Dexedrine vs. Adderall: Differences, similarities, and which is better for you
Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ
Dexedrine and Adderall are two prescription medications classified as central nervous system (CNS) stimulants. Dexedrine and Adderall are brand-name medications, but they have generics available. These two CNS stimulants are used in the treatment of a condition known as attention deficit hyperactivity disorder (ADHD) as well as narcolepsy. These drugs affect neurotransmitters in the brain which affect how focused and alert a patient feels.
What are the main differences between Dexedrine and Adderall?
Dexedrine is a brand medication whose generic is dextroamphetamine sulfate. It is a CNS stimulant, and more specifically, it is a type of amphetamine. Amphetamines stimulate the release of norepinephrine, and the primary site of this activity is in the cerebral cortex of the brain. CNS stimulation by amphetamines leads to a decreased sense of fatigue, increased motor activity and alertness, and an overall better mood. Dexedrine (Dexedrine details) is FDA approved in the treatment of ADHD and narcolepsy. It is also used off-label, or without approval from the FDA, in the treatment of certain types of obesity-resistant to other interventions. Dexedrine is available in immediate-release tablets, spansules, and extended-release capsules are available as well.
Adderall is a combination of amphetamine salts, containing a 3 to 1 ratio of dextroamphetamine (d-amphetamine) and levoamphetamine (l-amphetamine). It contains the active ingredient of Dexedrine, combined with other amphetamines. It is a prescription drug used in the treatment of ADHD and narcolepsy and works in the same manner as Dexedrine. Adderall is available in a much wider range of strengths as compared to Dexedrine. Adderall (Adderall details) comes in immediate-release tablets. Adderall XR is an extended-release capsule formulation.
The Drug Enforcement Agency (DEA) deems Dexedrine and Adderall schedule II narcotic drugs. Due to the fact that they are habit-forming and have a high potential for abuse, there are restrictions and guidelines for obtaining these drugs, which vary by state.
|Main differences between Dexedrine and Adderall|
|Drug class||Central nervous system stimulant||Central nervous system stimulant|
|Brand/generic status||Brand and generic available||Brand and generic available|
|What is the generic name?||Dextroamphetamine sulfate||Amphetamine salts (d-amphetamine and l-amphetamine)|
|What form(s) does the drug come in?||Tablets, spansules, and extended-release capsules||Tablets and extended-release capsules|
|What is the standard dosage?||5 mg once or twice daily titrated up to 40 mg/day||5 mg once or twice daily titrated up to 60 mg/day|
|How long is the typical treatment?||Long-term (indefinite)||Long-term (indefinite)|
|Who typically uses the medication?||Children and adolescents 3 years of age and older; adults||Children and adolescents 3 years of age and older; adults|
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Conditions treated by Dexedrine and Adderall
Dexedrine and Adderall are indicated in the treatment of ADHD. ADHD is characterized by moderate to severe distractibility, short attention span, hyperactivity, and impulsivity. If left untreated, ADHD can affect academic and professional performance, as well as basic daily functions.
Dexedrine and Adderall are each indicated in the treatment of narcolepsy as well. Narcolepsy is excessive and uncontrollable daytime sleepiness. Like ADHD, untreated narcolepsy can have negative effects on day-to-day activities.
Dexedrine is used off-label in the short-term (few weeks duration) treatment of obesity that has not been responsive to other interventions such as diet, exercise, group programs, or other drugs.
Only your physician can determine what treatment is best for your condition.
|Attention hyperactivity deficit disorder (ADHD)||Yes||Yes|
Is Dexedrine or Adderall more effective?
An analysis of 19 studies compares amphetamine-type treatments to placebo in the treatment of ADHD. In general, the analysis showed that amphetamine treatments reduced the severity of ADHD symptoms but were also linked with a higher number of patients who withdrew from the studies due to side effects. When comparing Dexedrine and Adderall directly, studies appeared to show that while Adderall showed an ability to decrease symptoms of ADHD overall, there was no evidence that Dexedrine reduced ADHD symptoms. Based on this information, Adderall may be preferred over Dexedrine.
Only your physician can decide which treatment is best for you.
Coverage and cost comparison of Dexedrine vs. Adderall
Dexedrine is a prescription medication that is typically covered by commercial insurance. Coverage by Medicare plans may vary or require special exceptions to be made. The out-of-pocket price for Dexedrine can cost more than $800. A coupon from SingleCare can bring the generic price to less about $91.
Get the SingleCare prescription discount card
Adderall is a prescription medication that is typically covered by commercial insurance. Coverage by Medicare plans may vary or require special exceptions to be made. The out-of-pocket price for Adderall can be more than $300. A coupon from SingleCare can bring the price of the generic to approximately $230 for 30, 20 mg tablets at select pharmacies.
|Typically covered by insurance?||Yes||Yes|
|Typically covered by Medicare Part D?||No||No|
|Standard dosage||30, 15 mg ER capsules||60, 30 mg tablets|
|Typical Medicare copay||n/a||n/a|
Dexedrine and Adderall have a similar list of potential adverse effects. This is expected due to the similarities in ingredients. Dexedrine and Adderall have been linked to serious side effects such as elevated blood pressure, tachycardia, and palpitation. In some instances, myocardial infarction (heart attack) and sudden death have occurred. Caution should be used when prescribing stimulants in patients when pre-existing cardiac abnormalities.
Dexedrine and Adderall may lead to a sleep disorder known as insomnia, or an inability to fall and stay asleep. This can affect daily functioning and should be monitored. These drugs are also known to cause dry mouth and dizziness. You should discuss these adverse events with your healthcare provider if they occur and are bothersome.
