# Adderall XR ### (amphetamine/dextroamphetamine extended-release)
**[ Full Prescribing Information ](https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/021303s062lbl.pdf)****[ DailyMed Drug Information ](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4bd6a68a-35a8-41ad-8b8e-d1e4a7b2123f)**
--- ### **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.