amphetamine mixtures

ROUTE	ONSET	PEAK	DURATION
PO	tablet: 0.5–1 hr	tablet: 3 hr capsule: 7 hr	4–6 hr

Contraindicated in:

Hypersensitivity;
Hyperexcitable states including hyperthyroidism;
Psychotic personalities;
Concurrent use or use within 14 days of MAO inhibitors or MAO-like drugs (linezolid or methylene blue);
Suicidal or homicidal tendencies;
Chemical dependence;
Glaucoma;
Serious structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmia, coronary artery disease, or other serious cardiac disease (may ↑ risk of sudden death);
End-stage renal disease;
Lactation: Lactation.

Use Cautiously in:

History of substance abuse
;
Continual use (may produce psychological dependence or physical addiction)
;
Hypertension;
Diabetes mellitus;
Tics or family history/diagnosis of Tourette syndrome (may worsen condition);
Severe renal impairment (↓ dose);
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk; may lead to premature delivery and low birth weight infants;
Geri: Older adults may be more susceptible to side effects.

Adv. Reactions/Side Effects ⬆ ⬇

CV: palpitations, tachycardia, cardiomyopathy (↑ with prolonged use or high doses), hypertension, hypotension, peripheral vasculopathy, SUDDEN DEATH

Derm: alopecia, urticaria

EENT: blurred vision, ↑intraocular pressure, mydriasis

Endo: growth inhibition (with long term use in children)

GI: anorexia, constipation, cramps, diarrhea, dry mouth, intestinal ischemia, nausea, vomiting

GU: libido changes, erectile dysfunction, priapism

MS: RHABDOMYOLYSIS

Neuro: hyperactivity, insomnia, restlessness, tremor, aggression, anger, behavioral disturbances, dizziness, dysgeusia, hallucinations, headache, irritability, mania, paresthesia, skin picking, talkativeness, thought disorder, tics, Tourette syndrome

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS AND ANGIOEDEMA),

physical dependence

psychological dependence

Interactions ⬆ ⬇

Drug-drug:

Concurrent use with MAO inhibitors or MAO-inhibitor-like drugs, such as linezolid or methylene blue, may result in serious, potentially fatal reactions; wait at least 14 days following discontinuation of MAO inhibitor before initiation of amphetamine mixtures.
Drugs that affect serotonergic neurotransmitter systems, including MAO inhibitors, tricyclic antidepressants, SSRIs, SNRIs, fentanyl, buspirone, tramadol, lithium, and triptans, may ↑ risk of serotonin syndrome.
↑adrenergic effects with other adrenergics or thyroid preparations.
Drugs that alkalinize urine, including sodium bicarbonate or acetazolamide, may ↓ excretion and ↑ risk of toxicity.
Drugs that acidify urine, including large doses of ascorbic acid, may ↑ excretion and ↓ effectiveness.
↑risk of hypertension and bradycardia with beta blockers.
↑risk of arrhythmias with digoxin.
Tricyclic antidepressants may ↑ risk of arrhythmias, hypertension, or hyperpyrexia.
Proton pump inhibitors may ↑ risk of toxicity.

Drug-Natural Products:

Use with St. John's wort may ↑ risk of serotonin syndrome.

Drug-Food:

Foods that alkalinize the urine (fruit juices) can ↑ effect of amphetamine.

Route/Dosage ⬆ ⬇

Dose is expressed in total amphetamine content (amphetamine + dextroamphetamine).