The following is not intended to be an all-inclusive list of potential side effects. A complete list can be obtained from your healthcare professional.
|High blood pressure||Yes||Not defined||Yes||Not defined|
|Tachycardia||Yes||Not defined||Yes||Not defined|
|Palpitation||Yes||Not defined||Yes||Not defined|
|Insomnia||Yes||Not defined||Yes||Not defined|
|Loss of appetite||Yes||Not defined||Yes||Not defined|
|Vomiting||Yes||Not defined||Yes||Not defined|
|Weight loss||Yes||Not defined||Yes||Not defined|
|Dry mouth||Yes||Not defined||Yes||Not defined|
|Dizziness||Yes||Not defined||Yes||Not defined|
Source: Dexedrine (DailyMed) Adderall (DailyMed).
Drug interactions of Dexedrine vs. Adderall
Dexedrine and Adderall, when used concurrently with serotonergic drugs, may increase the incidence of serotonin syndrome. This syndrome can result in the patient feeling agitated, dizzy, and having an increased heart rate. Common antidepressants such as selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors, as well as the pain medication Tramadol, may cause this interaction with Dexedrine or Adderall.
Dexedrine and Adderall should not be used in patients taking monoamine oxidase inhibitors (MAOIs). MAO inhibitors slow amphetamine metabolism, increasing the amphetamine’s effect on the release of norepinephrine and other monoamines from the nerve endings causing headaches and other signs of hypertensive crisis.
The following list is not intended to be a complete list of drug interactions. It is best to consult your doctor or pharmacist for a complete list.
Warnings of Dexedrine and Adderall
Dexedrine and Adderall have each been associated with strokes, myocardial infarction, and sudden death in children and adults. These may be more likely to occur in patients with pre-existing cardiac conditions. Prescribers should screen for these conditions and use extreme caution in prescribing these drugs for patients who may have cardiac abnormalities.
Dexedrine and Adderall, along with other CNS stimulants, have been associated with moderate increases in blood pressure and heart rate. These parameters should be monitored when patients take stimulants.
Some types of ADHD medication, such as Dexedrine and Adderall, can exacerbate behavior disturbances in patients with pre-existing psychiatric disorders. These patients should be monitored closely if CNS stimulants are necessary. Bipolar patients may experience mixed or manic episodes while on CNS stimulants.
Long-term use of stimulants in children and adolescents has been linked to growth suppression. Patients experiencing slow growth while on stimulants may be encouraged to temporarily pause treatment. Oftentimes, healthcare providers recommend taking breaks from treatment when children are not in school, such as on weekends, holidays, and summer breaks.
If you have experienced allergic reactions to other stimulants or amphetamine drugs, you should not take Dexedrine or Adderall.
Frequently asked questions about Dexedrine vs. Adderall
What is Dexedrine?
Dexedrine is a CNS stimulant used in the treatment of ADHD and narcolepsy. It is considered a schedule II narcotic by the DEA due to its abuse potential and is available by prescription only. Dexedrine is available in a variety of strengths in immediate-release tablets and spansules, as well as extended-release capsules.
What is Adderall?
Adderall is a CNS stimulant used in the treatment of ADHD and narcolepsy. It is also considered a schedule II narcotic by the DEA due to its abuse potential and is available by prescription only. Adderall is available in a variety of strengths in both immediate-release tablets and extended-release capsules.
Are Dexedrine and Adderall the same?
Dexedrine and Adderall are similar drugs but are not exactly the same. Dexedrine is composed of dextroamphetamine sulfate, while Adderall is made of mixed amphetamine salts, including dextroamphetamine. Both drugs are CNS stimulants and have similar side effects and drug interaction profiles.
Is Dexedrine or Adderall better?
Collective data across multiple studies comparing amphetamine treatments to placebo in the treatment of ADHD showed that Adderall may be preferred as it showed some improvement in ADHD symptoms, while Dexedrine did not. Amphetamine drugs overall cause side effects that may make it difficult for some patients to continue treatment long term.
Can I use Dexedrine or Adderall while pregnant?
Dexedrine and Adderall are pregnancy category C, meaning there are no adequate, controlled studies to establish safety. These drugs should only be used in pregnancy when the benefit clearly outweighs the risk.
Can I use Dexedrine or Adderall with alcohol?
Alcohol use could increase the serum blood concentrations of Dexedrine and Adderall, and therefore alcohol should be avoided when on these medications.
Continuing Education Activity
Dextroamphetamine/amphetamine belongs to a class of drugs known as central nervous system stimulants. The Drug Enforcement Administration/Food and Drug Administration classifies these medications as schedule II drugs with high potential for abuse in the United States. Immediate-release and sustained-release amphetamine medications are FDA-approved to treat ADHD and narcolepsy in both adult and pediatric populations. Non-FDA-approved clinical uses for dextroamphetamine/amphetamine include cerebrovascular accidents. This activity will highlight the mechanism of action, adverse event profile, approved and off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions of dextroamphetamine/amphetamine, pertinent for interprofessional team members using these medications for their intended indications.
Identify the mechanism of action of dextroamphetamine/amphetamine.
Review the approved and off-label indications for dextroamphetamine/amphetamine.
Summarize the contraindications and adverse events associated with dextroamphetamine/amphetamine therapy.
Explain the importance of interprofessional communication in improving care coordination among the interprofessional team when initiating dextroamphetamine/amphetamine therapy.
