monitor.
- scullcap
scullcap increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- secobarbital
secobarbital increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- selegiline transdermal
selegiline transdermal and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
- serdexmethylphenidate/dexmethylphenidate
serdexmethylphenidate/dexmethylphenidate and dextroamphetamine both decrease sedation. Use Caution/Monitor.
serdexmethylphenidate/dexmethylphenidate and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - sertraline
sertraline will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
sertraline and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely. - shepherd's purse
shepherd's purse increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sodium acid phosphate
sodium acid phosphate decreases levels of dextroamphetamine by increasing renal clearance. Use Caution/Monitor.
- sodium bicarbonate
sodium bicarbonate will increase the level or effect of dextroamphetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.
- sodium citrate/citric acid
sodium citrate/citric acid will increase the level or effect of dextroamphetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.
- sodium lactate
sodium lactate will increase the level or effect of dextroamphetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.
- sodium zirconium cyclosilicate
sodium zirconium cyclosilicate will increase the level or effect of amphetamine by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate. Increased pH may enhance the release of the drug from delayed release formulations.
sodium zirconium cyclosilicate will increase the level or effect of dextroamphetamine by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate. Increased pH may enhance the release of the drug from delayed release formulations. - solriamfetol
dextroamphetamine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- sufentanil SL
sufentanil SL, amphetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
Minor (56)
- acetazolamide
acetazolamide increases levels of dextroamphetamine by passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown.
- alfentanil
dextroamphetamine increases effects of alfentanil by unspecified interaction mechanism. Minor/Significance Unknown.
- amantadine
amantadine, dextroamphetamine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Potential for additive CNS stimulation.
- American ginseng
American ginseng increases effects of dextroamphetamine by pharmacodynamic synergism. Minor/Significance Unknown.
- amiodarone
amiodarone will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- asenapine
asenapine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- ashwagandha
ashwagandha increases effects of dextroamphetamine by unspecified interaction mechanism. Minor/Significance Unknown.
- belladonna and opium
dextroamphetamine increases effects of belladonna and opium by unspecified interaction mechanism. Minor/Significance Unknown.
- buprenorphine
dextroamphetamine increases effects of buprenorphine by unspecified interaction mechanism. Minor/Significance Unknown.
- buprenorphine buccal
dextroamphetamine increases effects of buprenorphine buccal by unspecified interaction mechanism. Minor/Significance Unknown.
- butorphanol
dextroamphetamine increases effects of butorphanol by unspecified interaction mechanism. Minor/Significance Unknown.
- celandine
celandine increases effects of dextroamphetamine by unspecified interaction mechanism. Minor/Significance Unknown. Based on animal studies.
- celecoxib
celecoxib will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- chloroquine
chloroquine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- cimetidine
cimetidine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- codeine
dextroamphetamine increases effects of codeine by unspecified interaction mechanism. Minor/Significance Unknown.
- darifenacin
darifenacin will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- desmopressin
desmopressin increases effects of dextroamphetamine by pharmacodynamic synergism. Minor/Significance Unknown.
- dextromoramide
dextroamphetamine increases effects of dextromoramide by unspecified interaction mechanism. Minor/Significance Unknown.
- diamorphine
dextroamphetamine increases effects of diamorphine by unspecified interaction mechanism. Minor/Significance Unknown.
- difenoxin hcl
dextroamphetamine increases effects of difenoxin hcl by unspecified interaction mechanism. Minor/Significance Unknown.
- diphenhydramine
diphenhydramine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- diphenoxylate hcl
dextroamphetamine increases effects of diphenoxylate hcl by unspecified interaction mechanism. Minor/Significance Unknown.
- dipipanone
dextroamphetamine increases effects of dipipanone by unspecified interaction mechanism. Minor/Significance Unknown.
- dronedarone
dronedarone will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- ethosuximide
dextroamphetamine decreases levels of ethosuximide by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- eucalyptus
eucalyptus increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.
- guarana
guarana increases effects of dextroamphetamine by pharmacodynamic synergism. Minor/Significance Unknown.
- haloperidol
haloperidol will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- hydromorphone
dextroamphetamine increases effects of hydromorphone by unspecified interaction mechanism. Minor/Significance Unknown.
- imatinib
imatinib will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- levorphanol
dextroamphetamine increases effects of levorphanol by unspecified interaction mechanism. Minor/Significance Unknown.
- maraviroc
maraviroc will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- marijuana
marijuana will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- meperidine
dextroamphetamine increases effects of meperidine by unspecified interaction mechanism. Minor/Significance Unknown.
- methadone
dextroamphetamine increases effects of methadone by unspecified interaction mechanism. Minor/Significance Unknown.
- morphine
dextroamphetamine increases effects of morphine by unspecified interaction mechanism. Minor/Significance Unknown.
- nalbuphine
dextroamphetamine increases effects of nalbuphine by unspecified interaction mechanism. Minor/Significance Unknown.
- opium tincture
dextroamphetamine increases effects of opium tincture by unspecified interaction mechanism. Minor/Significance Unknown.
- oxycodone
dextroamphetamine increases effects of oxycodone by unspecified interaction mechanism. Minor/Significance Unknown.
- oxymorphone
dextroamphetamine increases effects of oxymorphone by unspecified interaction mechanism. Minor/Significance Unknown.
