Pharm

Dextroamphetamine

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Dextroamphetamine, Amphetamine-Dextroamphetamine, Amphetamine Dextroamphetamine, Dexedrine, Dextrostat, Adderall, Lisdexamfetamine, Vyvanse

  • See Also
  1. Attention Deficit Disorder in Children
  2. School Problem Evaluation
  3. Attention Deficit Disorder in Adults
  4. ADHD Diagnosis
  5. ADHD Differential Diagnosis
  6. ADHD Comorbid Conditions
  7. ADHD Non-Pharmacologic Management
  8. ADHD Medications
  9. Methylphenidate (Ritalin, Methylin, Concerta)
  10. Atomoxetine (Strattera)
  • Indications
  1. Attention Deficit Hyperactivity Disorder (ADHD)
  • 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]
  • Precautions
  1. See ADHD Medication for overall approach and medication selection
  2. 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
      1. Doses 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
  • Medications
  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
  5. Lisdexamfetamine (Vyvanse)
    1. Indicated for ADHD in ages 6-12 years
    2. Dextroamphetamine is a D-Amphetamine prodrug, metabolized to the active form
    3. Inactive until cleaved in GI Tract
      1. Decreased abuse potential when injected or snorted
      2. Decreased "buzz" when swallowed
  • 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
  • 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
  • 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
  • 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
  • Dosing
  • Lisdexamfetamine (Vyvanse)
  1. Start with lowest effective dose
  2. Medication doses range from 30 mg to 70 mg qAM
  • Management Difficulty Swallowing Medication - Long Acting Amphetamines
  1. Generic
    1. Adderall XR (may be sprinkled on apple sauce)
  2. Expensive
    1. Adzenys XR Orally Disolving Tablet 6.3 mg (lasts 12 hours)
    2. Dynavel XR Suspension 2.5 mg/ml (lasts 12 hours)
    3. Arynta (Lisdexamfetamine dimesylate, 10 mg/ml) solution
  3. References
    1. (2016) Presc Lett 23(3):16
    2. (2025) Presc Insights 32(11): 65
  • Adverse Effects
  1. See ADHD Medication
  • Safety
  1. Pregnancy Category C
  2. Avoid in Lactation
  • Drug Interactions
  1. CYP2D6 Inhibitors
    1. Increases Amphetamine levels (with risk of Serotonin Syndrome)
  2. Acidifying Agents (esp. decreasing pH in Stomach and unine)
    1. Decreases Amphetamine drug levels via decreased GI absorption and increased urinary excretion
    2. Examples: Methenamine Therapy, Vitamin C
  3. Alkalinizing Agents (esp. increasing pH in Stomach and unine)
    1. Increases Amphetamine drug levels via increased GI absorption and decreased urinary excretion
    2. Examples: Antacids (e.g. Omeprazole)
  4. MAO Inhibitors
    1. Hypertensive Crisis risk
  5. Serotonergic Drugs
    1. Serotonin Syndrome risk
  6. Tricyclic Antidepressants
    1. May significantly increase CNS Dextroamphetamine levels
    2. May also potentiate cardiovascular effects
  7. Lithium Carbonate
    1. Lithium inhibits the stimulatory and anorexic effects of Amphetamines
  8. Antihistamines
    1. Amphetamines decrease Sedative effect of Antihistamines
  9. Antihypertensives
    1. May decrease efficacy of Antihypertensives in Blood Pressure control
  10. Meperidine
    1. Amphetamines potentiate MeperidineAnalgesic effects
  11. Propoxyphene
    1. Fatal Seizures may occur when Amphetamines are present in PropoxypheneOverdose
  12. Adrenergic Blockers
    1. Adrenergic blockers are inhibited by Amphetamines
  13. Norepinephrine
    1. Amphetamines enhance Norepinephrine adrenergic effects
  14. Dopamine or Norepinephrine receptor blockers (inhibits Amphetamine CNS effects)
    1. Chlorpromazine
    2. Haloperidol
  15. Delayed medication absorption
    1. Ethosuximide
    2. Phenobarbital
    3. Phenytoin
  • Resources
  1. Adderal (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f22635fe-821d-4cde-aa12-419f8b53db81
  2. Adderal XR (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=aff45863-ffe1-4d4f-8acf-c7081512a6c0
  3. Vyvanse (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=704e4378-ca83-445c-8b45-3cfa51c1ecad
  • References
  1. (1996) Pediatrics 98:301-4 [PubMed]
  2. Andesman (1999) Pediatr Clin North Am 46:945-63 [PubMed]
  3. Bennett (1999) Pediatr Clin North Am 46:929-44 [PubMed]
  4. Challman (2000) Mayo Clin Proc 75:711-21 [PubMed]
  5. Chang (2020) Am Fam Physician 102(10):592-602 [PubMed]
  6. Dopheide (2005) Am J Health Syst Pharm 62(14):1502-9 [PubMed]
  7. Pelham (1999) Pediatrics 103:e43 [PubMed]
  8. Pliszka (2007) J Am Acad Child Adolesc Psychiatry 46(7):894-921 [PubMed]
    1. http://www.jaacap.com/article/S0890-8567(09)62182-1/fulltext