Dextroamphetamine patch

XELSTRYM

What it isTransdermal dopamine-releasing dextroamphetamine for ADHD; Approved ages (ADHD label): 6-17, adults.

Why this oneDuration of action ~12 h (Carlat Table 1); wear 9 h, with removal providing a duration control oral amphetamine cannot offer.

What limits itSkin reactions, appetite loss, insomnia, cardiovascular stimulation, and misuse risk limit use; external heat can raise absorption.

FDA-approved for

BOXED WARNING Abuse, misuse, and addiction

FDA dosing	Population	Start	Target	Max
ADHD	Adults	9 mg/9h QD		18 mg/9h QD
ADHD	Pediatric 6–17 y	4.5 mg/9h QD		18 mg/9h QD

Titration Pediatric: adjust in weekly increments of 4.5 mg

Renal Severe (GFR 15–<30): max 13.5 mg/9h; ESRD (GFR <15): max 9 mg/9h

Hepatic Undefined

Not recommended in pediatric patients <6 years (higher exposure/adverse reactions)

Apply one patch 2 h before effect needed; remove within 9 h; one patch per 24 h
Apply to clean, dry, intact skin (hip, upper arm, chest, upper back, or flank); rotate sites
Avoid external heat sources during wear
Do not substitute for other amphetamine products on a mg-per-mg basis

Use with monoamine oxidase inhibitor (MAOI), or within 14 days of stopping MAOIs (including MAOIs such as linezolid or intravenous methylene blue), because of an increased risk of hypertensive crisis

Pregnancy No clear drug-associated major-defect/miscarriage risk; possible premature delivery and low birth weight

Lactation Amphetamine present in human milk; breastfeeding not recommended during treatment

⚠ BOXED WARNING

Direct muscarinic antagonism0 / 4