Dextroamphetamine (Dexedrine) is a central nervous system stimulant with sympathomimetic properties.

Apart from its medical uses, it is used recreationally as an aphrodisiac and enhances athletes' performance.

Indications of Dextroamphetamine (Dexedrine):

• Attention-deficit/ hyperactivity disorder:

  • Dextroamphetamine (Dexedrine) is suggested for kids aged 3 to 16 with ADHD.

  • It's part of a plan that usually includes other treatments like therapy, education, and social help.

• Narcolepsy:
  • It works well for treating narcolepsy.

Dextroamphetamine (Dexedrine) dose in adults:

Dextroamphetamine (Dexedrine) dose in the treatment of Narcolepsy:

• Start with 10 mg by mouth once a day. You can raise the dose by 10 mg each week until it works best for you.

• Normally, take between 5 to 60 mg daily, split into smaller doses throughout the day.

Dextroamphetamine (Dexedrine) dose in children:

Remember to use the smallest dose that works well for you.

Dextroamphetamine (Dexedrine) dose in the treatment of Attention-deficit/ hyperactivity disorder:

• Immediate-release tablets and oral solution:

  • For kids aged 3 to 5:

  • Begin with 2.5 mg orally once a day in the morning.
  • Increase the dose by 2.5 mg each week until it works well.
  • The most you should take in a day is 40 mg, split into 2-3 doses spaced 4-6 hours apart.
  • Note: Even though the FDA says it's okay, experts don't recommend it for kids under five due to limited data.

  • For children 6 years and older and teenagers:

  • Start with 5 mg orally once or twice a day in the morning.
  • Keep increasing the dose by 5 mg every week until it's effective.
  • Usually, take between 5-20 mg a day.
  • The highest amount per day is 40 mg, divided into 2-3 doses with 4-6 hours between each.

  • Extended and sustained-release capsules:

    • For children 6 years and older, as well as teenagers:

    • Start with 5 mg by mouth once or twice a day, taking the first dose in the morning.
    • Once you see the desired response, increase the daily dose by 5 mg each week.
    • Typically, the dose ranges from 5-20 mg a day.
    • The highest amount per day is 40 mg, split into 1-2 doses, with a 6- to 8-hour gap between each dose.
    • In patients weighing over 50 kg, a maximum daily dose of 60 mg split into several doses throughout the day has been used.

Dextroamphetamine (Dexedrine) dose in the treatment of Narcolepsy:

• Immediate-release tablets and oral solution:

  • For children aged 6-12 years:

  • Start with 5 mg orally daily and increase by 5 mg every other week until it works well.
  • The most you should take in a day is 60 mg, split into 1-3 doses with 4-6 hours between each.

  • For adolescents:

  • Begin with 10 mg orally daily and raise it by 10 mg each week until it's effective.
  • The maximum daily dose is 60 mg, divided into 1-3 doses with 4-6 hours between each.
• Extended and sustained-release capsules:

  • For children aged 6-12 years:

  • Start with 5 mg orally daily, increasing by 5 mg every other week until it works well.
  • The maximum daily dose is 60 mg, split into 1-2 doses spaced 6-8 hours apart.

  • For adolescents:

  • Begin with 10 mg orally daily, increasing by 10 mg each week until it's effective.
  • The maximum daily dose is 60 mg, divided into 1-2 doses with a 6- to 8-hour interval between each dose.

Dextroamphetamine (Dexedrine) dose in the treatment of Obesity secondary to hypothalamic-pituitary dysfunction:

• Immediate-release tablets and oral solution:

  • For children 6 years and older, as well as adolescents:

  • Start with 5 mg orally once a day in the morning. Increase by 2.5 mg each week until it's effective.
  • If more doses are needed, they can be given between lunch and supper.
  • The highest single dose reported is 7.5 mg.
  • The maximum daily dose is split into two doses of 20 mg.

Dextroamphetamine (Dexedrine) pregnancy Risk Category: C

• In studies with animals, there were negative effects on pregnancy.

• Most of what we know from humans comes from illegal use of methamphetamine or amphetamine, not prescribed use during pregnancy.

• Using amphetamine during pregnancy raises the chances of having a baby with low birth weight or being born too early.

• Newborn babies might show withdrawal symptoms. Sometimes children might have behavioral problems.

Breastfeeding:

• Dextroamphetamine can be found in breast milk.

