What is/are Adderall?
Amphetamine mixed salts (also known as amphetamine and dextroamphetamine mixed salts, amphetamine salt combo, or simply amphetamine salts, and sold under the brand name Adderall) is a pharmaceutical drug used in the treatment of attention deficit hyperactivity disorder (ADHD) and narcolepsy. The active ingredient contained in this medication is a mixture of the salts of amphetamine and dextroamphetamine, both of which act as stimulants. As of 2013, there is a single commercial formulation, which contains a 3:1 ratio of dextroamphetamine (the dextrorotary or "right-handed" enantiomer) to levoamphetamine (the levorotary or "left-handed" enantiomer). Amphetamine mixed salts are available in immediate release and extended release formulations.
Amphetamine mixed salts is generally used for the treatment of ADHD and narcolepsy. These are the only two conditions for which the United States Food and Drug Administration has approved its use. However, it is sometimes prescribed off-label for other conditions such as depression. It has been used to treat obesity, but the American Society of Health-System Pharmacists does not recommend this use. Nearly 14 million monthly prescriptions for the condition were written for Americans ages 20 to 39 in 2011, two and a half times the 5.6 million just four years before, according to the data company I.M.S. Health.
Attention deficit hyperactivity disorder
The comparative effectiveness of treatment options for children with ADHD, including different amphetamine medications, has been studied by the US Agency for Health Care Research and Quality, and summarized for parents. Amphetamines may improve ADHD in symptoms in children over the age of six, but there is not enough evidence to be sure.Use for younger children and use for longer than a year in particular require further study.
Amphetamine mixed salts have also been shown to reduce ADHD in adults, but research is limited.
Dosing and administration
Amphetamine mixed salts is available as immediate release form or extended-release form.The extended release capsule is generally used in the morning. Generic forms are available in some doses.
The extended release formulation available under the brand Adderall XR is designed to provide therapeutic effect and plasma concentrations identical to taking two doses 4 hours apart.
Side effects of amphetamine salts include dry mouth, insomnia, tired feeling, drowsiness, dizziness, nervousness, headache and weight loss, diarrhea, as well as changes in heartbeat and blood pressure.
A study on comparative effects between amphetamine mixed salts and methylphenidate in children who have been treated for a year or more have shown a temporary decrease in growth rate that does not affect final adult height. Change in weight was reported as slightly greater for amphetamine mixed salts and authors concluded that the result may be clinically insignificant.
Studies on rats show long-term neurological and behavioral changes resulting from prenatal and early postnatal exposure to amphetamines. Warnings from the Patient Medication Guide for Adderall include emergence of new psychotic or manic symptoms, aggression and blurred vision. Recent studies by the FDA indicate that, in children, young adults, and adults, there is no association between serious adverse cardiovascular events (sudden death, myocardial infarction, and stroke) and the use of amphetamines or other ADHD stimulants.
Contraindications, interactions, and precautions
- MAOIs (monoamine oxidase inhibitors, e.g., phenelzine, selegiline, iproniazid, etc.) —There is a high risk of a hypertensive crisis if amphetamine is administered within two weeks after last use of an MAOI type drug. Preliminary trials of low-dose amphetamine and MAOIs being administered together are in progress. However, this is to be done only under strict supervision of the prescribing parties.
- SSRIs (selective serotonin reuptake inhibitors, e.g., fluvoxamine, citalopram, paroxetine, etc.) — While a common combination, and although rare, the risk for serotonin syndrome exists. (Use only when directed)
- NRIs (norepinephrine reuptake inhibitors, e.g., atomoxetine, etc.) — NRI medications and amphetamine both enhance noradrenergic activity. Possible augmentation/potentiation of effects. (Use only when directed)
- SNRIs (selective serotonin-norepinephrine reuptake inhibitors) — See SSRIs and NRIs.
- Bupropion — Both bupropion and amphetamine have noradrenergic and dopaminergic activity. Bupropion is a potent CYP2D6 inhibitor. Bupropion has pro-convulsant properties that may be enhanced or cumulatively potentiated by amphetamine. (Use only when directed)
- Monoaminergic tricyclic antidepressant — See NRIs, SNRIs, and SSRIs. Possible potentiation of serotonin-, dopamine-, and/or norepinephrine-related drug effects. The combination of monoaminergic tricyclics and amphetamine compounds has been associated with increased sympathomimetic effects. The exceptions to this class (i.e. non-monoaminergic tricyclic antidepressants) include the glutamatergic tricyclic tianeptine and sigmaergic tricyclic opipramol.
- CYP2D6 (liver enzyme) inhibitors, e.g., Bupropion and most SSRIs such as fluoxetine, citalopram, paroxetine, etc. Some anti-psychotics such as thioridazine, haloperidol, and levomepromazine, as well as cocaine, the opioid agonist methadone, and others. It is important to determine if any medication or drug taken is a CYP2D6 inhibitor. Taking a CYP2D6-inhibiting drug along with amphetamine will lead to an elevated level of amphetamine in the system, resulting in the drug's remaining in the body for a longer period, which can lead to undesirable and possibly serious side effects.
- Individuals with pre-existing cardiac conditions or mental illnesses.
- Individuals with a history of drug abuse
Amphetamine mixed salts is in FDA pregnancy category C. Drugs assigned category C have been demonstrated to have adverse effect on fetus in animal studies, but no adequate studies on human are available.
Prolonged use and withdrawal
Prolonged use of amphetamines can lead to dependence. Chronic abuse of amphetamines can result in the manifestation of amphetamine psychosis; occasionally this psychosis can occur at therapeutic doses during chronic therapy as a treatment emergent side effect.
Most longterm users of amphetamines will experience severe, time-limited withdrawal symptoms within 24 hours of their last dose. Symptoms can include dysphoric mood, irritability, anxiety, agitation, vivid or unpleasant dreams, hypersomnia or fatigue, cravings and more. Thoughts of suicide have been reported. This initial "crash" can last up to a week, followed generally by about two weeks of less acute withdrawal symptoms. Antidepressant drugs have been studied to ease amphetamine withdrawal, but more research on their effects is needed..
Mechanism of action
Amphetamine's pharmacological activity is due mainly to the release of dopamine and norepinephrine. It can also increase serotonin release, although it is disputed whether this is pharmacologically significant at therapeutic doses.Dextroamphetamine (the dextrorotary enantiomer) and levoamphetamine (the levorotary enantiomer) have different pharmacological properties. Dextroamphetamine is several times more potent in the central nervous system than levoamphetamine, but the two isomers have comparable activity in the peripheral nervous system. The overall greater potency of dextroamphetamine to central actions suggests that this form may have a higher potential for abuse.
Levoamphetamine provides mixed amphetamine salts quicker onset and longer-lasting effects than dextroamphetamine alone. It has been reported that certain children have a better clinical response to levoamphetamine.
This article uses material from the Wikipedia article Adderall, which is released under the Creative Commons Attribution-Share-Alike License 3.0.