Adderall (amphetamine/dextroamphetamine immediate-release) Full Prescribing Information DailyMed Drug Information 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 FDA Prescribing Information - Adderall Tablets, 2007, https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/011522s040lbl.pdf DailyMed - Mixed Salts of a Single Entity Amphetamine Product, 2023, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=175e125c-8df5-484c-a5c0-4b61e05f75ba StatPearls - Dextroamphetamine-Amphetamine, 2023, https://www.ncbi.nlm.nih.gov/books/NBK507808/ DrugBank - Amphetamine, 2024, https://go.drugbank.com/drugs/DB00182