Xelstrym

(generic)

Forms/Strengths

• Transdermal system: 4.5 mg/9 hours, 9 mg/9 hours, 13.5 mg/9 hours, 18 mg/9 hours

Dosing

• Age: ≥ 6 y/o
• Onset: Approximately 2 hours after application
• Duration: 9-hour wear time; continuous release for 9-12 hours
• Considerations: Apply the patch to the hip, upper arm, chest, upper back, or flank area 2 hours before the effect is needed. Rotate application sites with each new patch. Do not use more than one patch in a 24-hour period. Do not substitute for other amphetamine products on a milligram-per-milligram basis.
• Initial Dose:
  • Pediatric (6-17 y/o): 4.5 mg/9 hours daily
  • Adults: 9 mg/9 hours daily
• Titration: 4.5 mg/9 hours weekly
• Max Dose: 18 mg/9 hours
  • Severe Renal Impairment: 13.5 mg/9 hours
  • End-Stage Renal Disease (ESRD): 9 mg/9 hours
    

Quick Facts

• Increases synaptic dopamine and norepinephrine by promoting presynaptic release and inhibiting reuptake
• Enhances focus, attention, and impulse control
• Extended-release capsule with a multi-phase release profile for rapid onset and sustained effect
• Unique formulation for consistent plasma levels throughout the day
• Common side effects: decreased appetite, insomnia, headache, gastrointestinal discomfort

Indications

•  ADHD (ICD-10: F90.0)

Off-Label Uses

•  N/A

How to Take

• Apply one patch daily to clean, dry, intact skin.
• Apply to the hip, upper arm, chest, flank, or upper back—rotate application sites daily.
• Press firmly for at least 30 seconds to ensure full adhesion.
• Wear the patch for 9 hours and remove it after the prescribed duration.
• Avoid cutting or altering the patch, as this may affect drug release.
• Wash hands after applying or removing the patch.

Side Effects

• Common: decreased appetite, headache, insomnia, tic, abdominal pain, vomiting, nausea, irritability, increased blood pressure, and increased heart rate

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, rapid heartbeat, shortness of breath (cardiovascular concerns).
  • Uncontrolled movements, tics, or worsening anxiety.
  • Skin irritation, blistering, or severe redness at the application site.
  • Numbness, coldness, or color changes in fingers or toes (circulatory issues).
  • Unexplained weight loss or delayed growth in pediatric patients.

• Safety Tips:

  • Monitor blood pressure and heart rate, especially in patients with cardiovascular risk.
  • Use caution in patients with anxiety, bipolar disorder, or psychosis, as symptoms may worsen.
  • Avoid external heat sources (e.g., heating pads, electric blankets, hot tubs) as heat can increase drug absorption.
  • Ensure adequate hydration and nutrition, as appetite suppression is common.
  • If the patch falls off, replace with a new one but remove at the usual time.

• Parent Tips for Pediatric Patients:

  • Encourage a nutrient-dense diet to counteract appetite suppression.
  • Administer in the morning before school for optimal effect.
  • Monitor school performance and behavioral changes.
  • Observe for sleep disturbances; adjust timing if necessary.
  • Communicate regularly with teachers and caregivers about medication effects.
  • Dispose of used patches safely by folding them in half and placing them in a secure disposal container.

Additional Information

• Contraindications:

  • Hypersensitivity to amphetamines or 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)