Dextroamphetamine/amphetamine belongs to a class of drugs known as central nervous system stimulants. The Drug Enforcement Administration/Food and Drug Administration (DEA/FDA) classifies these medications as schedule II drugs with high potential for abuse in the United States. Based on the published data by the American Psychiatric Association, 3% to 7% of school-aged children and 4% of adults in the United States have a diagnosis of attention-deficit/hyperactivity disorder (ADHD). Immediate-release amphetamine medication and sustained-release amphetamine medication are used to treat ADHD and narcolepsy in both the adult and pediatric populations.
Non-FDA-approved clinical uses for dextroamphetamine/amphetamine:
FDA approval: Adult, no; Pediatric, no
Recommendation: Adult, Class III (et al.)
Strength of evidence: Adult, Category B
Research by Walker-Batson et al. in 1995 and Crisostomo et al. in 1988 shows that amphetamine use in patients with ischemic stroke improved motor function compared with patients undergoing physical therapy alone. However, another study showed conflicting results, as the mean scores on the Fugl-Meyer motor scale were not significant for the amphetamine group compared with the placebo group.
Amphetamine/dextroamphetamine is used off-label by college students for memory enhancement, test-taking ability, and study marathons.
FDA-approved clinical uses for dextroamphetamine/amphetamine:
Attention Deficit Disorder with Hyperactivity
Dextroamphetamine/amphetamine is FDA-approved for adult and pediatric (ages 3 to 16 years) populations. Amphetamines, along with other remedial measures such as psychological, educational, and social, are prescribed to manage patients with symptoms like distractibility, short attention span, hyperactivity, and impulsivity.
In the pediatric population, the immediate-release tablet is recommended for patients three years of age or older, and the extended-release capsule can be prescribed to patients six years or older.
Adult, Category B Class IIb (Class ll; have a high potential for abuse and dependence, an accepted medical use, and the potential for severe addiction)
Pediatric, Category B, Class IIb
Dextroamphetamine/amphetamine is FDA-approval for adult and pediatric patients who are six years of age or older.
Adult, Category B, Class IIb
Pediatric, Category B, Class IIb
Amphetamines are Pregnancy Category C (prior to 2015) (Category C; Animal reproduction studies have shown an adverse effect on the fetus, but no adequate and well-controlled studies in humans. Potential benefits may warrant use in women who are pregnant.)
The American Academy of Pediatrics rates amphetamines as drugs of abuse for which there are reports of adverse effects on the infant during breastfeeding.
Consider potential risks and benefits before prescribing amphetamines during pregnancy and breastfeeding. Use during pregnancy only if the potential maternal benefit outweighs the potential fetal risk.
Reports exist of increased risk of premature delivery and low birth weight in infants born to mothers with amphetamine dependence as amphetamine crosses the placenta. Reported cases show biliary atresia in infants who were exposed to amphetamine in utero during the second and third trimesters.
Amphetamine should not be prescribed to nursing women as it is excreted in human breast milk. Physicians should consider an alternative medication or advise the patient to discontinue breastfeeding. The result of a study on a nursing mother with the diagnosis of narcolepsy who was receiving a daily dose of 20 mg amphetamine was significant for an elevated level of amphetamine in breast milk compared to maternal plasma. Studies showed amphetamines were 3 and 7 times higher in breast milk than maternal plasma on the 10th and 42nd days after delivery, respectively. Measurable amounts of amphetamine were also present in the urine of the infant.
Mechanism of Action
Amphetamines are non-catecholamines, sympathomimetic amines with central nervous system (CNS) stimulant activity. Amphetamines increase dopamine and norepinephrine in the synaptic space by promoting the release of catecholamines from the presynaptic nerve terminals. They also block norepinephrine and dopamine reuptake into the presynaptic neuron by competitive inhibition. Released norepinephrine affecting both alpha-adrenergic receptor sites and beta-adrenergic receptor sites.
Stimulation of beta-adrenergic receptor sites by these medications increases heart rate, stroke volume, and skeletal muscle blood flow.
Alpha-adrenergic stimulation causes vasoconstriction and an increase in total peripheral resistance, leading to elevations of both systolic and diastolic blood pressures, a weak bronchodilator, and respiratory stimulant action.
However, the mechanism of amphetamine's mental and behavioral effects in children is not clearly understood.
Both immediate-release tablets and extended-release capsules contain both enantiomer, d-amphetamine, and l-amphetamine salts in the ratio of 3:1. The bioavailable average half-lives are similar for both the sustained-release capsule and immediate-release tablet.
Duration of action
The immediate-release tablet is 4 to 6 hours; the extended-release is 8 to 12 hours.
Children 6 to 12 years: D-enantiomer: 9 hours; L-enantiomer: 11 hours
Adolescents 13 to 17 years: D-enantiomer: 11 hours; L-enantiomer: 13 to 14 hours
Adults: D-enantiomer: 10 hours; L-enantiomer: 13 hours
Time to Peak
Immediate release tablet: 3 hours; extended-release: 7 hours
Dextroamphetamine/amphetamine administration is via the oral route. Prescriptions can be as a tablet (immediate-release) or capsule (extended-release).
Extended-release capsule: 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg
Tablet: 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg
Extended-release capsules should be swallowed whole (without chewing), or the entire capsule may be sprinkled on food and consumed immediately. Do not divide the dose of a single capsule.
Patients should avoid afternoon or late evening doses due to insomnia caused by dextroamphetamine/amphetamine.
The temperature of 20 to 25 degrees C (68 to 77 degrees F) is the preferred temperature to store the medication.
FDA Dosage for Management of Attention Deficit Hyperactivity Disorder
Younger than 3 years
Dextroamphetamine/amphetamine is not recommended for children younger than 3 years of age.
Three to 5 years
An immediate-release tablet is used for children 3 to 5 years of age. Clinicians should evaluate the potential for misuse by the patient or parents before prescribing the short-acting tablets.
