Adult Dosing
Attention deficit hyperactivity disorder
Immediate release
- Start with 5 mg PO qam or bid; may increase 5 mg/day qwk until optimal response
- Usual dose: 5-40 mg/day PO div qd-tid
- Max: 40 mg/day
- Notes:
- Give first dose on awakening; administer additional doses at intervals of 4-6 hrs
- Individualize dosage according to therapeutic needs and response of the patient
- Avoid late evening doses because of the potential for insomnia
Extended release
- 20 mg PO qam
- Notes:
- Individualize dosage according to therapeutic needs and response of the patient
- May switch from IR to ER at same total daily dose qam
- Avoid afternoon doses because of the potential for insomnia
- Doses >20 mg/day are rarely more effective
Narcolepsy
Immediate release
- Start 10 mg PO qam; may increase 10 mg/day qwk until optimal response
- Usual dose: 5-60 mg/day PO div qd-tid
- Notes:
- Individualize dosage according to therapeutic needs and response of the patient
- Give first dose on awakening; administer additional doses at intervals of 4-6 hrs
Pediatric Dosing
Attention deficit hyperactivity disorder
Immediate release
- 3-5 yrs
- Start 2.5 mg PO qam; may increase 2.5 mg/day qwk until optimal response
- 6 yrs
- 5 mg PO qam or bid; may increase 5 mg/day qwk until optimal response
- Usual dose: 5-40 mg/day PO div qd-tid
- Max: 40 mg/day
- Notes:
- Give first dose on awakening; administer additional doses at intervals of 4-6 hrs
- Individualize dosage according to therapeutic needs and response of the patient
- Avoid late evening doses because of the potential for insomnia
Extended release
- 6-12 yrs
- Start 10 mg PO qam; may increase 5-10 mg/day qwk
- Max: 30 mg/day
- Notes:
- Individualize dosage according to therapeutic needs and response of the patient
- If lower initial dose is appropriate, initiate therapy with 5 mg PO qam
- May switch from IR to ER at same total daily dose qam
- Avoid afternoon doses because of the potential for insomnia
- 13-17 yrs
- Start 10 mg PO qam; may increase 20 mg/day after 1 week if symptoms are not controlled adequately
- Notes:
- Individualize dosage according to therapeutic needs and response of the patient
- May convert from IR to ER at same total daily dose qam
- Avoid afternoon doses because of the potential for insomnia
- Doses >20 mg/day are rarely more effective
Narcolepsy
Immediate release
- 6-12 yrs
- Start 5 mg PO qam; may increase 5 mg/day qwk until optimal response
- Usual dose: 5-60 mg/day PO div qd-tid
- Notes:
- Individualize dosage according to therapeutic needs and response of the patient
- Give first dose on awakening; administer additional doses at intervals of 4-6 hrs
- >12 yrs
- Start 10 mg PO qam; may increase 10 mg/day qwk until optimal response
- Usual dose: 5-60 mg/day PO div qd-tid
- Notes:
- Individualize dosage according to therapeutic needs and response of the patient
- Give first dose on awakening; administer additional doses at intervals of 4-6 hrs
[Outline]
See Supplemental Patient Information
- Sudden death and pre-existing structural cardiac abnormalities or other serious heart problems are associated with CNS stimulant therapy, even at usual doses. Children and adolescents with structural cardiac abnormalities or other serious heart problems are more prone to sudden death. Avoid using this therapy in children or adolescents with known structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or other serious cardiac problems that may place them at increased vulnerability to the sympathomimetic effects of the drug. Adults are more susceptible for development of cardiovascular related events. Modest increase in average blood pressure (about 2-4 mmHg) and average heart rate (about 3-6 bpm) may occur in patients receiving stimulant medications; monitor patients for larger changes in heart rate and blood pressure. Carefully undertake history including assessment for a familial history of sudden death or ventricular arrhythmia. Perform physical examination to assess for the presence of cardiac disease; perform electrocardiogram and echocardiogram if findings suggest presence of cardiac disease. Immediately perform cardiac evaluation on developing symptoms such as exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease in patients undergoing therapy
- Patients with preexisting psychotic disorder are prone for development of exacerbating symptoms of behavior disturbance and thought disorder
