# Adderall ### (amphetamine/dextroamphetamine immediate-release)
**[Full Prescribing Information](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=f22635fe-821d-4cde-aa12-419f8b53db81&type=display)**[**DailyMed Drug Information**](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f22635fe-821d-4cde-aa12-419f8b53db81)
--- **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).