An initial dose of 2.5 mg of an immediate-release tablet once daily in the morning. The first dose should be upon awakening. Subsequent doses of immediate-release tablets may be at intervals of 4 to 6 hours.
Increase daily dose by 2.5 mg at weekly intervals until reaching the optimal response.
The dosage range is 2.5 to 40 mg per day, given in 1 to 3 divided doses.
Six years and older
Both immediate-release tablets and extended-release capsules are appropriate for children 6 years of age and older.
An initial dose of 5 mg once or twice daily. The first dose should be upon awakening. Subsequent doses of immediate-release tablets may be at intervals of 4 to 6 hours.
Increase daily dose by 5 mg weekly until obtaining an optimal response.
The dosage range is 5 to 40 mg per day in 1 to 3 divided doses.
An initial dose of 5 to 10 mg once daily in the morning.
Increase daily dose by 5 to 10 mg weekly until obtaining an optimal response.
The maximum daily dose is 30 mg.
Both immediate-release tablets and extended-release capsules are appropriate for this age.
An initial dose of 5 mg once or twice daily. The first dose should be upon awakening. Subsequent doses of immediate-release tablets may be at intervals of 4 to 6 hours.
Increase daily dose by 5 mg weekly until obtaining an optimal response.
The dosage ranges from 5 to 40 mg per day in 1 to 3 divided doses.
An initial dose of 10 mg once daily in the morning.
Increase to 20 mg daily after one week if needed. There is no adequate evidence that higher doses afford additional benefits.
Immediate release tablet:
An initial dose of 5 mg once or twice daily
Increase daily dose by 5 mg weekly until obtaining an optimal response
Usually, dosage range from 5 to 40 mg per day in 1 to 3 divided doses. Subsequent doses may be at 4 to 6 hours intervals
An initial dose of 20 mg once daily in the morning;
Based on the available evidence, higher doses (up to 60 mg per day) do not provide additional benefits.
FDA Dosage for management of Narcolepsy
Pediatric (6 years or older)
An initial dose of 5 mg immediate-release tablet daily.
Increase daily dose by 5 mg weekly until obtaining an optimal response.
Usually, the dosage ranges from 5 to 60 mg per day in 1 to 3 divided doses.
An initial dose of 10 mg immediate-release tablet once daily in the morning.
Increase daily dose by 10 mg weekly until obtaining an optimal response.
Usual dosage range: 5 to 60 mg per day in 1 to 3 divided doses
There are no specific dosage adjustments provided in the manufacturer's labeling for patients with renal or hepatic impairment and geriatric population, but dextroamphetamine/amphetamine should be used with caution and start at the low end of the dosage range.
Cardiovascular: Increased systolic arterial pressure
Neurologic: Headache, insomnia
Endocrine metabolic: Weight loss
Gastrointestinal (GI): Dry mouth, decrease in appetite, weight loss, abdominal pain, nausea, diarrhea
Psychiatric: Feeling nervous, mood swings
Cardiovascular: Cardiomyopathy, myocardial infarction, peripheral vascular disease, Raynaud disease, sudden cardiac death
Neurologic: Cerebrovascular accident, seizure
Dermatologic: Stevens-Johnson syndrome, toxic epidermal necrolysis
Immunologic: Hypersensitivity reaction
Psychiatric: Psychotic disorder such as new or worsening psychotic or manic symptoms, behavior changes, or emotional lability
Symptomatic cardiovascular disease
Concomitant use or use within 14 days of MAOI administration, including linezolid or IV methylene blue, may result in hypertensive crisis.
History of drug abuse
Hypersensitivity or idiosyncrasy to amphetamine or other product components
Moderate to severe hypertension
Caution is necessary when prescribing stimulants for ADHD to patients with comorbid conditions such as pre-existing psychosis and bipolar illness because they may worsen behavior disturbances and thought disorders that might occur in these patients. Detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression screening, should be considered in these patients to evaluate the risk of bipolar disorder.
Cardiovascular Events (US black box warning)
Sudden death is one of the main concerns associated with CNS stimulant treatment. Misuse or even usual doses of amphetamine in children and adolescents with structural cardiac abnormalities or other serious heart problems may cause sudden death and serious cardiovascular adverse events. Avoid prescribing amphetamine to patients with known serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, or other serious cardiac problems that could increase the risk of sudden death.
Evaluating cardiovascular status in patients before the initiation of stimulant medication is highly recommended. A careful history and physical exam, including all the possible risk factors such as a family history of sudden death or ventricular arrhythmia, should undergo assessment for the presence of cardiac disease. Additional cardiac evaluation with electrocardiogram and echocardiogram should take place if finding suggests cardiac disease.
Abuse/Misuse/Diversion (US black box warning)
Amphetamines are DEA Schedule II controlled substances with a high potential for misuse and dependence. Avoid administration for extended periods as it may lead to drug dependence. Particular attention should focus on the possibility of subjects obtaining amphetamines for non-therapeutic use. The drug should not be distributed to others, and healthcare professionals should prescribe or dispense the medication sparingly.
Assess the risk of abuse before prescribing, and monitor for signs of misuse and dependence while on therapy. Clinicians should exercise caution with this drug in patients with a history of ethanol or drug use disorder.
Documentation strongly suggests the interaction with concurrent use of amphetamine and monoamine oxidase inhibitor drugs is contraindicated as it may result in a hypertensive crisis.
Although available documentation is poor, pharmacologic considerations lead physicians to suspect the interaction of amphetamine and thiazide diuretics. The interaction may be life-threatening as it may result in increased exposure to amphetamine.
