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.

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

Amphetamine-Dextroamphetamine (on 2/9/2012 at DrugStore.com)
Amphetamine-Dextroamphetamine 5mg 24 Hour Capsule #20 for $116.00 ($5.80/unit)
Amphetamine-Dextroamphetamine 10mg 24 Hour Capsule #20 for $121.99 ($6.10/unit)
Amphetamine-Dextroamphetamine 15mg 24 Hour Capsule #30 for $171.99 ($5.73/unit)
Amphetamine-Dextroamphetamine 20mg 24 Hour Capsule #20 for $114.99 ($5.75/unit)
Amphetamine-Dextroamphetamine 25mg 24 Hour Capsule #20 for $114.99 ($5.75/unit)
Amphetamine-Dextroamphetamine 30mg Limited Availability #20 for $114.99 ($5.75/unit)
Amphetamine-Dextroamphetamine 5mg Tablets #20 for $35.99 ($1.80/unit)
Amphetamine-Dextroamphetamine 10mg Tablets #20 for $38.99 ($1.95/unit)
Amphetamine-Dextroamphetamine 7.5mg Tablets #20 for $32.99 ($1.65/unit)
Amphetamine-Dextroamphetamine 12.5mg Tablets #20 for $31.18 ($1.56/unit)
Amphetamine-Dextroamphetamine 15mg Tablets #20 for $32.99 ($1.65/unit)
Amphetamine-Dextroamphetamine 30mg Tablets #20 for $33.32 ($1.67/unit)
Amphetamine-Dextroamphetamine 20mg Tablets #20 for $26.99 ($1.35/unit)
Dextroamphetamine Sulfate (on 2/9/2012 at DrugStore.com)
Dextroamphetamine Sulfate 10mg Tablets #20 for $20.21 ($1.01/unit)
Dextroamphetamine Sulfate 5mg Tablets #20 for $14.99 ($0.75/unit)
Dextroamphetamine Sulfate CR (on 2/9/2012 at DrugStore.com)
Dextroamphetamine Sulfate CR 10mg 24 Hour Capsule #20 for $100.99 ($5.05/unit)
Dextroamphetamine Sulfate CR 15mg 24 Hour Capsule #20 for $128.99 ($6.45/unit)
Dextroamphetamine Sulfate CR 5mg 24 Hour Capsule #20 for $80.99 ($4.05/unit)
Dexedrine (on 2/9/2012 at DrugStore.com)
Dexedrine 5mg 24 Hour Capsule #20 for $149.99 ($7.50/unit)
Dexedrine 10mg 24 Hour Capsule #20 for $150.99 ($7.55/unit)
Dexedrine 15mg 24 Hour Capsule #20 for $149.99 ($7.50/unit)
Adderall (on 2/9/2012 at DrugStore.com)
Adderall 5mg Tablets #20 for $80.99 ($4.05/unit)
Adderall 10mg Tablets #20 for $85.99 ($4.30/unit)
Adderall 15mg Tablets #20 for $77.99 ($3.90/unit)
Adderall 30mg Tablets #20 for $80.99 ($4.05/unit)
Adderall 20mg On Manufacturer Backorder Until January 2012. #20 for $84.99 ($4.25/unit)
Adderall XR (on 2/9/2012 at DrugStore.com)
Adderall XR 5mg 24 Hour Capsule #20 for $156.99 ($7.85/unit)
Adderall XR 10mg 24 Hour Capsule #20 for $158.26 ($7.91/unit)
Adderall XR 15mg 24 Hour Capsule #20 for $162.00 ($8.10/unit)
Adderall XR 20mg 24 Hour Capsule #20 for $158.26 ($7.91/unit)
Adderall XR 30mg 24 Hour Capsule #20 for $158.26 ($7.91/unit)
Adderall XR 25mg 24 Hour Capsule #20 for $158.26 ($7.91/unit)
Vyvanse (on 2/9/2012 at DrugStore.com)
Vyvanse 20mg Capsules #20 for $125.99 ($6.30/unit)
Vyvanse 30mg Capsules #20 for $126.99 ($6.35/unit)
Vyvanse 40mg Capsules #20 for $113.99 ($5.70/unit)
Vyvanse 50mg Capsules #20 for $118.57 ($5.93/unit)
Vyvanse 60mg Capsules #20 for $117.70 ($5.89/unit)
Vyvanse 70mg Capsules #20 for $117.98 ($5.90/unit)

Ontology: 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 (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 (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 Organic Chemical (T109) , Pharmacologic Substance(T121)
MSH D003913
SnomedCT 50868004, 387278002, 409880008
English Dexamphetamine, d Amphetamine, d-Amphetamine, dextro Amphetamine, dextro-Amphetamine, dextroamphetamine, Benzeneethanamine, alpha-methyl-, (S)-, Dexamfetamine, AMPHETAMINE A D, D amphetamine, Dextroamphetamine, (+)-Amphetamine, Dextroamphetamine [Chemical/Ingredient], dexamphetamines, d amphetamine, dextro-amphetamine, dextro amphetamine, d-amphetamine, dextroamphetamines, d amphetamines, amphetamines d, Dextroamphetamine (product), Dextroamphetamine (substance), Amphetamine (d-), DEXTROAMPHETAMINE, dexamphetamine, Dexamfetamine (substance)
Swedish Dextroamfetamin
Spanish dexanfetamina, dexanfetamina (sustancia), dextroanfetamina (producto), dextroanfetamina (sustancia), dextroanfetamina, d-Anfetamina, Dextroanfetamina
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
Portuguese d-Anfetamina, Dextroanfetamina

Ontology: Adderall (C0290795)

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

Ontology: Dexedrine (C0591355)

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

Ontology: DextroStat (C0719850)

Concepts Organic Chemical (T109) , Pharmacologic Substance(T121)
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)
SnomedCT 426249000, 425597005
English Lisdexamfetamine, lisdexamfetamine, LISDEXAMFETAMINE, Lisdexamfetamine (product), Lisdexamfetamine (substance)
Spanish lisdexanfetamina, lisdexanfetamina (producto), lisdexanfetamina (sustancia)