Amphetamine XR suspension
DYANAVEL XR
“Dye Anna’s velvet amp”
What it isExtended-release amphetamine suspension (DYANAVEL XR, 2015) that releases norepinephrine, dopamine, and serotonin; ADHD.
Why this oneLiquid permits fine dose adjustment: 2.5 mg = 4 mg mixed salts, with 8-12 h (Carlat Table 1) of action.
What limits itAppetite loss, insomnia, cardiovascular stimulation, and abuse risk remain those of amphetamine.
FDA-approved for
- ADHD (2015)
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 |
|---|---|---|---|---|
| Attention Deficit Hyperactivity Disorder (ADHD) | Patients 6 years and older | 2.5 or 5 mg QD in the morning | Titrate to clinical response | 20 mg QD |
Titration Increase in increments of 2.5 to 10 mg/day every 4 to 7 days
Renal Undefined
Hepatic Undefined
Instructions
- Administer orally once daily in the morning, with or without food
- Extended-release oral suspension: shake bottle well before each dose; use the provided oral dosing dispenser
- Extended-release tablets: may be chewed or swallowed whole (5 mg tablet is scored, divisible to 2.5 mg)
- Oral suspension and tablets are substitutable on a mg-per-mg basis; do not substitute mg-per-mg for other amphetamine products
- Assess for cardiac disease and screen for tics/Tourette's before initiating
- Urinary alkalinizers raise, acidifiers lower amphetamine levels — adjust dose accordingly
Available strengths
- ER tab 5, 10, 15, 20 mg
- ER susp 2.5 mg/mL
Contraindications
- Concomitant use of an MAOI, or within 14 days of stopping an MAOI, because of increased risk of hypertensive crisis
Cautions
- Serious cardiac disease — avoid in structural cardiac abnormalities, cardiomyopathy, serious arrhythmia, CAD; sudden death reported
- Increased blood pressure and heart rate
- Psychiatric reactions (exacerbation of psychosis, induction of mania, new psychotic/manic symptoms)
- Long-term growth suppression in pediatric patients — monitor height/weight
- Peripheral vasculopathy, including Raynaud's phenomenon
- Serotonin syndrome with serotonergic drugs/CYP2D6 inhibitors
- Motor and verbal tics; worsening of Tourette's syndrome
Adverse reactions
- Dry mouth
- Anorexia
- Weight loss
- Abdominal pain
- Nausea
- Insomnia
- Restlessness
- Emotional lability
- Dizziness
- Tachycardia
- Epistaxis
Pregnancy Limited data insufficient to determine risk; may cause IUGR and premature delivery; monitor neonates for withdrawal
Lactation Amphetamine present in human milk; breastfeeding not recommended during treatment
Cost
| Strength | #/mo | generic $ | CostPlus | |
|---|---|---|---|---|
| 5 mg | ER tab | 30 qd | not offered | |
| 10 mg | ER tab | 30 qd | not offered | |
| 15 mg | ER tab | 30 qd | not offered | |
| 20 mg | ER tab | 30 qd | not offered | |
| 2.5 mg/mL | ER susp | per unit | not offered |
Serotonin and MAOI
Provisional washout figures
Elevating mechanismNone identified
Exposure dependenceNo serotonin-elevating mechanism identified
Evidence confidenceModerate
InterpretationNo clinically meaningful serotonin-elevating mechanism identified in this first-pass Gillman-based review.
Open Amphetamine XR suspension in the interactive console ↗
Memory aids: interaction avatars
Open Amphetamine XR suspension in the interactive console ↗
Self-check
- DYANAVEL XR 2.5 mg corresponds to how much mixed amphetamine salt?
4 mg. - What action duration is listed for DYANAVEL XR?
8–12 h (Carlat Table 1).