Pharm

Dextroamphetamine

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Dextroamphetamine, Dexedrine, Dextrostat, Adderall, Lisdexamfetamine, Vyvanse

  • 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
  • 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
  • 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
  • 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
  • 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
  • Adverse Effects