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]

IV. 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

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. 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. References
    1. (2016) Presc Lett 23(3):16

XII. Adverse Effects

Images: Related links to external sites (from Bing)

Related Studies

Cost: Medications

dextroamphetamine (on 8/17/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
DEXTROAMPHETAMINE 10 MG TAB Generic $0.34 each
DEXTROAMPHETAMINE 5 MG TAB Generic $0.39 each
DEXTROAMPHETAMINE 5 MG/5 ML Generic $1.27 per ml
DEXTROAMPHETAMINE ER 10 MG CAP Generic $0.88 each
DEXTROAMPHETAMINE ER 15 MG CAP Generic $1.26 each
DEXTROAMPHETAMINE ER 5 MG CAP Generic $0.82 each
adderall (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
ADDERALL 10 MG TABLET Generic $0.25 each
ADDERALL 15 MG TABLET Generic $0.27 each
ADDERALL 20 MG TABLET Generic $0.29 each
ADDERALL 30 MG TABLET Generic $0.30 each
ADDERALL XR 10 MG CAPSULE Generic $0.55 each
ADDERALL XR 15 MG CAPSULE Generic $0.54 each
ADDERALL XR 20 MG CAPSULE Generic $0.52 each
ADDERALL XR 25 MG CAPSULE Generic $0.57 each
ADDERALL XR 30 MG CAPSULE Generic $0.64 each
ADDERALL XR 5 MG CAPSULE Generic $0.68 each
vyvanse (on 1/3/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
VYVANSE 10 MG CAPSULE $11.23 each
VYVANSE 10 MG CHEWABLE TABLET $11.28 each
VYVANSE 20 MG CAPSULE $11.24 each
VYVANSE 20 MG CHEWABLE TABLET $11.23 each
VYVANSE 30 MG CAPSULE $11.25 each
VYVANSE 30 MG CHEWABLE TABLET $11.27 each
VYVANSE 40 MG CAPSULE $11.24 each
VYVANSE 40 MG CHEWABLE TABLET $11.23 each
VYVANSE 50 MG CAPSULE $11.25 each
VYVANSE 50 MG CHEWABLE TABLET $11.24 each
VYVANSE 60 MG CAPSULE $11.26 each
VYVANSE 60 MG CHEWABLE TABLET $11.30 each
VYVANSE 70 MG CAPSULE $11.25 each