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DextroamphetamineAka: Dexedrine, Dextrostat, Adderall, Lisdexamfetamine, Vyvansa

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  1. Indications
    1. Attention Deficit Hyperactivity Disorder (ADHD)
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. Adverse Effects
    1. Similar to Methylphenidate
  10. References
    1. (1996) Pediatrics 98:301
    2. Andesman (1999) Pediatr Clin North Am 46:945
    3. Bennett (1999) Pediatr Clin North Am 46:929
    4. Challman (2000) Mayo Clin Proc 75:711
    5. Dopheide (2005) Am J Health Syst Pharm 62(14):1502
    6. Pelham (1999) Pediatrics 103:e43

Dextroamphetamine (C0011812)

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.
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)
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD003913
EnglishAMPHETAMINE A D, D amphetamine, d-Amphetamine, Dexamfetamine, Dexamphetamine, dextro Amphetamine, dextro-Amphetamine, Dextroamphetamine, DEXTROAMPHETAMINE PREPARATION
Spanishdexanfetamina, dextroanfetamina
Parent Conceptsprimary stimulants of abuse (C0678472), Amphetamine (C0002658), Adrenergic Agents (C0001637), Central Nervous System Stimulants (C0002763), Amphetamines (C0002667), Psychostimulant (C0304403), Duplicate concept (C1274013)
SourcesAOD, CSP, LNC, MSH, MTH, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Adderall (C0290795)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHC090411
EnglishAdderall
SourcesMSH, NCI, PDQ, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)


Dexedrine (C0591355)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD003913
EnglishCelltech Brand of Dextroamphetamine Sulfate, Dexedrine, GlaxoSmithKline Brand of Dextroamphetamine Sulfate, Mallinckrodt Brand of Dextroamphetamine Sulfate
SourcesAOD, CSP, MSH, NCI, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)


DextroStat (C0719850)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD003913
EnglishDextroStat, Shire Brand of Dextroamphetamine Sulfate
SourcesMSH, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)


Lisdexamfetamine (C1873633)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishLisdexamfetamine
Parent ConceptsAmphetamine (C0002658), Psychostimulant (C0304403)
SourcesRXNORM, SNOMEDCT, VANDF
Derived from the NIH UMLS (Unified Medical Language System)



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