Concurrent use of amphetamine and serotonergic agents that inhibit CYP2D6 may increase amphetamine exposure and increase the risk of serotonin syndrome.
Concurrent use of ascorbic acid and amphetamines may cause decreased amphetamine efficacy in patients.
Monitor improvement in mental and behavioral symptoms of patients diagnosed with attention-deficit/hyperactivity disorder (ADHD). Reevaluate the patient for the long-term usefulness of the drug by temporarily withdrawing therapy.
Monitor decreased frequency of narcoleptic attacks.
Evaluate cardiovascular status before and during treatment. Conduct a further evaluation of any patient who develops any symptoms indicative of a cardiac condition, including exertional chest pain, palpitations, near syncope, or syncope during treatment with stimulants.
Evaluate ADHD patients for bipolar disorder risk factors before starting the treatment.
Monitor pediatric patients with new-onset or worsening aggressive behavior after starting the treatment
Monitor growth in pediatric patients during treatment.
Evaluate for any sign of peripheral vasculopathy such as Raynaud phenomenon, tics, and Tourette syndrome before and during treatment.
Methamphetamine abuse became an epidemic during the last decade and is one of the main concerns. Increased rates of depression, suicidal ideation, and attempts are seen more in the methamphetamine-abusing adolescent patient population. Twenty to 25 mg/kg is reportedly the lethal dose in the adult population, but the dose-response is variable between the patients. Chronic amphetamine abusers may develop tolerance to up to 15,000 mg/day without lethal results.
The mechanism of toxicity is primarily related to excessive extracellular dopamine, norepinephrine, and serotonin. The primary clinical syndrome involves prominent neurological and cardiovascular effects, but secondary complications can involve renal, muscle, pulmonary, and GI effects.
Hyperactivity, hyperthermia, tachycardia, tachypnea, mydriasis, tremors, seizures, and altered mental status are some of the most common signs and symptoms of amphetamine intoxication. Diagnosis can be confirmed by detecting amphetamine in stomach contents or vomitus or by positive urine toxicology for illicit drugs. False-positive amphetamine screen can present following trazodone overdose or bupropion overdose.
There is no antidote for amphetamine toxicity; however, activated charcoal is an emergency treatment. In patients who can drink safely, the recommendation to administer activated charcoal, 1 to 2 g/kg up to 100 g by mouth if the ingestion occurred within the previous hour.
Amphetamine-related toxicity requires management by controlling life-threatening central nervous system and cardiovascular signs in a quiet environment. Hospital supportive care includes monitoring the airway, breathing, and circulation. Agitation and seizures are controllable with benzodiazepines, phenothiazines, pentobarbital, and propofol. A beta-blocker such as propranolol can help to manage cardiac tachyarrhythmias. Consider intravenous nitroprusside (start at 0.5 to 1 mcg/kg per minute and titrate as needed) for severe hypertension. Intravenous fluid should be given as it counters hyperthermia, assists in maintaining renal function, and helps promote the elimination of amphetamine and its analogs.
In cases of severe agitation, clinicians should consider aggressive treatment to avoid malignant hypertension, rhabdomyolysis, hyperthermia, and seizures. Evidence supports using large doses of benzodiazepines to treat amphetamine-overdose-related psychosis and agitation. In cases where agitation, delirium, and movement disorders are unresponsive to benzodiazepines, second-line therapies include antipsychotics such as ziprasidone or haloperidol, central alpha-adrenoreceptor agonists such as dexmedetomidine, or propofol can be administered. Neuromuscular paralysis, intubation, and active cooling measures may be necessary in severe cases. In patients with tachycardia, obtain ECG, and consider telemetry. Use intravenous fluid and sedation to control cardiac symptoms. In cases of severe hypertension, consider intravenous nitroprusside. Starting 0.9% normal saline and monitoring creatine kinase (CK), electrolytes, and creatinine is the best way to manage rhabdomyolysis.
There are case reports regarding the Takotsubo cardiomyopathy (TTC), also known as stress-induced cardiomyopathy, which is triggered by amphetamine overdose. In one case, a patient presented to the emergency department after ingesting 30 amphetamine salt tablets with symptoms of chest pain and shortness of breath. At the time of presentation, cardiac enzymes were elevated, the electrocardiogram was unremarkable, and ejection fraction (EF) was 25% to 30% with severe hypokinesis. However, 24 hours later, symptoms were resolved, and a repeated echocardiogram performed three days later showed an EF of 60% with no regional wall motion abnormalities.
Enhancing Healthcare Team Outcomes
All interprofessional healthcare team members should know the potential complications with amphetamine-like agents. This team includes clinicians, specialists, mid-level practitioners, nurses, and pharmacists. These agents should not be prescribed liberally, and even when prescribed, the patient must have close monitoring to ensure that there is no misuse of the medication.
A careful history, physical exam, and cardiovascular evaluation should take place before initiating stimulant medication because serious cardiac problems can increase the risk of sudden death. Evaluate and monitor the risk of abuse and dependence before prescribing amphetamines and during therapy. Physicians should avoid prescribing the immediate-release (short-acting) type if there is a suspicion of potential for misuse in the patient or the parents. The prescribing physician should advise the patient to report symptoms of tachycardia, hypertension, angina, peripheral vasculopathy, or Raynaud phenomenon. Also, patients should receive education regarding the most common adverse effect of the medication. Most amphetamine-related toxicity is safely manageable with supportive care, including monitoring airway, breathing, and circulation and controlling agitation with benzodiazepines.
