Adderall, Adderall XR
Classifications: cerebral stimulant; anorexiant; Therapeutic: cerebral stimulant
Pregnancy Category: C
Controlled Substance: Schedule II
5 mg, 10 mg tablets
Adderall: 5 mg, 10 mg, 20 mg, 30 mg tablets; 5 mg, 15 mg, 20 mg, 25 mg, 30 mg sustained release capsules
Marked stimulant effect on CNS thought to be due to action on cerebral cortex and possibly the reticular activating system.
Acts indirectly on adrenergic receptors by increasing synaptic release of norepinephrine in the brain and by blocking reuptake
of norepinephrine at presynaptic membranes.
CNS stimulation results in increased motor activity, diminished sense of fatigue, alertness, wakefulness, and mood elevation.
Anorexigenic effect thought to result from direct inhibition of hypothalamic appetite center, as well as mood elevation.
Narcolepsy, attention deficit disorder in children and adults (hyperkinetic behavioral syndrome, minimal brain dysfunction).
Use as short-term adjunct to control exogenous obesity not generally recommended because of its potential for abuse.
Hypersensitivity to sympathomimetic amines; history of drug abuse; severe agitation; hyperthyroidism; diabetes mellitus;
moderate to severe hypertension, advanced arteriosclerosis, angina pectoris or other cardiovascular disorders; Gilles de
la Tourette disorder; glaucoma; during or within 14 d after treatment with MAOIs; pregnancy (category C); lactation.
Route & Dosage
Adult: PO 560 mg/d divided q46h in 23 doses
Child: PO >12 y, 10 mg/d, may increase by 10 mg at weekly intervals; 612 y, 5 mg/d, may increase by 5 mg at weekly intervals
Attention Deficit Disorder
Adult/Adolescent: PO 10 mg extended release once daily in a.m.; may increase by 510 mg at weekly intervals if needed to max 30 mg/d.
Child: PO 6 y, 5 mg 12 times/d, may increase by 5 mg at weekly intervals (max: 40 mg/d); 35 y, 2.5 mg 12 times/d, may increase by 2.5 mg at weekly intervals; 10 mg extended release once daily in a.m.; may increase
by 510 mg at weekly intervals if needed to max of 30 mg/d.
Adult: PO 510 mg 1 h before meals
- Give first dose on awakening or early in a.m. when prescribed for narcolepsy.
- Give last dose no later than 6 h before patient retires to avoid insomnia.
- Ensure that sustained release capsules are not crushed or chewed.
- Give drug on an empty stomach 3060 min before meal to suppress appetite when prescribed for obesity.
- Store at 15°30° C (59°86° F) unless otherwise directed.
Adverse Effects (≥1%)Body as a Whole:
Allergy, urticaria, sudden death
(reported in children with structural cardiac abnormalities). CNS: Irritability,
nervousness, headache, insomnia,
dysphoria, drowsiness, trembling, hyperactive reflexes. CV: Palpitation,
elevated BP; tachycardia, vasculitis. Urogenital:
Impotence & change in libido with high doses. GI:
Dry mouth, anorexia, unusual weight loss, nausea, vomiting, diarrhea
, or constipation
Diagnostic Test Interference
Elevations in serum thyroxine (T4) levels with high amphetamine doses.
InteractionsDrug: Acetazolamide, sodium bicarbonate
decrease amphetamine elimination; ammonium chloride, ascorbic acid
increase amphetamine elimination; effects of both amphetamine and barbiturate
may be antagonized if given together; furazolidone
may increase BP effects of amphetamines, and interaction may persist for several weeks after furazolidone
antagonizes antihypertensive effects; because mao inhibitors
can precipitate hypertensive crisis (fatalities reported), do not administer amphetamines during or within 14 d of these
may inhibit mood elevating effects of amphetamines; tricyclic antidepressants
enhance amphetamine effects through increased norepinephrine
release; beta agonists
increase cardiovascular adverse effects.
Rapid. Peak effect:
15 h. Duration:
Up to 10 h. Distribution:
All tissues, especially CNS
In liver. Elimination: Renal
; excreted into breast milk. Half-Life:
Assessment & Drug Effects
- Monitor for therapeutic effectiveness. Tolerance to the mood-elevating effects commonly occurs within a few weeks. Drug
is usually discontinued when tolerance develops. Generally, tolerance does not occur when used for attention deficit disorder
- Monitor for S&S of toxicity in children. Response to this drug is more variable in children than adults; acute toxicity
has occurred over a wide range of dosage.
- Monitor for S&S of insomnia or anorexia. Report complaints to physician. Dosage reduction may be required.
- Monitor diabetics closely for loss of glycemic control.
- Monitor growth in children; drug may be discontinued periodically to allow for normal growth.
- Note: Drug's excitatory and euphoric effects are associated with a high abuse potential.
Patient & Family Education
- Keep physician informed of clinical response and persistent or bothersome adverse effects. This drug exerts a stimulating
effect that masks fatigue; after exhilaration disappears, fatigue and depression are usually greater than before, and a longer
period of rest is needed.
- Report insomnia or undesired weight loss.
- Do not drive or engage in potentially hazardous tasks until response to drug is known.
- Rinse mouth frequently with clear water, especially after eating, to relieve mouth dryness; increase fluid intake, if allowed;
chew sugarless gum or sourballs.
- Note: Meticulous oral hygiene is required because decreased saliva encourages demineralization of tooth surfaces and mucosal erosion.
Use of a commercially available oral lubricant, such as Moi-Stir or Xero-Lube, can relieve soft tissue problems and reduce
the potential of tooth decay.
- Note: Appetite suppression usually lessens within a few weeks and appetite increases; dose increase is not indicated.
- Avoid caffeine-containing beverages because caffeine increases amphetamine effects.
- Note that drug is usually tapered gradually following prolonged administration of high doses. Abrupt withdrawal may result
in lethargy, profound depression, or other psychotic manifestations that may persist for several weeks.