• Studies have shown that when mothers take doses ranging from 15 to 45 mg per day, the amount of dextroamphetamine in breast milk can range from 3.9% to 13.8%. If the relative infant dose (RID) is less than 10%, breastfeeding is usually considered safe.

• Some sources suggest a stricter guideline of less than 5% for psychotropic agents.

• The RID of dextroamphetamine is calculated using average milk levels of 0.066 to 0.3313 mcg/mL.

• This means the baby may receive 10 to 47 mg per kilogram per day of dextroamphetamine through breast milk, with a median of 21 mg per kilogram per day.

• This concentration was seen in the milk of mothers who took 15-45 mg per day, divided into doses, in a study involving four women.

• Two out of three babies had dextroamphetamine in their blood, but no negative effects were observed in breastfed infants.

• However, it's essential to note that most of what we know about the effects of amphetamines during breastfeeding comes from illegal use, not prescribed maternal use.

• Breastfeeding may lead to increased crying, agitation, and irritability in infants, and amphetamines can reduce milk production.

• Therefore, it's generally not recommended to breastfeed while taking amphetamines.

Dextroamphetamine (Dexedrine) Dose adjustment in renal disease:

Dosage adjustments are not specified on the labeling.

Dextroamphetamine (Dexedrine) Dose adjustment in liver disease:

Dosage adjustments are not specified on the labeling.

Side effects of Dextroamphetamine (Dexedrine):

• Cardiovascular:
  • Cardiomyopathy
  • Hypertension
  • Palpitations
  • Tachycardia
• Central Nervous System:
  • Headache
  • Aggressive Behavior
  • Dizziness
  • Mania
  • Dysphoria
  • Psychosis
  • Euphoria
  • Exacerbation Of Tics
  • Gilles De La Tourette Syndrome
  • Insomnia
  • Overstimulation
  • Restlessness
• Dermatologic:
  • Urticaria
  • Alopecia
• Endocrine & Metabolic:
  • Weight Loss
  • Change In Libido
• Gastrointestinal:
  • Constipation
  • Unpleasant Taste
  • Diarrhea
  • Xerostomia
  • Anorexia
• Genitourinary:
  • Impotence
  • Prolonged Erection
  • Frequent Erections
• Neuromuscular & Skeletal:
  • Rhabdomyolysis
  • Tremor
  • Dyskinesia
• Ophthalmic:
  • Blurred Vision
  • Accommodation Disturbances

Contraindications to Dextroamphetamine (Dexedrine):

• Avoid using dextroamphetamine if you have:

• Allergic reactions like angioedema or anaphylaxis to dextroamphetamine, sympathomimetic drugs, or any ingredient in the medicine.
• Moderate to severe high blood pressure.
• Overactive thyroid (hyperthyroidism).
• Advanced hardening of the arteries (arteriosclerosis).
• Glaucoma.
• Symptoms of heart disease.
• Agitated behavior or a history of drug abuse.
• Used a monoamine oxidase inhibitor (MAOI) in the past 14 days, including drugs like linezolid and intravenous Methylene Blue.

• Although there isn't much evidence of direct allergy cross-reactivity between amphetamines and other substances, there might still be cross-sensitivity due to similarities in chemical structure or how they work in the body.

Warnings and precautions

• Cardiovascular events: [US Boxed Warn]

  • Amphetamines can increase the risk of fatal heart problems, even causing sudden death in people with existing heart issues or serious health conditions.

  • Individuals with severe heart problems, cardiomyopathy, or significant heart rhythm issues are especially at risk and should avoid using amphetamines altogether.

  • Before starting amphetamine therapy, it's crucial to thoroughly evaluate the patient's health.

  • If patients experience symptoms like chest pain during activity or fainting without explanation, they should get their heart health checked right away.

• CNS effects

  • Amphetamines can affect cognitive function, which includes abilities like driving and operating machinery.

  • It's important to be cautious and avoid these activities if you're taking amphetamines, as they may impair your ability to do them safely.

• Peripheral vasculopathy

  • Amphetamines like dextroamphetamine can lead to peripheral vasculopathy, which may manifest as Raynaud phenomenon, causing mild or intermittent symptoms.

  • If you develop this condition while taking the medication, your doctor may recommend reducing or stopping the medication to alleviate symptoms.

  • While it's uncommon, amphetamines can sometimes lead to soft tissue or digital ulceration.

  • It's essential to keep an eye on any changes in your fingers or toes and discuss them with your healthcare provider.

  • Regular monitoring of your digital changes and evaluating other features during treatment is important to ensure your overall health and well-being.

