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Pharmacologic class: Amphetamine
Therapeutic class: Sympathomimetic amine, CNS stimulant
Controlled substance schedule II
Pregnancy risk category C
FDA Box 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.
Produces CNS and respiratory stimulation by promoting release of norepinephrine from nerve terminals
Capsules (sustained-release): 5 mg, 10 mg, 15 mg
Oral solution: 5 mg/ml
Tablets: 5 mg, 10 mg
Indications and dosages
➣ Attention deficit hyperactivity disorder
Adults: 5 to 60 mg P.O. daily in divided doses until optimal response is obtained
Children ages 6 and older: 5 mg (capsules, oral solution, or tablets) P.O. once or twice daily, increased by 5 mg at weekly intervals until optimal response is obtained
Children ages 3 to 5: 2.5 mg (oral solution) P.O. daily, increased by 2.5 mg at weekly intervals until optimal response is obtained
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
• Hypersensitivity to drug or tartrazine
• Psychotic disorders, agitated states
• Advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension
• MAO inhibitor use within past 14 days
• Pregnancy or breastfeeding
Use cautiously in:
• cardiovascular disease, hypertension, diabetes mellitus
• history of substance abuse
• elderly patients.
• Make sure patient swallows sustained-release capsules whole without chewing or crushing.
• Before starting therapy, perform complete cardiac evaluation, including ECG and echocardiogram.
• 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.
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
Other: metallic taste, decreased appetite, physical or psychological drug dependence
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
• Interrupt therapy or reduce dosage periodically to assess drug efficacy in patients with behavior disorders.
• Monitor patient for new or worsening aggressive behavior.
• Monitor blood and urine glucose levels carefully in diabetic patient. Drug may alter regular insulin requirements.
• 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 immediately notify prescriber if chest pain, irregular pulse, or worsening aggressive behavior occurs.
• 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.
dex·tro·am·phet·a·mine sul·fate(deks'trō-am-fet'ă-mēn sul'fāt)
Synonym(s): dextroamphetamine sulphate.