Attention-Deficit Hyperactivity Disorder

PO (Adults ): Immediate-release tablets: 5 mg 1–2 times daily; may ↑ daily dose in 5-mg increments at weekly intervals; usual dose range = 5–40 mg/day in 1–3 divided doses. Extended-release capsules (Adderall XR): 20 mg once daily; Extended-release capsules (Mydayis): 12.5–25 mg once daily in the morning upon awakening; may ↑ daily dose in 12.5-mg increments at weekly intervals (maximum dose = 50 mg/day).
PO (Children ≥13 yr): Immediate-release tablets: 5 mg 1–2 times daily; may ↑ daily dose in 5-mg increments at weekly intervals; usual dose range = 5–40 mg/day in 1–3 divided doses. Extended-release capsules (Adderall XR): 10 mg once daily in the morning; may ↑ to 20 mg once daily in the morning after 1 wk; Extended-release capsules (Mydayis): 12.5 mg once daily in the morning upon awakening; may ↑ daily dose in 12.5-mg increments at weekly intervals (maximum dose = 25 mg/day).
PO (Children 6–12 yr): Immediate-release tablets: 5 mg 1–2 times daily; may ↑ daily dose in 5-mg increments at weekly intervals; usual dose range = 5–40 mg/day in 1–3 divided doses. Extended-release capsules (Adderall XR): 5–10 mg once daily in the morning; may ↑ daily dose in 5–10-mg increments at weekly intervals (maximum dose = 30 mg/day).
PO (Children 3–5 yr): Immediate-release tablets: 2.5 mg once daily in the morning; may ↑ daily dose in 2.5-mg increments at weekly intervals; usual dose range = 2.5–40 mg/day in 1–3 divided doses.

Renal Impairment

PO (Adults ): GFR 15–29 mL/min/1.73 m²: Extended-release capsules (Adderall XR): 15 mg once daily in the morning; Extended-release capsules (Mydayis)—12.5 mg once daily in the morning upon awakening; may ↑ daily dose in 12.5-mg increments at weekly intervals (maximum dose = 25 mg/day).

Renal Impairment

(Children ≥13 yr): GFR 15–29 mL/min/1.73 m²: Extended-release capsules (Mydayis): 12.5 mg once daily in the morning upon awakening (maximum dose = 12.5 mg/day).

Renal Impairment

(Children ≥6 yr): GFR 15–29 mL/min/1.73 m²: Extended-release capsules (Adderall XR): 5 mg once daily in the morning (maximum dose = 20 mg/day in children 6–12 yr).

Narcolepsy

PO (Adults and Children ≥13 yr): Immediate-release tablets: 10 mg once daily in the morning; may ↑ daily dose in 10-mg increments at weekly intervals; usual dosage range = 5–60 mg/day in 1–3 divided doses.
PO (Children 6–12 yr): Immediate-release tablets: 5 mg once daily; may ↑ daily dose in 5-mg increments at weekly intervals; usual dose range = 5–60 mg/day in 1–3 divided doses.

Availability ⬆ ⬇

(Generic available)

Amount is expressed in total amphetamine content (amphetamine + dextroamphetamine).

Immediate-release tablets: 5 mg; 7.5 mg; 10 mg; 12.5 mg; 15 mg; 20 mg; 30 mg
Extended-release capsules (Adderall XR): 5 mg; 10 mg; 15 mg; 20 mg; 25 mg; 30 mg
Extended-release capsules (Mydayis): 12.5 mg; 25 mg; 37.5 mg; 50 mg

Assessment ⬆ ⬇

Monitor BP, HR, and respiratory rate before and periodically during therapy. Obtain a history (including assessment of family history of sudden death, ventricular arrhythmia, tics, or Tourette syndrome), physical exam to assess for cardiac disease, and further evaluation (ECG and echocardiogram), if indicated. If exertional chest pain, unexplained syncope, or other cardiac symptoms occur, evaluate promptly.
May produce a false sense of euphoria and well-being. Provide frequent rest periods and observe patient for rebound depression after the effects of the medication have worn off.
Monitor closely for behavior change during therapy.
Assess for risk of abuse, misuse, or addiction prior to starting therapy and during therapy. Has high dependence and abuse or misuse potential. Misuse and abuse of CNS stimulants can result in overdose and death; this risk is ↑ with higher doses or unapproved methods of administration, such as snorting or injection. Tolerance to medication occurs rapidly; do not ↑ dose.
Assess infants born to mothers taking amphetamines for symptoms of withdrawal (feeding difficulties, irritability, agitation, excessive drowsiness).
ADHD: Monitor weight biweekly and inform health care provider of significant loss. Pedi: Monitor height periodically in children; report growth inhibition. Growth suppression may occur in children with long-term use.
Assess child's attention span, impulse control, and interactions with others. Therapy may be interrupted at intervals to determine whether symptoms are sufficient to continue therapy.
Narcolepsy: Observe and document frequency of narcoleptic episodes.

