III. Contraindications

  1. Congenital Heart Defect (ask related PMH, Family History and screen on ADHD exam)
    1. Consider an EKG before prescribing
    2. Vetter (2008) Circulation 117(18):2407-23. [PubMed] (or open in [QxMD Read])

IV. Precautions: Maximum Dosing

  1. Adults and older adolescents (>50 kg) may in some cases need dosing in excess of listed maximum
  2. Exercise caution and Informed Consent as these doses are not FDA approved and exceed the manufacturers recommendation
  3. Absolute maximum dose of mixed Amphetamine salts: 60 mg per day
  4. References
    1. (2013) Presc Lett 20(9): 50-1

V. Pharmacokinetics

  1. Immediate Release Dextroamphetamine (Dexedrine, Dextrostat)
    1. Onset of activity: 20 to 60 minutes
    2. Peak effect: 1 to 2 hours
    3. Duration of activity: 4 to 6 hours
  2. Extended Release Dextroamphetamine (Dexedrine Spansules)
    1. Onset of activity: 60 to 90 minutes
    2. Duration of activity: 8 hours
  3. Amphetamine-Dextroamphetamine (Adderall)
    1. Onset of activity: 30 to 60 minutes
    2. Peak effect: 1 to 2 hours
    3. Duration of activity: 6-8 hours
  4. Adderall XR Capsules
    1. Duration of activity: 10-12 hours
    2. Biphasic release (similar to Ritalin LA)
      1. Immediate release beads: 50%
      2. Delayed release beads: 50% (starts 4 hours later)
    3. High fat breakfast alters absorption

VI. Dosing: Immediate Release Dextroamphetamine (Dexedrine, Dextrostat)

  1. Range: 0.15 to 0.5 mg/kg/day
  2. Maximum: 40 mg/day
  3. Frequency: Lasts 4 hours (dose up to three times daily)
  4. Start: 2.5 mg orally qAM and/or noon
  5. Typical Dose: 5-15 mg orally twice daily or 5-10 mg orally three times daily

VII. Dosing: Intermediate Release Dextroamphetamine (Dexedrine Spansules)

  1. Range: 0.3 to 0.8 mg/kg/dose
  2. Maximum: 40 mg/day
  3. Start: 5 mg orally once or twice daily
  4. Typical Dose: 5-30 mg orally once daily or 5-15 mg orally twice daily

VIII. Dosing: Intermediate Release Amphetamine-Dextroamphetamine (Adderall)

  1. Very similar to Extended Release Dextroamphetamine (Dexedrine Spansules)
  2. Range: 0.15 to 0.5 mg/dose
  3. Maximum: 40 mg/day
  4. Start: 2.5 to 5 mg orally once to twice daily
  5. Typical Dose: 5-30 mg orally once daily or 5-15 mg orally twice daily

IX. Dosing: Extended Release Amphetamine-Dextroamphetamine (Adderall XR)

  1. Initial: 10 mg orally once daily
  2. Typical dose: 10-30 mg orally once daily
  3. Maximum: 30 mg/day

X. Preparation: Lisdexamfetamine (Vyvanse)

  1. Dextroamphetamine prodrug for ADHD in ages 6-12 years
  2. Dosing: Start with lowest effective dose
    1. Medication doses range from 30 mg to 70 mg qAM
  3. Inactive until cleaved in GI tract
    1. Decreased abuse potential when injected or snorted
    2. Decreased "buzz" when swallowed

XI. Adverse Effects

Images: Related links to external sites (from Google)

Cost: Medications

dextroamphetamine (on 1/21/2015 at Medicaid.Gov Survey of pharmacy drug pricing)
DEXTROAMPHETAMINE 10 MG TAB Generic $1.64 each
DEXTROAMPHETAMINE 5 MG TAB Generic $1.71 each
DEXTROAMPHETAMINE 5 MG/5 ML Generic $1.55 per ml
dexedrine (on 3/19/2014 at Medicaid.Gov Survey of pharmacy drug pricing)
DEXEDRINE SPANSULE 10 MG Generic $3.72 each
adderall (on 1/1/2015 at Medicaid.Gov Survey of pharmacy drug pricing)
ADDERALL 10 MG TABLET Generic $0.87 each
ADDERALL 15 MG TABLET Generic $0.95 each
ADDERALL 20 MG TABLET Generic $0.86 each
ADDERALL 30 MG TABLET Generic $0.87 each
ADDERALL 5 MG TABLET Generic $0.89 each
ADDERALL XR 10 MG CAPSULE Generic $3.64 each
ADDERALL XR 15 MG CAPSULE Generic $3.67 each
ADDERALL XR 20 MG CAPSULE Generic $3.61 each
ADDERALL XR 25 MG CAPSULE Generic $3.79 each
ADDERALL XR 30 MG CAPSULE Generic $3.67 each
ADDERALL XR 5 MG CAPSULE Generic $3.81 each
vyvanse (on 1/21/2015 at Medicaid.Gov Survey of pharmacy drug pricing)
VYVANSE 20 MG CAPSULE $6.99 each
VYVANSE 30 MG CAPSULE $7.02 each
VYVANSE 40 MG CAPSULE $7.12 each
VYVANSE 50 MG CAPSULE $7.02 each
VYVANSE 60 MG CAPSULE $7.05 each
VYVANSE 70 MG CAPSULE $7.11 each