With interprofessional care coordination and open communication among the interprofessional team members, patients are more likely to experience therapeutic benefits and avoid adverse events and toxicity when prescribed amphetamine-like agents. [Level 5]
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Dexedrine vs. Adderall: Two Treatments for ADHD
Attention deficit hyperactivity disorder (ADHD) is a condition which occurs in childhood and adolescence, although it can last into adulthood, and even be initially diagnosed in adulthood. ADHD and attention deficit disorder (ADD) used to be considered separate conditions. Now, the term ADHD includes ADD. The symptoms of ADHD include:
- hyperactivity and impulsive behavior
- difficulty maintaining attention or focus
- easily distracted by external stimuli
- a combination of impulsive behavior and inattention
Psychotherapy, behavior training, and education can be effective for many people with ADHD. However, treating ADHD often includes the use of medications. Before turning to these medications, the FDA has issued a boxed warning indicating that “Misuse of amphetamine may cause sudden death and serious cardiovascular adverse reactions.” Providers who prescribe medications from this drug class may screen you for potential heart problems. In some cases, depending on the provider, a baseline EKG may be obtained by your provider before starting you on a stimulant medication.
The manufacturers of the medications also list contraindications which include:
“Advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, known hypersensitivity or idiosyncrasy to the sympathomimetic amines, glaucoma, and agitated states.”
Similarities and differences
Dextroamphetamine and amphetamine (brand name: Adderall) and dextroamphetamine (brand name: Dexedrine) are both central nervous system stimulants. They’re approved for the treatment of ADHD and also for narcolepsy (a neurological condition marked by severe daytime drowsiness). These drugs are more stimulating than methylphenidate (brand name: Ritalin), which is often the first drug your doctor might give you. However, variations in individual experiences with each medication have been reported.
Why they’re prescribed
When prescribed and used properly, both medications can help people with ADHD focus more effectively. Because they contain amphetamines, both drugs are sometimes abused. Over time, tolerance may develop, as may dependence, and both substances have been reported to have a high potential for abuse.
While the actual mechanism of action for both drugs is unknown, the drug is believed to work in two ways. It is believed that the drug makes neurotransmitters last longer in the parts of the brain that control attention and alertness, and they are also believed increase the concentration of neurotransmitters. Neurotransmitters are chemicals that send signals from one brain cell to another. By making these areas more active, the drugs can help a person focus their attention. Surprisingly, stimulants can help calm a person with ADHD.
Forms and dosing
Dextroamphetamine and amphetamine (Adderall) and dextroamphetamine (Dexedrine) are usually taken in tablet form once a day. However, they may also be taken twice (or even three times) a day, depending on how a person responds to the medication. Both drugs are FDA approved to treat ADHD in adults and children aged 3 and older.
If your doctor prescribes dextroamphetamine, the starting dose will often be between 2.5 mg and 5 mg per day. The dose may need to be adjusted gradually, as your doctor monitors how well the drug is working. Adult doses range from 5 mg to 60 mg per day. Children may be given doses ranging from 2.5 mg to 40 mg per day. There are several strengths and an extended release form, so the dose can be individualized.
Dextroamphetamine and amphetamine is also started at a low dose, usually 5 mg and may be gradually adjusted by your doctor. The maximum daily dose is 40 mg to 60 mg per day. Children are often started at 2.5 mg a day, and gradually increased to a maximum of 40 mg per day. There are several strengths and also an extended release form, which makes it easier for your doctor to find the right dose for you.
You will need a written prescription from your doctor to obtain either drug.
Both drugs are available in generic forms, which are less expensive than brand name medications. Ask your doctor and talk to your pharmacist about taking the generic form.
Side effects of each
The potential side effects of both drugs are similar. They both may raise blood pressure. The increase is usually minor, but if you’ve been diagnosed with a heart condition or hypertension, discuss the risks and benefits of these medications with your doctor.
The two medications may also cause:
- diarrhea or constipation
- urinary symptoms such as burning while urinating
- palpitations or irregular heartbeats
- dry mouth
- loss of appetite
- weight loss
- reduced growth (in children)
- changes in libido and impotence
In rare cases, dextroamphetamine and amphetamine (Adderall) use may result in alopecia, which is hair loss on the scalp and other parts of the body.
Warnings and interactions
People taking either medication should take the lowest dose possible, in order to avoid a possible overdose.
Although rare, both drugs can cause peripheral vasculopathy, which is a problem with blood vessels of the fingers, hands, legs, and feet. If your fingers start to feel numb or cold, or if unusual wounds appear on your fingers or toes, consult a doctor immediately.
If you have a psychiatric illness or a seizure disorder, these drugs may make symptoms worse. Tell your doctor about your medical history before taking a stimulant drug.
Dextroamphetamine and amphetamine (Adderall) may cause motor tics or changes in speech similar to Tourette syndrome. Changing the dosage or changing to a different medication may alleviate some of these problems.
Both medications have a high potential for abuse, and prolonged use of these drugs have been associated with psychological dependence. These drugs may not be appropriate to take if you have a history of substance abuse, and some prescribers will not write prescriptions for the for people who have had a history of addictive disorders. Keep both medications in a secure location in your home.
Pregnancy and breastfeeding
There haven’t been extensive studies conducted on how either drug affects pregnant women and their babies. However, there are concerns that amphetamines, even used at prescribed levels, may pose risks to a developing fetus, such as lower birth weight or premature birth. There is also a risk of behavioral problems in childhood. Nursing mothers should not take these drugs. Amphetamines can pass through breast milk and have toxic effects on infants.