Lab Test Considerations:

May interfere with urinary steroid determinations.
- May cause ↑ plasma corticosteroid concentrations; greatest in evening.

Implementation ⬆ ⬇

High Alert: Do not confuse Adderall with Adderall XR.
PO: Administer in the morning to prevent insomnia. May be taken without regard to food. Individualize dose to therapeutic needs and response of patient. Use the lowest effective dose.
- Administer short acting doses 4–6 hr apart.
- DNC: Extended-release capsules may be swallowed whole or opened and sprinkled on applesauce; swallow contents without chewing. Applesauce should be swallowed immediately; do not store. Do not divide contents of capsule; entire contents of capsule should be taken.
ADHD: Pedi: When symptoms are controlled, dose ↓ or interruption of therapy may be possible during summer months or may be given on each of the five school days, with medication-free weekends and holidays.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication once in the early morning as directed. With extended release capsule, avoid afternoon doses to prevent insomnia. Omit missed doses and resume schedule next day. Do not double doses. Discuss safe use, risks, and proper storage and disposal of amphetamines with patients and caregivers with each Rx. Advise patient and parents to read the Medication Guide prior to starting therapy and with each Rx refill in case of changes. Instruct patient not to alter dose without consulting health care provider. Abrupt cessation of high doses may cause extreme fatigue and mental depression.
Advise patient that amphetamine mixtures is a drug with known potential for abuse, misuse, and/or addiction. Store in safe place, protect it from theft, and never give to anyone other than the individual for whom it was prescribed.
Inform patient that the effects of drug-induced dry mouth can be minimized by rinsing frequently with water or chewing sugarless gum or candies.
Advise patient to limit intake of foods that alkalinize the urine (fruit juices).
May impair judgment. Advise patient to use caution when driving or during other activities requiring alertness until response to medication is known.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications, especially St. John's wort.
Inform patient that periodic holidays from the drug may be used to assess progress and decrease dependence. Pedi: Children should be given a drug-free holiday each yr to reassess symptoms and treatment. Doses will change as children age due to pharmacokinetic changes such as slower hepatic metabolism. If reduced appetite and weight loss occur, advise parents to provide high-calorie meals when drug levels are low (at breakfast and or bedtime).
Advise patient and/or parents to notify health care provider of behavioral changes (new or worse behavior and thought problems, bipolar illness, or aggressive behavior or hostility; new psychotic symptoms such as hearing voices, believing things that are not true, suspicion, or new manic symptoms).
Advise patient to notify health care provider if symptoms of heart problems (chest pain, shortness of breath, fainting), nervousness, restlessness, insomnia, dizziness, anorexia, or dry mouth becomes severe.
Inform patients of risk of peripheral vasculopathy. Instruct patients to notify health care provider of any new numbness, pain, skin color change from pale to blue to red, or coolness or sensitivity to temperature in fingers or toes, and call if unexplained wounds appear on fingers or toes.
Rep: May cause fetal harm. Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or and to avoid breastfeeding during therapy. May ↑ risk or premature birth and low birth weight. Monitor infants born to mothers taking amphetamines for symptoms of withdrawal (feeding difficulties, irritability, agitation, excessive drowsiness). Encourage patients exposed to amphetamines during pregnancy to join the registry. Health care providers may call the National Pregnancy Registry for Psychiatric Medications at 1-866-961-2388 or online at https://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/othermedications/ to register patients.
Emphasize the importance of routine follow-up exams to monitor progress.
Home Care Issues: Advise parents to notify school nurse of medication regimen.

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆ ⬇

Contr. Subst. Schedule ⬆