Adderall

(amphetamine/dextroamphetamine immediate-release)

Forms/Strengths

•  Tablets: 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg

Dosing

• Age: ≥ 3 y/o
• Onset: 30-60 minutes
• Duration: 4-6 hours
• Considerations: May be taken with or without food. Administer first dose upon awakening and additional doses at intervals of 4-6 hours.
• Initial Dose:
  • 3-5 y/o: 2.5 mg daily
  • 6+ y/o: 5 mg 1-2 times daily
• Titration:
  • 3-5 y/o: 2.5 mg weekly
  • 6+ y/o: 5 mg weekly
• Max Dose:
  • ≤50 kg: 40 mg/day
  • >50 kg: 60 mg/day (Narcolepsy)
    

Quick Facts

• Increases synaptic norepinephrine/dopamine by stimulating presynaptic release and inhibiting reuptake
• Enhances focus, attention, and impulse control
• Side effects: decreased appetite, insomnia, elevated blood pressure
• Immediate release formulation for rapid onset
• Unique amphetamine salt blend; monitor cardiovascular status; caution with MAO inhibitors
  

Indications

• ADHD (ICD-10: F90.0)
• Narcolepsy (ICD-10: G47.419)

Off-Label Uses

• Depression (ICD-10: F33.9): Occasionally used adjunctively in treatment-resistant cases.
• Cognitive Disorders in TBI: May be prescribed to improve attention and concentration.

How to Take

• Administer once or multiple times daily, as directed.
• Take with or without food; high-fat meals may delay absorption.
• If using the tablet, swallow whole; do not crush, chew, or split unless scored.
• Avoid dosing late in the day to prevent insomnia.
  

Side Effects

• Cardiovascular: Palpitations, tachycardia, hypertension, sudden death
• CNS: Psychotic episodes, overstimulation, irritability, euphoria
• GI: Dry mouth, anorexia, weight loss
• Allergic: Rash, hypersensitivity reactions
• Endocrine: Changes in libido, impotence

Monitoring / Labs

• Cardiovascular: Baseline and routine monitoring of heart rate and blood pressure.
• Growth in Pediatrics: Regular monitoring of height and weight to detect growth suppression.
• Psychiatric Symptoms: Observe for mood changes, anxiety, or psychosis.
• Abuse Potential: Monitor for misuse or diversion.
  

Education

• When to Call the Doctor:

  • Severe mood changes, aggression, or suicidal thoughts.
  • Chest pain, shortness of breath, or palpitations (cardiovascular concerns).
  • Uncontrolled movements, tics, or worsening anxiety.
  • Signs of circulatory issues (e.g., numbness, coldness, or color changes in fingers/toes).
  • Unexplained weight loss or growth suppression in pediatric patients.

• Safety Tips:

  • Monitor blood pressure and heart rate regularly, especially in patients with cardiovascular risk.
  • Use caution in patients with history of anxiety, bipolar disorder, or psychosis, as symptoms may worsen.
  • Avoid caffeine and other stimulants, which may increase side effects.
  • Ensure adequate hydration and nutrition, as appetite suppression is common.
  • Do not abruptly discontinue; tapering may be needed in long-term users.

• Parent Tips for Pediatric Patients:

  • Encourage a high-calorie diet to offset appetite suppression.
  • Monitor school performance and behavioral changes.
  • Administer the first dose before school for optimal effect.
  • Observe for sleep disturbances and adjust dosing schedule if needed.
  • Keep communication open with teachers and caregivers regarding medication effects.
    

Additional Information

• Contraindications:

  • Hypersensitivity to amphetamines or any formulation components.
  • Use within 14 days of MAOI therapy (risk of hypertensive crisis).
  • Symptomatic cardiovascular disease, moderate-to-severe hypertension, hyperthyroidism, glaucoma.
  • History of substance use disorder, unless benefits outweigh risks.

• Pregnancy:

  • Category C; use only if benefits outweigh risks.
  • May cause neonatal withdrawal symptoms or low birth weight.

• Lactation:

  • Excreted in breast milk; not recommended due to potential infant exposure.

• Drug Interactions:

  • Serotonergic drugs (e.g., SSRIs, SNRIs, MAOIs) increase serotonin syndrome risk.
  • Acidifying agents (e.g., ascorbic acid) may reduce drug absorption.
  • Alkalinizing agents (e.g., sodium bicarbonate) may increase amphetamine levels.
  • May potentiate hypertensive effects of certain medications (e.g., decongestants, beta-agonists).