Amphetamine
DRUG CLASS
- CNS stimulant[1]
INDICATIONS
FDA
NON-FDA APPROVED USES
- Depression in medically ill older adults or adult patients with terminal illness and/or receiving palliative care
- Fatigue, cancer-related
MECHANISM
- Increases intrasynaptic concentrations of NE and DA through reuptake inhibition
FORMS
brand name | generic | manufacturer | route | form | dosage^ | cost* |
Adderall | Amphetamine | DSM Pharmaceuticals Inc | PO | Tablet | 2.5-40 mg | 5 mg (100): $622.00 |
*Prices represent cost per unit specified, are representative of "Average Wholesale Price" (AWP).
^Dosage is indicated in mg unless otherwise noted.
ADULT DOSING
USUAL
Adderall IR
- Starting dose is 2.5 mg twice daily, or 5 mg once a day[1]
- Increase dosage by 5 mg/wk until therapeutic range is reached. Maximum dosage is 40 mg/day[1]
Adderall XR
- Initial dosing at 10-20mg every morning. Maximum dosage is 40 mg/day
GERIATRIC
- Amphetamines like Adderall have not been studied in the geriatric population[1]
RENAL
- Renal dysfunction can hinder elimination of amphetamine[1]
HEPATIC
- Hepatic insufficiency can hinder elimination of amphetamine[1]
PREGNANCY
- Pregnancy Category C[1]
BREASTFEEDING
PEDIATRIC DOSING
USUAL
RENAL
- Renal dysfunction can hinder elimination of amphetamine[1]
ADVERSE DRUG REACTIONS
GENERAL
- Appetite suppression, weight loss, transient sleep disturbances, abdominal pain, headaches[1]
COMMON
- Headaches, dizziness, nausea, stomach pain, reduced appetite, weight loss
OCCASIONAL
- Urticaria, hypersensitivity reactions, insomnia, euphoria, dysphoria, tremor[1]
RARE
- Hypertension, tics, mania, hallucinations, aggression, anxiety, dyphoria
- Blackbox warning: sudden death due to cardiac problems exacerbated by psychiatric drugs
DRUG INTERACTIONS
Drug | Effect of Interaction | Recommendations/Comments |
Antacids | May increase effect of stimulants | Monitor therapy |
Atomoxetine | May increase effect of stimulants | Monitor therapy |
Cannabinoids | May increase effect of stimulants | Monitor therapy |
Linezolid | May increase effect of stimulants | Monitor therapy |
MAO Inhibitors | May increase effect of stimulants | Monitor therapy |
Proton Pump Inhibitors | May increase effect of stimulants | Monitor therapy |
TCAs | May increase effect of stimulants | Monitor therapy |
Antipsychotics | May decrease effect of stimulants | Monitor therapy |
Ascorbic Acid | May decrease effect of stimulants | Monitor therapy |
Lithium | May decrease effect of stimulants | Monitor therapy |
Multivitamins | May decrease effect of stimulants | Monitor therapy |
Opioids | Stimulants may increase effect of opioids | Monitor therapy |
Sympathomimetics | Stimulants may increase effect of sympathomimetics | Monitor therapy |
PHARMACOKINETIC
Absorption
- Immediate release: rapid absorption
- Extended release: rapid absorption
Protein Binding
- 16%
Bioavailability
- The pH of GI system impacts bioavailability of amphetamine; it is well absorbed in the gut
- Exact bioavailability not established
Distribution
- 6 L/kg
New heading
Metabolism
- Hepatic metabolism via CYP2D6 enzyme
Elimination
- Primarily eliminated in urine
Half Life
- Immediate release: 9 hours
- Extended release: 10-13 hours
COMMENTS
- The FDA classifies Adderall as a Schedule II controlled substance[1]
- Amphetamines are frequently abused and are established to cause dependence[1]
- In case of overdose, contact Poison Control Center immediately[1]
- The FDA estimates approximately 3 kg of weight loss after the first year and 1 kg of weight loss after the second year of using amphetamines
- Decision between short- and long-acting products should be based on patient’s daily behavioral routines
- It is not necessary to taper when discontinuing stimulant use
- It is recommended for patients to eat a high-fat meal in the evenings, as stimulant effects are lower at this time. This helps address nausea and appetite issues.
- Use with caution in individuals with preexisting or possible: Bipolar disorder (possible induction of mixed/manic episode), preexisting psychotic disorder, tic or Tourette’s (exacerbate motor and phonic tics and Tourette’s syndrome) and substance use disorder. [1]
References
- Adderall (FDA Package Insert). DSM Pharmaceuticals Inc. Greenville, NC. 2007. Accessed: January 3, 2019. https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/011522s040lbl.pdf
- Amphetamine. Drug Bank. Accessed: January 3, 2019. https://www.drugbank.ca/drugs/DB00182
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Washington, DC: American Psychiatric Association, 2000.
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