Generic Name: dextroamphetamine

Brand Names: Dexedrine, ProCentra, Zenzedi

Drug Class: Stimulants; ADHD Agents

What is dextroamphetamine, and what is it used for?

Dextroamphetamine is a stimulant drug used to treat a chronic sleep disorder (narcolepsy) that causes daytime drowsiness, and attention deficit hyperactivity disorder (ADHD) in both adults and children.

Dextroamphetamine is a sympathomimetic amine drug that mimics the action of natural chemicals in the body that stimulate the sympathetic nervous system.

Dextroamphetamine increases the concentration of two chemicals (neurotransmitters), dopamine and norepinephrine in the brain, which stimulate the central nervous system. Dextroamphetamine promotes the release of these two neurotransmitters and also blocks their reabsorption (reuptake) after the completion of neurotransmission.

Dopamine and norepinephrine have multiple functions that include regulation of movement, attention, memory, motivation and pleasure. Increase in the levels of these neurotransmitters improves concentration and reduces hyperactive and impulsive behaviors associated with ADHD, and improves daytime wakefulness in narcolepsy patients.

Stimulants including dextroamphetamine also increase heart rate, blood pressure and blood glucose and dilate the respiratory tract. Stimulants have a high potential for abuse and dependence, and are used illegally as a street drug. Athletes have been known to use many drugs belonging to the amphetamine class of drugs for physical performance enhancement. These drugs fall under bans by the world anti-doping agency (WADA).

Warnings

• Do not use dextroamphetamine in patients with the following conditions:
  • Known hypersensitivity to sympathomimetic amines
  • Symptomatic cardiovascular disease, moderate to severe hypertension, or advanced plaque formation in the arteries (arteriosclerosis)
  • Hyperthyroidism
  • Glaucoma, an eye condition with high intraocular pressure that causes progressive damage to the optic nerve
• Do not administer dextroamphetamine concurrently or within 14 days following the administration of monoamine oxidase inhibitors (MAOI), an antidepressant drug. it can lead to a hypertensive crisis.
• Concurrent use with drugs that increase serotonin levels including selective serotonin reuptake inhibitors (SSRIs), MAOIs and others can lead to serotonin syndrome, a potentially life-threatening reaction.
• Do not administer dextroamphetamine to patients in an agitated state.
• Dextroamphetamine has a high potential for abuse:
  • Prescribe dextroamphetamine sparingly, keeping in mind the possibility of patients obtaining it for recreational use or distribution to others
  • Prolonged use can lead to drug dependence
  • Misuse can cause sudden death and serious cardiovascular adverse events
• Do not administer dextroamphetamine to patients with structural cardiac abnormalities or other heart conditions. Stroke, heart attack (myocardial infarction) and sudden death have been reported with even recommended doses.
• Evaluate cardiovascular status before initiating stimulant treatment and discontinue therapy if patients develop symptoms of cardiac disease during treatment.
• Stimulants may exacerbate symptoms in patients with pre-existing psychotic disorders.
• Use with caution in ADHD patients with bipolar disorder, stimulants may induce mixed and manic episodes in such patients.
• Consider discontinuing dextroamphetamine if patients without a history of psychotic disorders develop psychotic or manic symptoms.
• Monitor children and adolescents for development or worsening of aggressive behavior or hostility.
• Dextroamphetamine may lower seizure threshold. Monitor the patient and discontinue if seizure occurs.
• May cause blurry vision or difficulty focusing (accommodation disorder).
• Dextroamphetamine may suppress growth in young children, monitor growth in children 7 to 10 years of age and interrupt treatment, if required.
• Dextroamphetamine is associated with peripheral vascular diseases such as Raynaud’s phenomenon.
• Dextroamphetamine may exacerbate phonic and motor tics in Tourette syndrome.
• Dextroamphetamine may rarely cause prolonged and painful erection (priapism), sometimes requiring surgical intervention.

What are the side effects of dextroamphetamine?

Common side effects of dextroamphetamine include:

• Loss of appetite (anorexia)
• Abdominal pain
• Nausea
• Vomiting
• Diarrhea
• Constipation
• Indigestion (dyspepsia)
• Dry mouth
• Unpleasant taste
• Weight loss
• Sleeplessness (insomnia)
• Nervousness
• Mood swings (emotional lability)
• Euphoria
• Uneasiness (dysphoria)
• Erratic, involuntary muscle movements (dyskinesia)
• Dizziness
• Tremor
• Headache
• Infection
• Fever
• Fatigue
• Palpitations
• Rapid heart rate (tachycardia)
• Increase in blood pressure
• Hives (urticaria)
• Hair loss
• Impotence
• Changes in libido
• Frequent or prolonged erections (priapism)
• Breakdown of muscle cells (rhabdomyolysis)
• Peripheral vascular disease
• Abuse and dependence
• Withdrawal symptoms on discontinuation
• Exacerbation of tics (Tourette syndrome)
• Psychotic episodes (rare)

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug.

Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

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What are the dosages of dextroamphetamine?

Capsule, Extended-Release (Dexedrine): Schedule II

• 5mg
• 10mg
• 15mg

Tablet, Immediate-Release (Zenzedi): Schedule II

• 2.5mg
• 5mg
• 7.5mg
• 10mg
• 15mg
• 20mg
• 30mg

Oral Solution (ProCentra): Schedule II

• 5mg/5mL

Adult:

Narcolepsy

• 10 mg/day orally; may titrate every week until side effects appear
• Not to exceed 60 mg/day

Attention Deficit Hyperactivity Disorder

• 5 mg orally once a day or twice a day (4-6 hours apart); may increase 5 mg/day every week until optimal response
• Rarely necessary to exceed 40 mg/day

Pediatric:

Attention Deficit Hyperactivity Disorder

Children younger than 3 years

• Safety and efficacy not established

Children 3-5 years

• Initial: 2.5 mg orally once a day
• May increase by 2.5 mg/day every week

Children 6 years or older

• Initial: 5 mg orally once a day or twice a day (4-6 hours apart); may increase by 5 mg/day every week until optimal response
• Maintenance: 5-15 mg orally once every 12 hours OR 5-10 mg orally every 8 hours
• May substitute with every day dosing of extended-release capsules
• Rarely necessary to exceed 40 mg/day

Narcolepsy

Children older than 12 years

• 10 mg orally once a day initially
• May increase by 10 mg every week to optimal response

Dosing considerations

• Narcolepsy seldom occurs in children younger than 12 years; however, when it does, dextroamphetamine may be used; suggested initial dose for patients aged 6 – 12 is 5 mg daily; daily dose may be raised in increments of 5 mg at weekly intervals until an optimal response obtained
• Capsules may be used for once-a-day dosage wherever appropriate

Geriatric:

Narcolepsy

• Start at lowest dose
• 5 mg/day orally; may increase the dose by 5 mg/day every week until side effects appear
• Not to exceed 60 mg/day

Addiction/overdose

• Dextroamphetamine has a high potential for abuse and dependence. Misuse of dextroamphetamine may cause sudden death and serious cardiovascular adverse events.
• Dextroamphetamine overdose symptoms include restlessness, tremor, overactive reflexes (hyperreflexia), rapid breathing, hallucination, cardiovascular symptoms, panic, fatigue, fever and gastrointestinal symptoms such as nausea, vomiting, diarrhea and abdominal cramps. Severe overdose can cause convulsions, coma and death.
• Treatment for dextroamphetamine overdose is symptomatic and supportive care. Undigested drug from the gastrointestinal tract may be eliminated with gastric lavage and administration of activated charcoal and purgative. The central nervous system (CNS) stimulant effects of dextroamphetamine may be neutralized by administering chlorpromazine, a sedative drug.

The abbreviated term ADHD denotes the condition commonly known as:
See Answer

What drugs interact with dextroamphetamine?

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

• Severe interactions of dextroamphetamine include:
  • iobenguane I 123
  • isocarboxazid
  • linezolid
  • phenelzine
  • procarbazine
  • rasagiline
  • safinamide
  • selegiline
  • selegiline transdermal
  • tranylcypromine
• Dextroamphetamine has serious interactions with at least 39 different drugs.
• Dextroamphetamine has moderate interactions with at least 225 different drugs.
• Dextroamphetamine has mild interactions with at least 58 different drugs.

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.

Pregnancy and breastfeeding

• There are no adequate and well-controlled studies of dextroamphetamine use in pregnant women, however, animal reproductive studies indicate that it can cause fetal harm. Use during pregnancy only if potential benefits to the pregnant woman outweigh potential risks to the fetus.
• Dextroamphetamine is excreted in breast milk. Mothers should not breastfeed while on dextroamphetamine therapy.

What else should I know about dextroamphetamine?

• Dextroamphetamine is a Schedule II controlled substance, diversion of Schedule II products is subject to criminal penalty.
• Take dextroamphetamine exactly as prescribed, do not take larger or more frequent doses.
• Dextroamphetamine has a high risk for addiction and dependency, and can lead to fatal overdose, exercise caution.
• In case of overdose, immediately seek medical help or contact Poison Control.
• Store dextroamphetamine safely out of reach of children.
• Dextroamphetamine can impair mental and physical ability. Avoid driving, operating heavy machinery or other potentially hazardous tasks.