Adderall

Adderall is a stimulant amphetamine used to treat attention-deficit/hyperactivity disorder (ADHD) and narcolepsy. It was first prescribed in the 1920s as an anorectic (weight loss medication; under the brand name Obetrol®), but such usage is now rare. This product is a combination of Dextroamphetamine and Amphetamine.

Benefits of this Medication:

• This medication treats attention deficit / hyperactivity disorder (ADHD) and narcolepsy (a sleep problem). This medicine is a stimulant and is categorized as a controlled substance (C-II).

 
Important Information on Adderall:

• Indications: attention deficit/ hyperactivity disorder (ADHD) and narcolepsy (a sleep problem)
• Side Effects: nervousness, restlessness, sleeplessness, agitation, anxiety, increased heart rate, irregular heart beat, headache, weight loss
• Warnings: This medicine may be habit-forming. If you feel that the medicine is not working as well as you would expect, do not use more than your prescribed dose. Call your doctor for instructions.

 
Uses for this Medicine:

• This medication treats attention deficit/ hyperactivity disorder (ADHD) and narcolepsy (a sleep problem). This medicine is a stimulant.

 
When this Medicine Should Not be Used:

• You should not use this medicine if you or your child have had an allergic reaction to any amphetamine product or dextroamphetamine.
• You should not use this medicine if you have glaucohttp://www.1-800-therapist.com/sites/all/modules/fckeditor/fckeditor/edi...); background-position: 0px -416px; " class="TB_Button_Image" alt="" />ma, heart disease, blood vessel problems, an overactive thyroid, or high blood pressure.
• Do not use this medicine if you have a history of drug abuse, or if you are very nervous, tense, or agitated most of the time.
• You should not use this medicine if you have used a drug for depression called an MAO inhibitor (MAOI), such as Eldepryl®, Marplan®, Nardil®, or Parnate®, in the past 14 days.
• Use with caution in patients with pre-existing psychosis or bipolar disorder.
• This medicine should not be given to a child younger than 3 years old.

 
Dosing:
Adderall is available in the following forms (the amounts listed are total for the combination of the 2 amphetamines included in the product): oral capsule, extended release: 5mg, 10mg, 15mg, 20mg, 25mg, 30mg; and oral tablet: 5mg, 7.5mg, 10mg, 12.5mg, 15mg, 20mg, and 30mg.
 
Note regarding dosing: It is recommended that the first dose of the day be taken as soon as you wake up. Your doctor will prescribe the lowest dose necessary for the medication to do its job.

• This drug is not recommended for children under the age of 3. The dose for children varies with age and weight.
• The starting dose for children 3-5 years old should be 2.5mg/day (taken each morning). If this doesn't provide the desired effect, the dose should be increased by 2.5mg at weekly intervals until a good response is obtained. Increase the dose no more frequently than once a week. The maximum dose for this age range is 40mg/day given in 1-3 divided doses; use intervals of 4-6 hours between each dose.

• Children 6 years of age or older should receive 5mg initially 1-2 times per day. The dose should then be increased by 5mg per day and monitor response for a week until a good response is obtained. Increase the dose no more frequently than once a week. The usual maximum dose for this age range is a total of 40mg per day (given in 1-3 divided doses). When using Adderall XR®: 5mg -10mg once daily in the morning; if needed, the dose may be increased by 5-10mg per day, see how this works for a week, and change more if needed up to a maximum dose of 30mg/day)
• Adolescents between the ages of 13-17 years (Adderall XR®): the initial dose is 10mg once daily in the morning; the dose may be increased to 20mg/day after 1 week if symptoms are not controlled. Increase the dose no more frequently than once a week. Higher doses (up to 60mg/day) have been used; however, there is not adequate evidence that higher doses give additional benefit.

• Adults (Adderall XR®): Initial: 20mg once daily in the morning; higher doses (up to 60mg once daily) have been used; however, there is not adequate evidence that higher doses give additional benefit.

 
Narcolepsy (Adderall®):

• Children between the ages of 6-12 years should receive an initial dose of 5mg/day. This dose may be increased by 5mg per day and monitor response for a week until a good response is obtained. Increase the dose no more frequently than once a week. The maximum dose is 60mg/day given in 1-3 divided doses with intervals of 4-6 hours between doses.

• Children over the age of 12 years and adults should receive an initial dose of 10mg/day. This dose can be increased by 10mg per day and monitor response for a week until a good response is obtained. Increase the dose no more frequently than once a week. The maximum dose is 60 mg/day given in 1-3 divided doses with intervals of 4-6 hours between doses. Your doctor will tell you how much of this medicine to use and how often.
• If you miss a dose or forget to use your medicine, use it as soon as you can. If it is almost time for your next dose, wait until then to use the medicine and skip the missed dose. Do not use extra medicine to make up for a missed dose.
• Your dose may need to be changed several times in order to find out what works best for you. Do not use more medicine or use it more often than your doctor tells you to.
• This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions. Ask your pharmacist for the Medication Guide if you do not have one. Your doctor might ask you to sign some forms to show that you understand this information.
• It is best to take the extended-release capsule form (Adderall XR®) in the morning. Taking this medicine in the afternoon or evening could make it harder for you to fall asleep.
• If you use the short-acting tablet form of this medicine, take your last dose for the day about 6 hours before bedtime, unless your doctor gives you other instructions.
• Swallow the tablet or capsule whole. Do not crush, break, or chew it.

 
Overdosing:

• If you take too much Adderall, symptoms may vary widely. Symptoms of stimulation of your nervous system (such as nervousness, irritability, excitability) are usually followed by weakness and depression. Heart and stomach symptoms are also reported, as is high blood pressure. Treatment is focused on reducing the symptoms and providing support.
• An overdose with Adderall (combination of amphetamine and dextroamphetamine) can be a life-threatening situation that requires immediate medical attention. It is strongly recommended that you contact a poison center, emergency department or call 911 for assistance immediately.

