# Xelstrym ### (generic)
**[Full Prescribing Information](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0862f02a-72a8-41cc-8845-57cf4974bb6f&type=display)**[**DailyMed Drug Information**](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0862f02a-72a8-41cc-8845-57cf4974bb6f)
--- **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)