- Mixed manic episode may occur in ADHD patients with comorbid bipolar disorders receiving CNS stimulants; adequately screen patients with comorbid depressive symptoms for risk of developing bipolar disorder. Undertake a detailed psychiatric history, including a familial history of suicide, bipolar disorder, and depression
- Treatment-emergent psychotic or manic symptoms including hallucinations, delusional thinking, or mania may occur in children and adolescents without prior history of psychotic illness or mania. Discontinuation of therapy may be essential in such patients. Aggressive behavior or hostility may occur is in children and adolescents with ADHD during therapy; monitor patients for the appearance of or worsening of aggressive behavior or hostility
- Long-term suppression of growth may occur during therapy; monitor growth in children during treatment with stimulants and interrupt therapy in patients who are not growing or gaining weight as expected
- Convulsive threshold may be lowered in patients with prior history of seizures, patients with prior EEG abnormalities in the absence of seizures, and very rarely, in patients without a history of seizures and no prior EEG evidence of seizures. Discontinue therapy in the presence of seizures
- Difficulties with accommodation and blurring of vision may occur during therapy
- Prescribe or dispense the least amount of amphetamine at one time in order to minimize the possibility of overdosage
- Exacerbation of motor and phonic tics and Tourettes syndrome may occur during therapy; perform clinical evaluation for tics and Tourettes syndrome in patients and their families before initiating therapy
- Therapy is associated with peripheral vasculopathy, including Raynauds phenomenon. Signs and symptoms usually improve after reduction in dose or discontinuation of therapy
Cautions: Use cautiously in
- Geriatric patients
- History of cardiovascular disease
- Mild hypertension
- Increase in heart rate
- Heart failure
- Recent myocardial infarction
- Ventricular arrhythmia
- Psychosis
- History/risk of seizure
- Patients using other sympathomimetic drugs
- ADHD patients with comorbid bipolar disorder
Supplemental Patient Information
- Caution patients against engaging in potentially hazardous activities requiring alertness, such as operating machinery or driving a vehicle
- Inform patients, their families, and their caregivers about the potential benefits and risks associated with this drug and counsel them in its appropriate use
- Instruct patients to report to their physician about any numbness, pain, skin color change, or sensitivity to temperature in fingers or toes
Pregnancy Category:C
Breastfeeding: In dosages prescribed for medical indications, some evidence indicates that amphetamine/dextroamphetamine does not affect nursing infants adversely. The effect of amphetamine/dextroamphetamine in milk on the neurological development of the infant has not been well established. Large dosages might interfere with milk production, especially in women whose lactation is not well established. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 24 June 2011). Manufacturer advises mothers taking this combination drug to refrain from nursing.
US Trade Name(s)
- Adderall XR 5
- Adderall XR 10
- Adderall XR 15
- Adderall XR 20
- Adderall XR 25
- Adderall XR 30
US Availability
amphetamine/dextroamphetamine (generic)
- TABS:
- 2.5 mg/2.5 mg
- 3.75 mg/3.75 mg
- 5 mg/5 mg
- 6.25 mg/6.25 mg
- 7.5 mg/7.5 mg
- 10 mg/10 mg
- 15 mg/15 mg
- ECAPS:
- 2.5 mg/2.5 mg
- 5 mg/5 mg
- 7.5 mg/7.5 mg
- 10 mg/10 mg
- 12.5 mg/12.5 mg
- 15 mg/15 mg
Adderall XR 5 (amphetamine/dextroamphetamine)
Adderall XR 10 (amphetamine/dextroamphetamine)
Adderall XR 15 (amphetamine/dextroamphetamine)
Adderall XR 20 (amphetamine/dextroamphetamine)
Adderall XR 25 (amphetamine/dextroamphetamine)
Adderall XR 30 (amphetamine/dextroamphetamine)
Canadian Trade Name(s)
- Adderall XR 5
- Adderall XR 10
- Adderall XR 15
- Adderall XR 20
- Adderall XR 25
- Adderall XR 30
Canadian Availability
Adderall XR 5 (amphetamine/dextroamphetamine)
Adderall XR 10 (amphetamine/dextroamphetamine)
Adderall XR 15 (amphetamine/dextroamphetamine)
Adderall XR 20 (amphetamine/dextroamphetamine)
Adderall XR 25 (amphetamine/dextroamphetamine)
Adderall XR 30 (amphetamine/dextroamphetamine)
UK Trade Name(s)
UK Availability
Australian Trade Name(s)
Australian Availability
[Outline]