• Visual disturbance

  • The effects of amphetamines can include blurred vision and difficulty adjusting your eyesight, known as accommodation.

  • If you experience these symptoms while taking amphetamines, it's essential to discuss them with your healthcare provider.

  • They can help determine if adjustments to your treatment are needed to manage these side effects.

• Potential abuse: [US Boxed Warning]

  • Long-term use of amphetamines can potentially lead to dependence on the medication.

  • Therefore, it's crucial to use them as prescribed and under close medical supervision.

  • Individuals with a history of alcohol abuse should avoid using amphetamines, as it may exacerbate their condition or lead to further substance abuse issues.

  • When prescribing amphetamines, healthcare providers should consider providing small amounts to patients who are under good medical care.

  • This helps minimize the risk of accidental overdose and ensures proper monitoring of the patient's response to the medication.

• Hypertension
  • Patients with severe or moderate to severe hypertension should avoid using this medication altogether.
  • Additionally, individuals with hypertension or other cardiovascular conditions should exercise caution when considering the use of amphetamines.
  • It's essential for healthcare providers to carefully evaluate the risks and benefits of prescribing amphetamines to patients with cardiovascular issues and to monitor them closely during treatment.
• Psychiatric disorders

  • Therapy can help manage symptoms like behavior and thought disorders or mixed/manic episodes.

  • However, it's crucial to be aware that therapy can also trigger mania or new-onset psychosis.

  • Watch out for signs of aggression or hostility, as they may indicate adverse effects of the therapy.

  • People with pre-existing bipolar disorder or psychosis should avoid using this therapy, as it can worsen their condition.

• Seizure disorder

  • There's limited information about using stimulants in seizure disorders.

  • However, research suggests that ADHD patients may have a higher risk of seizures compared to the general population.

  • Interestingly, individuals who used stimulant medications had a reduced risk of seizures, as per a retrospective study using drug claims data.

  • If seizures do happen, it's recommended by the manufacturer to stop the therapy.

• Tourette syndrome and tics

  • Stimulant therapy can potentially trigger Tourette syndrome and worsen motor and vocal tics, although there isn't substantial evidence supporting this claim.

  • Before starting therapy, it's crucial to evaluate patients for Tourette syndrome and any existing tics.

  • Patients with a history of tic disorders or Tourette syndrome should not be given stimulant therapy.

Dextroamphetamine: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring parameters:

• In all patients using stimulants, it's essential to monitor their central nervous system activity, as well as keep an eye on their growth and weight if they're children.

• Watch for any behavioral changes and signs of peripheral vasculopathy, like changes in the fingers or toes.

• Be vigilant for signs of misuse, abuse, or addiction.

• If patients experience chest pain during activity, fainting without a clear reason, or any other signs of heart problems while taking stimulants, they should have their hearts checked.

• For treating ADHD, it's crucial to assess cardiovascular risk thoroughly.

• Before starting therapy, check their pulse, blood pressure, and perform an electrocardiogram (ECG).

How to administer Dextroamphetamine (Dexedrine)?

Give the first dose of medication in the morning when the person wakes up to avoid trouble sleeping later in the evening.

For immediate-release tablets and oral solution:

• If necessary, you can give 1 to 2 more doses every 4 to 6 hours.

For extended-release and sustained-release capsules:

• Don't crush sustained-release capsules.
• If suitable, some formulations allow once-daily dosing.

Mechanism of action of Dextroamphetamine (Dexedrine):

• Amphetamines, a type of non-catecholamine sympathomimetic amines, prompt the release of catecholamines like dopamine and norepinephrine from storage sites in nerve terminals.

• Another mechanism, though less significant, involves competitive inhibition, which prevents the reuptake of catecholamines.

• Duration of action:

  • Immediate-release: 4 to 6 hours
  • Extended-release: 8 hours

• Metabolism:

  • Metabolized in the liver via CYP monooxygenase and glucuronidation.

• Half-life elimination in adults:

  • 10 to 12 hours

• Time to peak serum concentration:

  • Immediate release: 3 hours
  • Sustained release: 8 hours

• Excretion:

  • Excreted in urine.
  • Urinary excretion is influenced by pH, with increased excretion in acidic urine (low pH).

International Brands of Dextroamphetamine:

• Dexedrine
• ProCentra
• Zenzedi
• ACT Dextroamphetamine SR
• Attent
• Dexamphetamini Sulfas

Dextroamphetamine brands in Pakistan:

No Brands Available in Pakistan.