dextroamphetamine sulfate

dex·tro·am·phet·a·mine sulfate (dkstr-m-ft-mn, -mn)

n.

A white crystalline isomer of amphetamine that acts as a central nervous stimulant and is used to treat narcolepsy and attention deficit hyperactivity disorder. Also called dexamphetamine sulfate.

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dextroamphetamine sulfate

[deks′trō·amfet′əmēn]

a central nervous system stimulant.

indications It is prescribed in the treatment of narcolepsy, hyperkinetic disorders, and attention deficit disorder in children and as an anorexiant in treating exogenous obesity.

contraindications Cardiovascular disease, glaucoma, hypertension, hyperthyroidism, agitation, history of drug abuse, concomitant administration of a monoamine oxidase inhibitor within 14 days, or known hypersensitivity to this drug prohibits its use.

adverse effects Among the more serious adverse reactions are manifestations of central nervous system excitation, increased blood pressure, arrhythmias and other cardiovascular effects, nausea, anorexia, and drug dependence.

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dextroamphetamine sulfate

n brand names: Dexedrine, Oxydess II;
drug class: amphetamine, Controlled Substance Schedule II;
action: increases release of norepinephrine and dopamine in the cerebral cortex to the reticular activating system;
uses: narcolepsy, attention deficit disorder with hyperactivity.

dextromethorphan hydrobromide

(dek´strōmthor´fan hī´drōbrō´mīd),
n brand names: Benylin DM, Robitussin Pediatric, Vicks Formula 44;
drug class: antitussive, nonnarcotic;
action: depresses cough center in medulla;
use: nonproductive cough.

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dextroamphetamine sulfate

Dexedrine Spansule, DextroStat

Pharmacologic class: Amphetamine

Therapeutic class: Sympathomimetic amine, CNS stimulant

Controlled substance schedule II

Pregnancy risk category C

FDA Boxed Warning

• Drug has high abuse potential. Prolonged use may lead to drug dependence. Stay alert for possibility of patient obtaining drug for nontherapeutic use or distribution. Drug should be prescribed sparingly.
• Misuse may cause sudden death and serious cardiovascular events.

Action

Produces CNS and respiratory stimulation by promoting release of norepinephrine from nerve terminals

Availability

Capsules (sustained-release): 5 mg, 10 mg, 15 mg

Tablets: 5 mg, 10 mg

⊘Indications and dosages

➣ Attention deficit hyperactivity disorder

Adults: 5 to 60 mg P.O. daily in divided doses

Children ages 6 and older: 5 mg P.O. once or twice daily, increased by 5 mg at weekly intervals

Children ages 3 to 5: 2.5 mg P.O. daily, increased by 2.5 mg at weekly intervals

➣ Narcolepsy

Adults: 5 to 60 mg P.O. daily as a single dose or in divided doses

Children ages 12 and older: 10 mg P.O. daily, increased by 10 mg at weekly intervals until desired response occurs or adult dosage is reached

Children ages 6 to 11: 5 mg P.O. daily, increased by 5 mg at weekly intervals until desired response occurs or adult dosage is reached

Contraindications

• Hypersensitivity to drug or tartrazine
• Glaucoma
• Psychotic disorders
• MAO inhibitor use within past 14 days
• Pregnancy or breastfeeding

Precautions

Use cautiously in:
• cardiovascular disease, hypertension, diabetes mellitus
• history of substance abuse
• elderly patients.

Administration

• Make sure patient swallows sustained-release capsules whole without chewing or crushing.
• Give last daily dose at least 6 hours before patient's bedtime.
☞ Don't give within 14 days of MAO inhibitor, because potentially fatal reaction may occur.

Route	Onset	Peak	Duration
P.O.	1-2 hr	Unknown	2-10 hr
P.O. (sustained)	Unknown	Unknown	Up to 24 hr

Adverse reactions

CNS: hyperactivity, insomnia, restlessness, tremor, depression, dizziness, headache, irritability

CV: palpitations, tachycardia, hypertension, hypotension, arrhythmias

GI: nausea, vomiting, constipation, diarrhea, abdominal cramps, dry mouth

GU: erectile dysfunction, increased libido

Skin: urticaria

Other: metallic taste, decreased appetite, physical or psychological drug dependence

Interactions

Drug-drug. Acetazolamide, sodium bicarbonate: urine alkalization, leading to increased dextroamphetamine effects

Adrenergic blockers: additive effects

Ammonium chloride, ascorbic acid (large doses): urine acidification, leading to decreased dextroamphetamine effects

Beta-adrenergic blockers, tricyclic antidepressants: increased risk of adverse cardiovascular effects

Guanethidine: reversal of hypotensive effect

MAO inhibitors: hypertensive crisis

Phenothiazines: decreased dextroamphetamine effects

Selective serotonin reuptake inhibitors: increased risk of serotonin syndrome

Drug-diagnostic tests. Plasma corticosteroids: increased levels

Drug-food. Caffeine: increased stimulant effect

Drug-herbs. Caffeine-containing herbs, ephedra (ma huang): increased stimulant effect

Patient monitoring

• Interrupt therapy or reduce dosage periodically to assess drug efficacy in patients with behavior disorders.
• Monitor blood and urine glucose levels carefully in diabetic patient. Drug may alter regular insulin requirements.

Patient teaching

• Tell patient to swallow sustained-release capsules whole with liquid without chewing or crushing.
• Advise patient to take drug early in day to avoid insomnia.
• Instruct patient to avoid driving and other hazardous activities until he knows how drug affects him.
• Caution patient not to stop therapy abruptly but to taper dosage gradually.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.