 
Side Effects:
Call your doctor or pharmacist right away if you notice any of these side effects:

• allergic reaction: itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• blurred vision
• changes in your mood or behavior
• chest pain, shortness of breath, or fainting
• fast, pounding, or uneven heartbeat
• feeling very excited, fearless, restless, or happy
• seeing, hearing, or feeling things that are not there
• seizures
• tremors or shaking

 
If you notice these less serious side effects, talk with your doctor or pharmacist:

• constipation, diarrhea, or upset stomach
• dry mouth or bad taste in your mouth
• feeling restless or nervous
• headache or dizziness
• loss of appetite or weight loss
• mild skin rash or itching
• problems having sex
• trouble sleeping

 
If you notice any other side effects, contact your doctor or pharmacist, as this is not a complete list of all of the side effects that may occur.
 
Drug Interactions:
Dextroamphetamine/amphetamine taken with an MAO Inhibitor (Nardil®, Marplan®, Parnate®, EmSam®) may cause a severe and possibly life threatening increase in blood pressure. Tell you doctor or pharmacist that you are taking any of the following medicines before you begin taking dextroamphetamine/amphetamine:

• acetazolamide (Diamox®)
• chlorpromazine (Thorazine®),
• antacids (such as Maalox®, Mylanta®)
• any medicines for treating high blood pressure (such as atenolol, lisinopril, metoprolol, Cozaar®, or Diovan®)
• pain medicines (such as meperidine, propoxyphene, Demerol®, or Darvon®)
• cold or allergy medicines (prescription or over-the-counter)
• ethosuximide (Zarontin®)
• haloperidol (Haldol®)
• lithium carbonate (Lithobid®)
• certain medicines for depression (such as amitriptyline, doxepin, nortriptyline, Pamelor®, or Sinequan®), methenamine (Hiprex®, Urex®)
• Phenobarbital
• phenytoin (Dilantin®)
• vitamin C

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products. Do not eat citrus fruits (oranges, lemons, limes, grapefruit) or drink citrus juice when you take this medicine because acidic foods may increase dextroamphetamine blood levels. Ask your doctor or pharmacist if dextroamphetamine may interact with other medicines that you take, as this is not a complete list of all interactions that may occur
 
How this Medication Works:

• Adderall stimulates a specific part of the brain which has been shown to improve behavior and attention in hyperactive children and adults.

 
Discussion Points for You and Your Healthcare Provider:

• Take exactly as directed; do not increase dose or frequency without consulting your doctor.
• This medication may cause physical and/or psychological dependence.
• Take this medication early in the day to avoid any problems with sleep.
• If you miss a dose, take it as soon as you can. If it is almost time for your next dose, do not take an extra dose or double-dose.
• Avoid alcohol, caffeine, or OTC medications that act as stimulants (ask your pharmacist for more information).
• You may experience the following side effects: restlessness, headaches, false sense of euphoria, or impaired judgment (use caution when driving or engaging in tasks requiring alertness until your response to the medication is known); dry mouth (frequent mouth care, sucking lozenges, or chewing gum may help); decreased appetite; nausea or vomiting (small frequent meals, frequent mouth care may help); constipation (increased exercise, fluids, non-citrus fruit, or fiber may help); diarrhea (buttermilk, boiled milk, or yogurt may help); change in sex drive (reversible); or a change in sense of taste or smell.
• Patients with diabetes need to monitor their blood sugar closely (this medication may change your diabetes medicine requirements).
• Call your doctor if any of the following occur: increased respirations, chest pain, palpitations, or irregular heartbeat; extreme fatigue or depression; CNS changes (aggressiveness, restlessness, euphoria, sleep disturbances); severe abdominal distress or cramping that doesn’t stop; blackened stool; changes in sexual activity; or blurred vision.
• Tell your doctor if you are pregnant. Do not breast-feed.
• Talk to you doctor if you or your child have heart problems, thyroid problems, or mild high blood pressure.
• Tell your doctor if you or your child have muscle tics or Tourette's syndrome, a condition that causes you to have muscle twitches or to make sounds you are not able to control.
• Your doctor should know if you or your child have epilepsy, or a history of seizures, depression or mental illness.
• Tell your doctor about any drug or alcohol problems.
• Also tell your doctor if you or anyone in your family has tried to commit suicide.
• This medicine may be habit-forming. If you feel that the medicine is not working as well as you think it should, do not use more than your prescribed dose. Call your doctor for instructions.
• This medicine may make you dizzy or drowsy. Avoid driving, using machines, or doing anything else that could be dangerous if you are not alert.
• This medicine may cause slow growth. If your child is using this medicine, the doctor will need to keep track of your child's height and weight to make sure that your child is growing properly.
• Your doctor will need to check your progress at regular visits while you are using this medicine. Be sure to keep all appointments.
• This medicine is part of an ADHD treatment program that may also include counseling or special education. Carefully follow your doctor's instructions about all treatment measures.

This information is not intended to cover all possible uses, directions, dosing, precautions, drug interactions or adverse effects. Talk to your doctor, pharmacist or other healthcare provider for more information.
 
More Information on this Medication:

• Adderall XR Information from Shire
• Public Health Advisory for Adderall and Adderall XR
• Adderall Patient Information Sheet

 
References:
Lacy CF, Armstrong LL, Goldman MP, Lance LL. Drug Information Handbook. 15th edition. Hudson (Ohio): Lexi-Comp’s Complete Management Information System; 2007

http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm111441.htm
http://www.fda.gov/downloads/Drugs/DrugSafety/ucm085819.pdf
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2005/ucm108411.htm