Dextroamphetamine

Dextroamphetamine may be found in some form under the following brand names:

• Dexedrine

• Dextrostat

• LiquADD

• ProCentra

• Zenzedi

Follow all directions on your prescription label. Your doctor may occasionally change your dose. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Dextroamphetamine may be habit-forming. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it. Selling or giving away this medicine is against the law.

Dextroamphetamine is sometimes taken 2 or 3 times per day. Extended-release dextroamphetamine is taken only once per day. Follow your doctor's dosing instructions very carefully.

Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.

Do not crush, chew, break, or open an extended-release capsule. Swallow it whole.

Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

While using this medicine, your doctor will need to check your progress at regular visits. Tell any doctor who treats you that you are using this medicine.

Store at room temperature away from moisture, heat, and light.

Keep track of your medicine. Dextroamphetamine is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

Take the missed dose as soon as you remember, but not late in the day. Skip the missed dose if it is almost evening. Do not take extra medicine to make up the missed dose.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of dextroamphetamine can be fatal.

Overdose symptoms may include restlessness, tremor, muscle twitches, rapid breathing, confusion, hallucinations, panic, aggressiveness, muscle pain or weakness, and dark colored urine. These symptoms may be followed by depression and tiredness. Other overdose symptoms include nausea, vomiting, diarrhea, stomach pain, uneven heartbeats, feeling light-headed, fainting, seizure (convulsions), or coma.

Many drugs can interact with dextroamphetamine. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any you start or stop using, especially:

• an antacid;

• an antidepressant;

• blood pressure medication; or

• seizure medicine.

This list is not complete and many other drugs can interact with dextroamphetamine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

Storage

Oral

Tight, light-resistant containers at 15–30°C.102

Tight, light-resistant containers at 20–25°C.102

Tight, light-resistant containers at 25°C (may be exposed to 15–30°C).101 103

• Amphetamines are sympathomimetic amines with CNS stimulant activity.d

• May block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneural space.d

• Pharmacologic actions of amphetamines are qualitatively similar to those of ephedrine and include CNS and respiratory stimulation and sympathomimetic activity including pressor response, mydriasis, bronchodilation, and contraction of the urinary bladder sphincter.d

• On a weight basis, dextroamphetamine has a stronger CNS action and a lesser activity on the peripheral nervous system than does the racemic amphetamine.d The CNS stimulating effect of dextroamphetamine is approximately twice that of amphetamine.d

• Mechanism of action on peripheral structures is thought to be a combination of release of norepinephrine from stores in adrenergic nerve terminals and a direct action on both alpha and beta receptor sites.d

• Mechanism of action involved in the central effect has not been determined.d The main sites of CNS action appear to be the cerebral cortex and possibly the reticular-activating system; stimulation by an amphetamine causes an increase in motor activity, mental alertness, diminished sense of fatigue, brighter spirits, and mild euphoria.d

• Theories of dysfunction in ADHD focus on the prefrontal cortex, which controls many executive functions (e.g., planning, impulse control).e Stimulants have putative effects on central dopamine and norepinephrine pathways that are crucial in frontal lobe function.e

• Produces an anorexigenic effect, leading to loss of weight.d No primary effect on appetite has been demonstrated in humans and it has been postulated that anorexigenic effects are secondary to increased sympathetic activity resulting from release of norepinephrine and dopamine. May also cause a loss of acuity of smell and taste, which may contribute to the anorexigenic effect of the drugs.d

In the U.S.

• Dexedrine
• Dexedrine Spansules
• Dextrostat
• Liquadd
• ProCentra
• Zenzedi

Available Dosage Forms:

• Capsule, Extended Release
• Solution
• Tablet

Therapeutic Class: CNS Stimulant

Chemical Class: Amphetamine (class)

Take dextroamphetamine only as directed by your doctor. Do not take more or less of it, do not take it more often, and do not take it for a longer time than your doctor ordered. If too much is taken, it may become habit-forming. If you or your child feel that the medicine is not working properly after you have taken it for several weeks, check with your doctor first and do not increase the dose.

dextroamphetamine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor if you have any questions. Ask your pharmacist for the Medication Guide if you do not have one.

If you or your child use the tablet form of dextroamphetamine, and you take it 2 or 3 times a day. Take the first dose in the morning. The other doses may be taken during the day with 4 to 6 hours between doses.

It is best to take the sustained-release capsule in the morning. Taking dextroamphetamine in the afternoon or evening could make it harder for you to fall asleep.

Swallow the sustained-release capsule whole. Do not crush, break, or chew it.

Dosing

The dose of dextroamphetamine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of dextroamphetamine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For attention-deficit hyperactivity disorder (ADHD):
  • For oral dosage form (sustained-release capsules):
    • Adults and children 6 years of age and older—At first, 5 milligrams (mg) 1 or 2 times a day. Your doctor may adjust your dose if needed.
    • Children younger than 6 years of age—Use is not recommended.
  • For oral dosage form (tablets):
    • Adults and children 6 years of age and older—At first, 5 milligrams (mg) 1 or 2 times a day. Your doctor may adjust your dose if needed.
    • Children 3 to 5 years of age—At first, 2.5 mg once a day. Your doctor may adjust your dose if needed.
    • Children younger than 3 years of age—Use and dose must be determined by your doctor.
• For narcolepsy:
  • For oral dosage forms (sustained-release capsules or tablets):
    • Adults and children 12 years of age and older—At first, 10 milligrams (mg) once a day. Your doctor may adjust your dose if needed.
    • Children 6 to 12 years of age—At first, 5 mg once a day. Your doctor may adjust your dose if needed.
    • Children younger than 6 years of age—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of dextroamphetamine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, known hypersensitivity or idiosyncrasy to the sympathomimetic amines, glaucoma.

Agitated states

Patients with a history of drug abuse

During or within 14 days following the administration of monoamine oxidase inhibitors (hypertensive crises may result).

Amphetamines are noncatecholamine, sympathomimetic amines that promote release of catecholamines (primarily dopamine and norepinephrine) from their storage sites in the presynaptic nerve terminals. A less significant mechanism may include their ability to block the reuptake of catecholamines by competitive inhibition.

Metabolism

Hepatic via CYP monooxygenase and glucuronidation

Excretion

Urine; urinary excretion is pH dependent and is increased with acid urine (low pH)

Time to Peak

Serum: Immediate release: ~3 hours; Sustained release: ~8 hours

Narcolepsy: Oral: Initial: 10 mg once daily; may increase in increments of 10 mg at weekly intervals until optimal response is obtained; usual dosage: 5 to 60 mg daily in divided doses.

Adverse effects have been observed in animal reproduction studies. The majority of human data is based on illicit amphetamine/methamphetamine exposure and not from therapeutic maternal use (Golub, 2005). Use of amphetamines during pregnancy may lead to an increased risk of premature birth and low birth weight; newborns may experience symptoms of withdrawal. Behavioral problems may also occur later in childhood (LaGasse, 2012).