If you take a stimulant drug, you can experience side effects that can include loss of appetite and weight loss. Children can also experience reduced growth. Your doctor may prescribe a “drug holiday,” which is a deliberate break in treatment for a specific amount of time and purpose, such as identifying side effects. For example, your doctor may prescribe a drug holiday for your child during the summer when school is not in session. Everyone who takes stimulant drugs should be periodically re-evaluated to see if the drug is still effective and needed.
Potential drug interactions
Amphetamines in both medications may interact negatively with several other medications.
These drugs can interfere with the action of anti-seizure medications, like ethosuximide, phenobarbital, or phenytoin. The drugs may block the sedative effects of antihistamines in allergy medications. Antihypertensive drugs may be less effective at lowering blood pressure if you take either drug. There is also a risk of complications if you take these ADHD medications and certain antidepressant or antipsychotic drugs.
If you take either of these stimulant drugs with multivitamins, iron, or fluoride, the drug levels may drop and they may not work as well.
If you take antacids, certain antibiotics, MAO inhibitors, or proton pump inhibitors with either drug, the drug level may be increased.
If you’re prescribed either drug, be sure to tell your doctor and pharmacist about all the other drugs and over-the-counter products you currently take. Ask your health providers about warnings and side effects.
Which one is best?
The effectiveness and safety profiles of both drugs are relatively similar. However, because each person responds differently to medication, you may find that your attention is better with one medication compared to the other. Your doctor may try you on one medication and then the other, to determine which one is most effective.
You may also have side effects with one drug that you don’t have with the other. You should know within several days of starting a new medication whether it’s effective and how well you tolerate the side effects.
Dextroamphetamine and amphetamine (Adderall) is more widely prescribed than dextroamphetamine (Dexedrine), but that doesn’t mean you wouldn’t do just as well or better on dextroamphetamine. Make sure your doctor has your complete medical history so they can make an informed recommendation. Don’t hesitate to ask for a different drug or a different dose, if you’re not experiencing adequate symptom relief with the first one you try.
Dextroamphetamine and Amphetamine
pronounced as (dex troe am fet' a meen) (am fet' a meen)
The combination of dextroamphetamine and amphetamine can be habit-forming. Do not take a larger dose, take it more often, or take it for a longer time than prescribed by your doctor. If you take too much dextroamphetamine and amphetamine, you may continue to feel a need to take large amounts of the medication, and you may experience unusual changes in your behavior. You or your caregiver should tell your doctor immediately, if you experience any of the following symptoms: fast, pounding, or irregular heartbeat; sweating; dilated pupils; abnormally excited mood; restlessness; irritability; difficulty falling sleeping or staying asleep; hostility; aggression; anxiety; loss of appetite; loss of coordination; uncontrollable movement of a part of the body; flushed skin; vomiting; stomach pain; or thinking about harming or killing oneself or others or planning or trying to do so. Overusing dextroamphetamine and amphetamine may also cause serious heart problems or sudden death.
Tell your doctor if you or anyone in your family drinks or has ever drunk large amounts of alcohol, uses or has ever used street drugs, or has overused prescription medications. Your doctor will probably not prescribe dextroamphetamine and amphetamine for you.
Do not stop taking dextroamphetamine and amphetamine without talking to your doctor, especially if you have overused the medication. Your doctor will probably decrease your dose gradually and monitor you carefully during this time. You may develop severe depression and extreme tiredness if you suddenly stop taking dextroamphetamine and amphetamine after overusing it.
Do not sell, give away, or let anyone else take your medication. Selling or giving away dextroamphetamine and amphetamine may harm others and is against the law. Store dextroamphetamine and amphetamine in a safe place so that no one else can take it accidentally or on purpose. Keep track of how many tablets or capsules are left so you will know if any are missing.
Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with dextroamphetamine and amphetamine and each time you get more medication. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer's website to obtain the Medication Guide.
The combination of dextroamphetamine and amphetamine (Adderall, Adderall XR, Mydayis) is used as part of a treatment program to control symptoms of attention deficit hyperactivity disorder (ADHD; more difficulty focusing, controlling actions, and remaining still or quiet than other people who are the same age). Adderall is used to treat ADHD in adults and children 3 years of age and older. Adderall XR is used to treat ADHD in adults and children 6 years of age and older. Mydayis is used to treat ADHD in adults and children 13 years of age and older. Dextroamphetamine and amphetamine (Adderall) is also used to treat narcolepsy (a sleep disorder that causes excessive daytime sleepiness and sudden attacks of sleep) in adults and children 12 years of age and older. The combination of dextroamphetamine and amphetamine is in a class of medications called central nervous system stimulants. It works by changing the amounts of certain natural substances in the brain.
The combination of dextroamphetamine and amphetamine comes as an immediate-relase tablet (Adderall) and as an extended-release (long-acting) capsule (Adderall XR, Mydayis) to take by mouth. The immediate-release tablet (Adderall) is usually taken 2 to 3 times daily, 4 to 6 hours apart, with or without food. The extended-release capsule (Adderall XR) is usually taken upon awakening with or without food. The extended-release capsule (Mydayis) is usually taken upon awakening and must be taken consistently either with or without food. Dextroamphetamine and amphetamine combination should not be taken in the late afternoon or evening because it may cause difficulty falling asleep or staying asleep. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take dextroamphetamine and amphetamine exactly as directed.
Swallow the extended-release capsules whole; do not chew or crush them. If you are unable to swallow the extended-release capsule, you may open the capsule and sprinkle the entire contents on a teaspoonful of applesauce. Swallow this mixture right away without chewing. Do not store the applesauce and medication mixture for future use, and do not divide the contents of one capsule into more than one dose.
Your doctor will probably start you on a low dose of dextroamphetamine and amphetamine and increase your dose gradually, not more often than once every week.
