# 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 - These are mixed amphetamine salts (MAS) in a 3:1 ratio of dextroamphetamine to levoamphetamine salts for balanced effects on focus (dextro) and alertness (levo). --- ### **Dosing** - **Age:** ≥ 3 y/o - **Onset:** 30-60 minutes - **Duration:** 4-6 hours - **Considerations:** Administer first dose upon awakening; additional doses at 4-6 hour intervals; may take with or without food (high-fat meals may delay absorption) - **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 dopamine and norepinephrine via presynaptic release, reuptake inhibition (DAT/NET), and VMAT2-mediated vesicular efflux - Enhances focus, attention, impulse control, and wakefulness in ADHD and narcolepsy - Common side effects: decreased appetite, insomnia, dry mouth, weight loss, increased heart rate/blood pressure - Schedule II controlled substance with high abuse/misuse potential - Black box warning: Abuse and dependence; sudden death and serious cardiovascular events reported - May suppress growth in pediatrics; monitor height/weight - 3:1 dextro:levo ratio balances cognitive focus (dextro) and peripheral alerting effects (levo) --- ### **Indications** - **ADHD** (ICD-10: F90.0, F90.1, F90.2, F90.8, F90.9) - **Narcolepsy** (ICD-10: G47.419) --- ### **Off-Label Uses** - **Treatment-resistant depression** (ICD-10: F33.9): Adjunctive for low-energy symptoms - **Cognitive enhancement post-TBI** (ICD-10: S06.0-S06.9): Improves attention and processing speed - **Augmentation in bipolar depression** (ICD-10: F31.4): Short-term for anhedonia --- ### **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** - **Common:** - Cardiovascular: Tachycardia, hypertension, palpitations - CNS: Insomnia, headache, irritability, anxiety, dizziness - GI: Dry mouth, anorexia, weight loss, abdominal pain - Other: Decreased appetite, euphoria - **Serious:** - Black box: Risk of abuse/dependence; sudden death, myocardial infarction, stroke in those with cardiac structural abnormalities - Psychiatric: Psychosis, mania, aggression, suicidal ideation - Cardiovascular: Cardiomyopathy, Raynaud's phenomenon - Growth suppression in children; priapism; serotonin syndrome (with serotonergics); hypersensitivity reactions --- ### **Monitoring / Labs** - Baseline and periodic: Heart rate, blood pressure, weight, height (pediatrics) - Psychiatric: Screen for bipolar, psychosis risk; monitor mood/behavior - Cardiac: ECG if history of heart disease; assess for misuse/diversion - Growth: Plot height/weight percentiles; consider drug holiday if suppression - No routine labs required; assess renal/hepatic function if impaired --- ### **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). --- ### **References** 1. FDA Prescribing Information - Adderall Tablets, 2007, [https://www.accessdata.fda.gov/drugsatfda\_docs/label/2007/011522s040lbl.pdf](https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/011522s040lbl.pdf) 2. DailyMed - Mixed Salts of a Single Entity Amphetamine Product, 2023, [https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=175e125c-8df5-484c-a5c0-4b61e05f75ba](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=175e125c-8df5-484c-a5c0-4b61e05f75ba) 3. StatPearls - Dextroamphetamine-Amphetamine, 2023, [https://www.ncbi.nlm.nih.gov/books/NBK507808/](https://www.ncbi.nlm.nih.gov/books/NBK507808/) 4. DrugBank - Amphetamine, 2024, [https://go.drugbank.com/drugs/DB00182](https://go.drugbank.com/drugs/DB00182)