- papaveretum
dextroamphetamine increases effects of papaveretum by unspecified interaction mechanism. Minor/Significance Unknown.
- parecoxib
parecoxib will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- pentazocine
dextroamphetamine increases effects of pentazocine by unspecified interaction mechanism. Minor/Significance Unknown.
- perphenazine
perphenazine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- propafenone
propafenone will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- quinacrine
quinacrine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- ranolazine
ranolazine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- ritonavir
ritonavir will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- sage
sage increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.
- sufentanil
dextroamphetamine increases effects of sufentanil by unspecified interaction mechanism. Minor/Significance Unknown.
- tapentadol
dextroamphetamine increases effects of tapentadol by unspecified interaction mechanism. Minor/Significance Unknown.
- thioridazine
thioridazine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- tipranavir
tipranavir will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- tramadol
dextroamphetamine increases effects of tramadol by unspecified interaction mechanism. Minor/Significance Unknown.
- yerba mate
yerba mate increases effects of dextroamphetamine by pharmacodynamic synergism. Minor/Significance Unknown.
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, intestinal ischemia, dryness of the mouth, diarrhea, anorexia, weight loss, and 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
Warnings
Black Box Warnings
This medication has a high potential for abuse and misuse, which can lead to development of substance use disorder, including addiction; misuse and abuse of CNS stimulants can result in overdose and death, and this risk is increased with higher doses or unapproved methods of administration, such as snorting or injection
Before prescribing this medication, assess each patient’s risk for abuse, misuse, and addiction; educate patients and their families about risks, proper storage of the drug, and proper disposal of any unused drug
Throughout treatment, reassess each patient’s risk of abuse, misuse, and addiction and frequently monitor for signs and symptoms of abuse, misuse, and addiction
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
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 hazardous activities due to CNS effects
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
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
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
Abuse, misuse, and addiction
- This medication has a high potential for abuse and misuse; use exposes individuals to risks of abuse and misuse, which can lead to development of a substance use disorder, including addiction; this medication can be diverted for non-medical use into illicit channels or distribution
- Risk of overdose and death is increased with higher doses or unapproved methods of administration, such as snorting or injection
- Educate patients and their families about abuse, misuse, and addiction and proper disposal of any unused drug; advise patients to store amphetamine sulfate in a safe place, preferably locked, and instruct patients to not give medication to anyone else; throughout treatment, reassess each patient’s risk of abuse, misuse, and addiction and frequently monitor for signs and symptoms of abuse, misuse, and addiction
Risks to patient with serious cardiac disease
- Sudden death reported in patients with structural cardiac abnormalities or other serious cardiac disease treated with CNS stimulant treatment at recommended ADHD dosages
- Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmia, coronary artery disease, or other serious cardiac disease
Motor and verbal tics, and worsening of Tourette’s Syndrome
- CNS stimulants, including amphetamine sulfate, associated with onset or exacerbation of motor and verbal tics; worsening of Tourette’s syndrome also reported
- Before initiating therapy, assess family history and clinically evaluate patients for tics or Tourette’s syndrome; regularly monitor patients for emergence or worsening of tics or Tourette’s syndrome with therapy, and discontinue treatment if clinically appropriate
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
Pregnancy & Lactation
Pregnancy
Pregnancy exposure registry is available that monitors pregnancy outcomes in women exposed during pregnancy; healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Psychostimulants at 1-866-961-2388 or visiting online at https://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/othermedications/
Available data from published epidemiologic studies and postmarketing reports on use of prescription amphetamine in pregnant women have not identified drug-associated risk of major birth defects and miscarriage; adverse pregnancy outcomes, including premature delivery and low birth weight, reported in infants born to mothers taking amphetamines during pregnancy
Amphetamines cause vasoconstriction and thereby may decrease placental perfusion; in addition, amphetamines can stimulate uterine contractions, increasing the risk of premature delivery; infants born to mothers taking amphetamines during pregnancy have increased risk of premature delivery and low birth weight
Monitor infants born to mothers taking amphetamines for symptoms of withdrawal such as feeding difficulties, irritability, agitation, and excessive drowsiness
Animal data
- No apparent effects on morphological development reported in embryo-fetal development studies, with oral administration of amphetamine to rats and rabbits during organogenesis at doses 2 and 12 times, respectively, the maximum recommended human dose (MRHD) of 20 mg/day given to adolescents, on a mg/m² basis
- However, in a pre- and post-natal development study, amphetamine (d-to l- ratio of 3:1) administered orally to pregnant rats during gestation and lactation caused a decrease in pup survival and a decrease in pup body weight that correlated with a delay in developmental landmarks at clinically relevant doses of amphetamine
- Adverse effects on reproductive performance observed in pups whose mothers were treated with amphetamine; long-term neurochemical and behavioral effects reported in animal developmental studies using clinically relevant doses of amphetamine
Lactation
Based on limited case reports in published literature, amphetamine is present in human milk; there are no reports of adverse effects on breastfed infant
Long-term neurodevelopmental effects on infants from amphetamine exposure are unknown; large dosages of amphetamine might interfere with milk production, especially in women whose lactation is not well established
Because of potential for serious adverse reactions in nursing infants, advise patients that breastfeeding is not recommended during therapy
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.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
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
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Formulary
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.
