DEXTROAMPHETAMINE

(eg. Dexadrine/Adderall)

  • Advantages/Disadvantages:
    • Long track record
    • Longer half life -- less likely to need afternoon dose.
    • Adderall is a mixture of dextro and levo amphetamine and has a slightly longer half-life (8-12 hours) potentially allowing less frequent dosing. These isomers have been shown to have equal effects on noradrenergic function but differential effects on dopaminergic function and clinical symptoms of inattention. The levo isomer is not as active as the dextro. These differences may have implications regarding the mixtures efficacy.
    • May unmask/exacerbate a tic disorder
  • Availability:
    • 5,10 mg
    • 5,10,15 mg SR
    • Adderall: 10, 20, 30 mg (double scored tabs).
  • Starting Dose:
    • preschool aged: 2.5 mg q am (w/ breakfast)
    • school aged: 5 mg q am (w/ breakfast)
  • Onset of Action:
    • 15-30 minutes
  • Duration of Action:
    • 2-6 hrs
  • Dosage Adjustment:
    • Increase 2.5-5 mg every 3-5 days until effect observed.
    • When a therapeutic effect achieved, a second dose of the same amount can be given at lunch to control afternoon symptoms -- usually slightly less than the am dose.
    • An occasional child with severe symptoms may need a 4:00pm dose to control evening symptoms.
    • Once the regimen has been adjusted the child can be switched to the long acting form. The total daily dose of long acting preparation often needs to be slightly higher than the total daily dose of short acting preparation. Long acting preparations may not be effective for some patients.
  • Maximum Dose:
    • 1.5 mg/kg/day (rarely need to exceed 40mg/day)

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