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CNS Stimulant

Amphetamine | Adderall

Clinical Overview

Amphetamine (mixed amphetamine salts) is a central nervous system stimulant indicated for Attention Deficit Hyperactivity Disorder (ADHD) and narcolepsy. It is one of the most effective treatments for ADHD, available in immediate-release and extended-release formulations to provide flexible dosing options for symptom control throughout the day.

Primary Clinical Applications

Amphetamine is indicated for ADHD in patients 3 years and older and for narcolepsy in adults and children 6 years and older. It is considered first-line treatment for ADHD due to its high efficacy in improving attention, reducing hyperactivity, and enhancing academic and occupational performance.

Mechanism and Clinical Benefits

Amphetamine increases dopamine and norepinephrine levels by blocking reuptake and promoting release from nerve terminals. This dual mechanism enhances neurotransmitter activity in brain regions responsible for attention and executive function, providing rapid and robust symptom improvement.

Formulation Considerations

Immediate-release formulations typically last 4-6 hours and may require multiple daily doses, while extended-release formulations (Adderall XR, Mydayis) provide 8-16 hours of symptom control with once-daily dosing. The choice depends on patient needs, lifestyle, and side effect tolerance.

Prescribing Information

Dosing & Administration

ADHD – Children (3-5 years):

  • Initial: 2.5 mg once daily
  • Titration: Increase by 2.5 mg weekly
  • Range: 2.5-40 mg daily in divided doses

ADHD – Children (6+ years):

  • Immediate Release: 5 mg 1-2 times daily, increase by 5 mg weekly (maximum 40 mg daily)
  • Extended Release: 5-10 mg once daily, increase by 5-10 mg weekly (maximum 30 mg daily)

ADHD – Adults:

  • Immediate Release: 5 mg 1-2 times daily, increase by 5 mg weekly (maximum 40 mg daily)
  • Extended Release: 20 mg once daily (maximum 60 mg daily)

Narcolepsy:

  • Children (6-12 years): 5 mg daily initially, increase by 5 mg weekly (maximum 60 mg daily)
  • Adults: 10 mg daily initially, increase by 10 mg weekly (maximum 60 mg daily)

Administration:

  • Give first dose upon awakening
  • Immediate release: Divide into 2-3 doses, 4-6 hours apart
  • Extended release: Once daily in morning, swallow whole

Indications

  • Treatment of ADHD in patients 3 years and older
  • Treatment of narcolepsy in patients 6 years and older

Contraindications

  • Advanced arteriosclerosis, symptomatic cardiovascular disease
  • Moderate to severe hypertension
  • Hyperthyroidism, glaucoma
  • Agitated states, history of drug abuse
  • MAOI use within 14 days
  • Known hypersensitivity to sympathomimetic amines

Warnings & Precautions

  • Boxed Warning: High potential for abuse and dependence
  • Cardiovascular effects: Monitor blood pressure and heart rate
  • Psychiatric adverse reactions: May exacerbate psychosis, mania, or aggression
  • Growth suppression: Monitor height and weight in pediatric patients
  • Peripheral vasculopathy: Raynaud’s phenomenon reported
  • Serotonin syndrome: Risk with concurrent serotonergic drugs

Drug Interactions

  • MAOIs: Contraindicated – hypertensive crisis risk
  • Acidifying agents: Decrease amphetamine absorption
  • Alkalinizing agents: Increase amphetamine absorption
  • Tricyclic antidepressants: Enhanced cardiovascular effects
  • CYP2D6 inhibitors: May increase amphetamine levels

Adverse Reactions

Common (>5%):

  • Decreased appetite, insomnia, upper abdominal pain
  • Emotional lability, vomiting, nervousness
  • Fever, nausea, dry mouth

Cardiovascular:

  • Increased blood pressure and heart rate, palpitations

Serious:

  • Sudden death (rare), psychosis, seizures

Special Populations

  • Pediatric: Monitor growth parameters regularly
  • Pregnancy: Category C – use only if benefits outweigh risks
  • Cardiovascular disease: Comprehensive evaluation before initiation
  • Schedule II: High abuse potential, requires careful monitoring
Medical Disclaimer: This information is for educational purposes only and is not intended as medical advice. Always consult with qualified healthcare professionals before making any treatment decisions. Individual patient circumstances may vary significantly.