Adderall XR

(amphetamine/dextroamphetamine extended-release)

Forms/Strengths

• Capsules: 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg

Dosing

• Age: Pediatric patients ≥6 years and adults
• Onset: Approximately 30–60 minutes
• Duration: 10–12 hours
• Release Profile: Biphasic – an immediate-release portion followed by a delayed-release phase via beaded capsule technology
• Considerations: May be taken with or without food; avoid concomitant use with acidifying agents (e.g., fruit juices, vitamin C) which may decrease absorption; high-fat meals may delay Tmax by 2.5 hours but do not affect overall bioavailability
• Initial Dose (Pediatric):
  • Typically 10 mg once daily in the morning
• Titration (Pediatric):
  • Increase by 5–10 mg increments at weekly intervals based on clinical response and tolerability
• Max Dose (Pediatric):
  • Generally should not exceed 30 mg per day

Quick Facts

• Mechanism: Increases the synaptic levels of norepinephrine and dopamine
• Main Benefits: Improves attention, reduces hyperactivity and impulsivity
• Side Effects: Decreased appetite, insomnia, headache, stomach upset
• Formulation Technology: Advanced beaded capsule system providing dual-phase drug release
• Special Notes: High potential for abuse; use with caution in patients with pre-existing cardiovascular conditions

Mechanism of Action

• Adderall XR contains mixed amphetamine salts that work by enhancing the release of norepinephrine and dopamine, thereby improving neurotransmission which aids in reducing ADHD symptoms.

Indications

• Attention-Deficit/Hyperactivity Disorder (ADHD) (ICD-10: F90.0)

Off-Label Uses

• Narcolepsy (ICD-10: G47.4) – Although primarily indicated for ADHD, Adderall XR may be used off-label in adults for the treatment of narcolepsy.

How to Take

• Take once daily in the morning to avoid insomnia
• May be taken with or without food; note that high-fat meals can delay absorption
• Swallow the capsule whole; do not crush or chew
• General missed-dose advice: Take as soon as remembered unless it is close to the next scheduled dose

Side Effects

• Common:
  • Central Nervous System: Insomnia, headache, irritability
  • Gastrointestinal: Decreased appetite, stomach upset, dry mouth
• Serious:
  • Cardiovascular: Increased blood pressure, tachycardia, potential for arrhythmias

Monitoring/Labs

• Vital Signs: Monitor blood pressure and heart rate periodically
• Growth Parameters: In pediatric patients, monitor height and weight at regular intervals
• Mental Health: Monitor for new or worsening psychiatric symptoms, including mood changes and anxiety
• Abuse Potential: Monitor for signs of misuse or diversion

Education

• When to Call the Doctor:
  • Experiencing chest pain, shortness of breath, or significant changes in mood or behavior
• Safety Tips:
  • Take medication strictly as prescribed
  • Do not share medication with others
  • Keep the medication in a secure place out of reach of children
  • Avoid alcohol and other CNS stimulants
  • Report any concerning side effects promptly to your healthcare provider
• Tips for Pediatric Patients:
  • Ensure dosing is appropriate for your child's weight and age
  • Monitor changes in appetite and growth
  • Maintain regular follow-up visits with the healthcare provider
  • Inform school personnel and caregivers about the medication schedule

Long-Term Use Considerations

• Periodic evaluation of cardiovascular status, especially in patients with underlying conditions
• Regular monitoring of growth and development in pediatric patients
• Assess for potential abuse or dependency over extended periods of use

Tapering Guidance

• Clinical Guidelines: Gradual dose reduction is recommended to mitigate withdrawal symptoms
• Caregiver Considerations: Work closely with your healthcare provider to design an individualized tapering schedule

Additional Information

• Contraindications:
  • History of cardiovascular disease, hyperthyroidism, or glaucoma
• Pregnancy:
  • Use during pregnancy only if the potential benefit justifies the potential risk to the fetus (Category C)
• Lactation:
  • May be excreted in breast milk; consult with your healthcare provider before use
• Drug Interactions:
  • Potential interactions with monoamine oxidase inhibitors (MAOIs), antacids, and other stimulants

References

• U.S. Food and Drug Administration. (2012). Adderall XR Prescribing Information. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/021303s062lbl.pdf
• DailyMed. (2021). Adderall XR Drug Information. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4bd6a68a-35a8-41ad-8b8e-d1e4a7b2123f
• Faraone, S. V., Biederman, J., & Mick, E. (2020). Pharmacotherapy of attention-deficit/hyperactivity disorder: Current trends. Current Opinion in Psychiatry, 33(4), 321–326.