Your doctor may tell you to stop taking dextroamphetamine and amphetamine from time to time to see if the medication is still needed. Follow these directions carefully.
The medication in each product is absorbed differently by the body, so one dextroamphetamine and amphetamine product cannot be substituted for another product. If you are switching from one product to another, your doctor will prescribe a dose that is best for you.
The combination of dextroamphetamine and amphetamine should not be used to treat excessive tiredness that is not caused by narcolepsy.
This medication may be prescribed for other conditions; ask your doctor or pharmacist for more information.
Before taking dextroamphetamine and amphetamine,
- tell your doctor and pharmacist if you are allergic to amphetamine, dextroamphetamine, other stimulant medications such as benzphetamine, lisdexamfetamine (Vyvanse), or methamphetamine (Desoxyn); any other medications, or any of the ingredients in dextroamphetamine and amphetamine preparations. Ask your pharmacist for a list of the ingredients.
- tell your doctor if you are taking the following medications or have stopped taking them in the past 14 days: monoamine oxidase (MAO) inhibitors including isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate). If you stop taking dextroamphetamine and amphetamine, you should wait at least 14 days before you start to take an MAO inhibitor.
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, and herbal products you are taking. Be sure to mention any of the following: acetazolamide (Diamox); alpha blockers such as alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), tamsulosin (Flomax, in Jalyn), and terazosin; antacids and other medications for heartburn or ulcers such as cimetidine (Tagamet), esomeprazole (Nexium), omeprazole (Prilosec, in Zegerid), and pantoprazole (Protonix); antidepressants ('mood elevators'); antihistamines (medications for colds and allergies); ascorbic acid (Vitamin C); beta blockers such as atenolol (Tenormin), labetalol (Trandate), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal, Innopran); buspirone; chlorpromazine; fentanyl (Actiq, Duragesic, Subsys, others); guanethidine (no longer available in U.S.Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor what herbal products you are taking, especially St. John's wort and tryptophan or nutritional supplements including glutamic acid (L-glutamine).
- tell your doctor if you have glaucoma (increased pressure in the eye that may cause vision loss), hyperthyroidism (condition in which there is too much thyroid hormone in the body), or feelings of anxiety, tension, or agitation. Your doctor will probably tell you not to take dextroamphetamine and amphetamine.
- tell your doctor if anyone in your family has or has ever had an irregular heartbeat or has died suddenly. Also tell your doctor if you have recently had a heart attack and if you have or have ever had a heart defect, high blood pressure, an irregular heartbeat, hardening of the arteries, heart or blood vessel disease, or other heart problems. Your doctor will examine you to see if your heart and blood vessels are healthy. Your doctor will probably tell you not to take dextroamphetamine and amphetamine if you have a heart condition or if there is a high risk that you may develop a heart condition.
- tell your doctor if you or anyone in your family has or has ever had depression, bipolar disorder (mood that changes from depressed to abnormally excited), or mania (frenzied, abnormally excited mood), motor tics (repeated uncontrollable movements), verbal tics (repetition of sounds or words that is hard to control), or Tourette's syndrome (a condition characterized by the need to perform repeated motions or to repeat sounds or words), or has thought about or attempted suicide. Also tell your doctor if you have or have ever had mental illness, seizures, an abnormal electroencephalogram (EEG; a test that measures electrical activity in the brain), or liver or kidney disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking dextroamphetamine and amphetamine, call your doctor. Do not breastfeed while taking dextroamphetamine and amphetamine.
- talk to your doctor about the risks and benefits of taking dextroamphetamine and amphetamine if you are 65 years of age or older. Older adults should not usually take dextroamphetamine and amphetamine because it is not as safe as other medications that can be used to treat the same condition.
- you should know that this medication may make it difficult for you to perform activities that require alertness or physical coordination. Do not drive a car or operate machinery until you know how this medication affects you.
- you should know that dextroamphetamine and amphetamine should be used as part of a total treatment program for ADHD, which may include counseling and special education. Make sure to follow all of your doctor's and/or therapist's instructions.
- you should know that dextroamphetamine and amphetamine may cause sudden death in children and teenagers, especially children and teenagers who have heart defects or serious heart problems. This medication also may cause sudden death, heart attack, or stroke in adults, especially adults with heart defects or serious heart problems. Call your or your child's doctor right away and get emergency help, if you or your child has any signs of heart problems while taking this medication including: chest pain, shortness of breath, or fainting.
Unless your doctor tells you otherwise, continue your normal diet.
If you miss your dose of the extended-release capsule the morning, skip the missed dose and take your next dose at the regular time the next day. Do not take a dose later in the day. Do not take a double dose to make up for a missed one.
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature, away from light and excess heat and moisture (not in the bathroom).
It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.
In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.
Symptoms of overdose may include the following:
- aggressive behavior
- feelings of panic
- hallucination (seeing things or hearing voices that do not exist)
- fast breathing
- uncontrollable shaking of a part of the body
- dark red or cola-colored urine
- muscle weakness or aching
- tirednessor weakness
- fast or irregular heartbeat
- blurred vision
- upset stomach
- coma (loss of consciousness for a period of time)
Keep all your appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body's response to dextroamphetamine and amphetamine.
Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking dextroamphetamine and amphetamine.
This prescription is not refillable. Be sure to schedule appointments with your doctor on a regular basis so that you do not run out of medication.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
- Mydayis® (as a combination product containing Amphetamine, Dextroamphetamine)
- Adderall® (containing Amphetamine, Dextroamphetamine)
- Adderall® XR (containing Amphetamine, Dextroamphetamine)
- Biphetamine® (containing Amphetamine, Dextroamphetamine)¶
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