II. Indications
III. Contraindications
-
Congenital Heart Defect (ask related PMH, Family History and screen on ADHD exam)
- Consider an EKG before prescribing
- Vetter (2008) Circulation 117(18):2407-23. [PubMed]
IV. Precautions
- See ADHD Medication for overall approach and medication selection
- Maximum Dosing
- Adults and older adolescents (>50 kg) may in some cases need dosing in excess of listed maximum
- Exercise caution and Informed Consent as these doses are not FDA approved
- Doses exceed the manufacturers recommendation
- Absolute maximum dose of mixed Amphetamine salts: 60 mg per day
- References
- (2013) Presc Lett 20(9): 50-1
V. Pharmacokinetics
- Immediate Release Dextroamphetamine (Dexedrine, Dextrostat)
- Onset of activity: 20 to 60 minutes
- Peak effect: 1 to 2 hours
- Duration of activity: 4 to 6 hours
- Extended Release Dextroamphetamine (Dexedrine Spansules)
- Onset of activity: 60 to 90 minutes
- Duration of activity: 8 hours
-
Amphetamine-Dextroamphetamine (Adderall)
- Onset of activity: 30 to 60 minutes
- Peak effect: 1 to 2 hours
- Duration of activity: 6-8 hours
- Adderall XR Capsules
- Duration of activity: 10-12 hours
- Biphasic release (similar to Ritalin LA)
- Immediate release beads: 50%
- Delayed release beads: 50% (starts 4 hours later)
- High fat breakfast alters absorption
VI. Dosing: Immediate Release Dextroamphetamine (Dexedrine, Dextrostat)
- Range: 0.15 to 0.5 mg/kg/day
- Maximum: 40 mg/day
- Frequency: Lasts 4 hours (dose up to three times daily)
- Start: 2.5 mg orally qAM and/or noon
- Typical Dose: 5-15 mg orally twice daily or 5-10 mg orally three times daily
VII. Dosing: Intermediate Release Dextroamphetamine (Dexedrine Spansules)
- Range: 0.3 to 0.8 mg/kg/dose
- Maximum: 40 mg/day
- Start: 5 mg orally once or twice daily
- Typical Dose: 5-30 mg orally once daily or 5-15 mg orally twice daily
VIII. Dosing: Intermediate Release Amphetamine-Dextroamphetamine (Adderall)
- Very similar to Extended Release Dextroamphetamine (Dexedrine Spansules)
- Range: 0.15 to 0.5 mg/dose
- Maximum: 40 mg/day
- Start: 2.5 to 5 mg orally once to twice daily
- Typical Dose: 5-30 mg orally once daily or 5-15 mg orally twice daily
IX. Dosing: Extended Release Amphetamine-Dextroamphetamine (Adderall XR)
- Initial: 10 mg orally once daily
- Typical dose: 10-30 mg orally once daily
- Maximum: 30 mg/day
X. Preparation: Lisdexamfetamine (Vyvanse)
- Dextroamphetamine is a D-Amphetamine prodrug, metabolized to the active form
- Inactive until cleaved in GI Tract
- Decreased abuse potential when injected or snorted
- Decreased "buzz" when swallowed
- Indicated for ADHD in ages 6-12 years
- Dosing: Start with lowest effective dose
- Medication doses range from 30 mg to 70 mg qAM
XI. Management Difficulty Swallowing Medication - Long Acting Amphetamines
-
Generic
- Adderall XR (may be sprinkled on apple sauce)
- Expensive
- Adzenys XR Orally Disolving Tablet 6.3 mg (lasts 12 hours)
- Dynavel XR Suspension 2.5 mg/ml (lasts 12 hours)
- References
- (2016) Presc Lett 23(3):16
XII. Adverse Effects
- See ADHD Medication
XIII. Safety
- Pregnancy Category C
- Avoid in Lactation
XIV. References
- (1996) Pediatrics 98:301-4 [PubMed]
- Andesman (1999) Pediatr Clin North Am 46:945-63 [PubMed]
- Bennett (1999) Pediatr Clin North Am 46:929-44 [PubMed]
- Challman (2000) Mayo Clin Proc 75:711-21 [PubMed]
- Chang (2020) Am Fam Physician 102(10):592-602 [PubMed]
- Dopheide (2005) Am J Health Syst Pharm 62(14):1502-9 [PubMed]
- Pelham (1999) Pediatrics 103:e43 [PubMed]
- Pliszka (2007) J Am Acad Child Adolesc Psychiatry 46(7):894-921 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| 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 |
| lisdexamfetamine (on 9/20/2023 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| LISDEXAMFETAMINE 10 MG CAPSULE | Generic | $5.88 each |
| LISDEXAMFETAMINE 20 MG CAPSULE | Generic | $3.28 each |
| LISDEXAMFETAMINE 20 MG TB CHEW | Generic | $7.51 each |
| LISDEXAMFETAMINE 30 MG CAPSULE | Generic | $3.56 each |
| LISDEXAMFETAMINE 30 MG TB CHEW | Generic | $7.80 each |
| LISDEXAMFETAMINE 40 MG CAPSULE | Generic | $3.33 each |
| LISDEXAMFETAMINE 50 MG CAPSULE | Generic | $3.31 each |
| LISDEXAMFETAMINE 60 MG CAPSULE | Generic | $3.39 each |
| LISDEXAMFETAMINE 70 MG CAPSULE | Generic | $3.16 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 | |