Mixed amphetamine salts
ADDERALL
“Amp to Add it all”
What it isStimulant that releases norepinephrine, dopamine and serotonin; ADHD and narcolepsy.
Why this oneIts release mechanism can work when methylphenidate reuptake blockade has not, but it carries greater misuse pressure.
What limits itAppetite loss, insomnia and blood-pressure rise often limit it. Schedule II diversion matters; urinary alkalinization can raise exposure.
Pearls
- IR lasts 4–6 h; XR 10–12 h; Mydayis up to 16 h
- XR capsules can be sprinkled on soft food
- IR approved from age 3; Mydayis only from 13
Mixed amphetamine salts prescription history
Animated chart of estimated U.S. prescriptions per year, ADHD meds (1938–2026). Mixed amphetamine salts enters in 1996 (estimated).
FDA-approved for
- ADHD (~1960)
- narcolepsy (~1960)
Off-label
- antidepressant augmentation (limited evidence)
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityMisuse, hypertension, hyperthermia, psychosis and potentially fatal sympathomimetic toxicity.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Narcolepsy | Adults and ≥12 yr | 10 mg QD | 5–60 mg/day in divided doses (usual) | Undefined |
| ADHD | Children 3–5 yr | 2.5 mg QD | Titrate to optimal response | Undefined |
| ADHD | Children ≥6 yr | 5 mg QD–BID | Titrate to optimal response | Rarely need >40 mg/day |
| Narcolepsy | Children 6–12 yr | 5 mg QD | Titrate to optimal response | Undefined |
Titration Weekly intervals (ADHD: +2.5 mg/day age 3–5, +5 mg/day ≥6 yr; narcolepsy: +5 mg/day age 6–12, +10 mg/day ≥12 yr)
Renal Undefined
Hepatic Undefined
Not recommended under 3 yr of age.
Instructions
- First dose on awakening; 1–2 additional doses at 4–6 h intervals
- Avoid late-evening doses (insomnia)
Available strengths
- tab 5, 7.5, 10, 12.5, 15, 20, 30 mg
Contraindications
- MAOIs, or within 14 days of stopping (incl. linezolid, IV methylene blue) — hypertensive crisis
- Pheochromocytoma or history of pheochromocytoma
Cautions
- Abuse, misuse, and addiction
- Risks in serious cardiac disease
- Increased blood pressure and heart rate
- Psychiatric adverse reactions (psychosis, mania)
- Long-term growth suppression in pediatrics
- Seizures
- Peripheral vasculopathy, incl. Raynaud's
- Serotonin syndrome
- Motor/verbal tics; worsening Tourette's
Adverse reactions
- Palpitations, tachycardia, elevated BP
- Psychotic episodes, overstimulation, restlessness
- Irritability, euphoria, dysphoria, depression
- Dyskinesia, tremor, motor/verbal tics
- Blurred vision, mydriasis
- Dry mouth, unpleasant taste
- Diarrhea, constipation
- Anorexia, weight loss
- Urticaria, rash, angioedema, anaphylaxis
- Impotence, libido changes, prolonged erections
- Alopecia
- Rhabdomyolysis
Pregnancy No adequate human studies; infants of amphetamine-dependent mothers risk prematurity, low birth weight, and withdrawal.
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 5 mg | tab | per unit | $0.26/ea | not offered |
| 7.5 mg | tab | per unit | $0.28/ea | not offered |
| 10 mg | tab | per unit | $0.23/ea | not offered |
| 12.5 mg | tab | per unit | $0.36/ea | not offered |
| 15 mg | tab | per unit | $0.24/ea | not offered |
| 20 mg | tab | per unit | $0.29/ea | not offered |
| 30 mg | tab | per unit | $0.30/ea | not offered |
Other forms: Mixed amphetamine salts XR (ADDERALL XR) · Mixed amphetamine salts (triple-bead) (MYDAYIS)
Generic entry1984
Serotonin and MAOI
Provisional washout figures
Elevating mechanismNone identified
Non-elevating actionNone recorded
Exposure dependenceNo serotonin-elevating mechanism identified
Evidence confidenceModerate
InterpretationNo clinically meaningful serotonin-elevating mechanism identified in this first-pass Gillman-based review.
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Memory aids: interaction avatars
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Self-check
- What urinary change can raise amphetamine exposure?
Alkalinization. - What controlled-substance schedule is stated for amphetamine?
Schedule II.