Dextro­ amphetamine

FDA label

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Titration Increase at weekly intervals.

Renal Undefined

Hepatic Undefined

Instructions

• Use the lowest effective dosage; individualize.
• Give first dose on awakening; 1 or 2 additional doses at 4–6 hr intervals.
• Avoid late-evening doses (causes insomnia).
• Reduce dose if bothersome adverse reactions appear (e.g. insomnia, anorexia).
• ADHD: interrupt therapy occasionally to determine whether behavioral symptoms recur and continued treatment is needed.
• Before treating: assess for cardiac disease (history, family history of sudden death or ventricular arrhythmia, physical exam) and evaluate family history/patient for motor or verbal tics or Tourette's syndrome.
• Not recommended in pediatric patients under 3 years of age.

Contraindications

• MAOIs (concurrently or within 14 days) due to risk of hypertensive crisis
• Pheochromocytoma or history of pheochromocytoma — serious reactions incl. elevated blood pressure and tachyarrhythmia reported

Cautions

• Abuse, misuse, and addiction (boxed) - high potential; can lead to substance use disorder, overdose, and death; assess risk before prescribing, reassess and monitor throughout treatment; counsel on secure (preferably locked) storage and disposal
• Sudden death reported in patients with structural cardiac abnormalities or other serious cardiac disease at recommended ADHD doses - avoid in known structural cardiac abnormalities, cardiomyopathy, serious arrhythmia, or coronary artery disease
• Increases blood pressure (mean ~2-4 mm Hg) and heart rate (mean ~3-6 bpm) - monitor all patients for tachycardia and hypertension
• Psychiatric reactions: may exacerbate pre-existing psychosis; may induce manic/mixed episode in bipolar disorder (screen for risk factors first); new psychotic or manic symptoms (~0.1%) at recommended doses in patients without prior history - consider discontinuing
• Long-term suppression of growth in pediatric patients - closely monitor weight and height; interrupt treatment if not growing/gaining as expected
• May lower the convulsive threshold - discontinue if seizures occur
• Peripheral vasculopathy, including Raynaud's phenomenon - observe for digital changes; rare digital ulceration/soft-tissue breakdown; consider rheumatology referral
• Serotonin syndrome (potentially life-threatening) with serotonergic drugs (SSRIs, SNRIs, triptans, TCAs, fentanyl, lithium, tramadol, tryptophan, buspirone, St. John's Wort) or CYP2D6 inhibitors; MAOI use contraindicated - discontinue immediately if it occurs
• Onset or exacerbation of motor/verbal tics and worsening of Tourette's syndrome - assess family history and evaluate before initiating; monitor regularly, discontinue if clinically appropriate

Adverse reactions

• Palpitations, tachycardia, elevated blood pressure; isolated reports of cardiomyopathy with chronic use
• Overstimulation, restlessness, insomnia, dizziness, tremor, headache
• Euphoria, dysphoria, dyskinesia; rare psychotic episodes at recommended doses
• Exacerbation of motor/verbal tics and Tourette's syndrome
• Dry mouth, unpleasant taste, diarrhea, constipation, intestinal ischemia
• Anorexia and weight loss
• Impotence, changes in libido, frequent or prolonged erections
• Urticaria; rhabdomyolysis

Pregnancy Undefined

Lactation Undefined