Adderall

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Adderall Description:

Adderall is an amphetamine stimulant for treatment of attention-deficit hyperactivity disorder (ADHD) and narcolepsy, and is a mixture of amphetamine salts. The four components are claimed to be metabolized at different rates. The drug was first prescribed in the 1970s as an anorectic (to suppress appetite), but this usage is rare now.

Adderall is manufactured by Catalytica Pharmaceuticals Inc. of Greenville, North Carolina and distributed by Shire Pharmaceuticals.

Classification:

Schedule II controlled substance

Clinical Pharmacology:

Amphetamines are non-catecholamine sypathomimetic amines with central nervous system stimulant activity. The mode of therapeutic action in ADHD is not yet known, but amphetamines are thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space.

Indications and Dosage:

In children 6 and older with ADHD 10mg per day is adequate to begin, and the daily dosage may be raised in increments of 5mg or 10mg at weekly intervals. Amphetamines should be administered at the lowest effective dosage. The maximum recommended dose is 30mg per day; doses greater than 30mg/day of Adderall have not been studied. Amphetamines are not recommended for children under 3 years old, and have not been studied in those under 6 years of age.

Adderall Side Effects and Interactions:

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Common side effects of Adderall may include insomnia, weight loss, vertigo, loss of appetite, increased heart rate, sweating, headaches, diarrhea, sexual dysfunction, and dry mouth. Less common side effects include nervousness, bruxism, mydriasis, upset stomach, urinary retention, Pyrexia, Tachycardia, Tics, Urticaria, Mydriasis, increased urination, and euphoria.

Rare side effects include high blood pressure, hallucinations, Tourette’s syndrome, cardiomyopathy, and Phonetic tics.

Information for Parents and Kids:

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Adderall XR has been approved for use in children over age six, though regular Adderall may be used in younger children from 3-5 years old. If children have difficulty swallowing a pill, Adderall XR can be opened and sprinkled onto foods, (applesauce is suggested) unlike some other sustained release medications.

Warnings and Precautions:

Recently, the FDA mandated that any medicine used for treating ADHD or ADD which is derived from amphetamines must carry the strongest warning available, or the “black box” warning. This mandate was due to a link established between long-term use (in both pediatric and adult patients) and sudden cardiac arrest and heart damage.

Use of amphetamine-based medications is expected to gradually reduce during the next decade due to the availability of newer, non-amphetamine-based drugs, such as Stratera. However, in March 2006 an FDA advisory panel decision barred the implementation of a “black box” warning and urged instead for a detailed “medication guide” to be created by manufacturers for distribution to patients receiving the drug.

Warnings associated with amphetamine drugs may include the following:

• In psychotic children, administration of amphetamine may elevate behavior disturbance and thought disorders.
• Sudden death has been reported in association with amphetamine treatment at normal doses in children with structural cardiac abnormalities, and should generally not be used by anyone exhibiting structural cardiac abnormalities.
• Mothers taking amphetamines should refrain from nursing infants, due to amphetamines being excreted in human milk.
• Amphetamines may exacerbate motor and phonic tics and Tourette’s syndrome.

Withdrawal:

Adderall can be habit forming. Physical and psychological dependence may occur with use of this drug, and withdrawal effects may occur if the medication is stopped suddenly after several weeks of continuous use. Symptoms of Adderall withdrawal may include extreme fatigue and depression, and in the most severe (but rare) cases, some patients reported psychosis.

Over-dosage & Contraindications:

A large overdose of Adderall can be fatal. Warning signs of a massive overdose include convulsions and coma. Symptoms of Adderall overdose may include confusion, diarrhea, hallucinations, abdominal cramping, irregular heartbeat, nausea, panic, rapid or ragged breath, restlessness, tremors, vomiting, and assaultiveness.

Contraindications include advanced arteriosclerosis, moderate to severe hypertension, hyperthyroidism, symptomatic cardiovascular disease, glaucoma, agitated states, and hypersensitivity or idiosyncrasy to sympathomimetic amines.

Generic Name: amphetamine and dextroamphetamine

Chemical Formula: 1-phenylpropan-2-amine

Routes of Administration: oral

Elimination Half Life: believed to be 10-13 hours

Legal Status: by prescription only

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