Ontology: Dextroamphetamine (C0011812)

Definition (NCI) A synthetic substance related to natural sympathomimetic amines and the synthetic agent amphetamine. In the central nervous system (CNS), dextroamphetamine induces the release of dopamine within the mesocorticolimbic system, a major component of the brain reward system, resulting in measurable behavioral changes such as euphoria. As a CNS stimulant, this agent may increase blood pressure and reduce appetite. Similar to other amphetamines, dextroamphetamine has a high potential for abuse, dependence, and addiction if used in large doses over extended periods of time. (NCI04)
Definition (MSH) The d-form of AMPHETAMINE. It is a central nervous system stimulant and a sympathomimetic. It has also been used in the treatment of narcolepsy and of attention deficit disorders and hyperactivity in children. Dextroamphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulating release of monamines, and inhibiting monoamine oxidase. It is also a drug of abuse and a psychotomimetic.
Definition (CSP) d-form of amphetamine; it is a central nervous system stimulant and a sympathomimetic; it has also been used in the treatment of narcolepsy and of attention deficit disorders and hyperactivity in children; dextroamphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulating release of monamines, and inhibiting monoamine oxidase; it is also a drug of abuse and a psychotomimetic.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D003913
SnomedCT 409880008, 387278002, 50868004
LNC LP18019-7, MTHU004761
English Dexamphetamine, d Amphetamine, d-Amphetamine, dextro Amphetamine, dextro-Amphetamine, Benzeneethanamine, alpha-methyl-, (S)-, Dexamfetamine, AMPHETAMINE A D, D amphetamine, Dextroamphetamine, (+)-Amphetamine, Dextroamphetamine [Chemical/Ingredient], d amphetamine, dextro-amphetamine, dextro amphetamine, d-amphetamine, dextroamphetamines, d amphetamines, amphetamines d, dexamfetamine, Dexamfetamine (substance), dextroamphetamine, DEXTROAMPHETAMINE, Dextroamphetamine (product), Dextroamphetamine (substance), Amphetamine (d-), dexamphetamine
Swedish Dextroamfetamin
Czech dextroamfetamin
Finnish Deksamfetamiini
Russian DEKSTROAMFETAMIN, DEKSAMFETAMIN, D-AMFETAMIN, D-АМФЕТАМИН, ДЕКСАМФЕТАМИН, ДЕКСТРОАМФЕТАМИН
Japanese デキストロアンフェタミン, デキセドリン, d-アンフェタミン
Italian Destro-amfetamina, Dexamfetamina, d-Amfetamina, Destroamfetamina
German AMPHETAMIN A D, D-Amphetamin, Dextroamphetamin
French Dexamfétamine, Dexamphétamine
Polish Dekstroamfetamina, Deksamfetamina
Spanish dexanfetamina (sustancia), dexanfetamina, dextroanfetamina (producto), dextroanfetamina (sustancia), dextroanfetamina, d-Anfetamina, Dextroanfetamina
Portuguese d-Anfetamina, Dextroanfetamina

Ontology: Adderall (C0290795)

Definition (CHV) a drug used to treat attention deficit hyperactivity disorder
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C090411
English Adderall, adderall

Ontology: Dexedrine (C0591355)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D003913
English dexedrine, Dexedrine, Celltech Brand of Dextroamphetamine Sulfate, GlaxoSmithKline Brand of Dextroamphetamine Sulfate, Mallinckrodt Brand of Dextroamphetamine Sulfate

Ontology: DextroStat (C0719850)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D003913
English Dextrostat, dextrostat, DextroStat, Shire Brand of Dextroamphetamine Sulfate

Ontology: Lisdexamfetamine (C1873633)

Definition (NCI) A prodrug of the d-isomer of amphetamine, a non-catecholamine sympathomimetic amine with central nervous system (CNS) stimulating activity. Upon administration, lisdexamphetamine is converted to dextroamphetamine through cleavage of the lysine group. Dextroamphetamine acts by facilitating the release of catecholamines, particularly noradrenaline and dopamine, from its storage sites in nerve terminals in the CNS, and inhibits their uptake within the mesocorticolimbic system, a major component of the brain reward system, resulting in measurable behavioral changes such as euphoria, mental alertness and excitement and appetite suppression. As a CNS stimulant, this agent may increase blood pressure.
Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH C514020
SnomedCT 426249000, 425597005
English Lisdexamfetamine, Lisdexamfetamine (product), Lisdexamfetamine (substance), lisdexamfetamine, LISDEXAMFETAMINE
Spanish lisdexanfetamina, lisdexanfetamina (producto), lisdexanfetamina (sustancia)