Amphetamine / Dextroamphetamine Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Narcolepsy

Tablets:
Initial Dose: 10 mg per day orally upon awakening.
Maintenance Dose: The daily dosage may be increased in increments of 10 mg at weekly intervals, up to 60 mg per day in 2 to 3 divided doses. Give first dose on awakening; additional doses (1 or 2) at intervals of 4 to 6 hours. If bothersome adverse reactions appear (e.g., insomnia or anorexia), dosage should be reduced.

Usual Adult Dose for Attention Deficit Disorder

Extended Release Capsules:
Initial Dose: In adults with ADHD who are either starting treatment for the first time or switching from another medication, the recommended dose is 20 mg/day.

Usual Pediatric Dose for Narcolepsy

Tablets:
<6 years: Not recommended.

6 years to 12 years:
Initial Dose: 5 mg per day orally upon awakening.
Maintenance Dose: The daily dose may be raised in increments of 5 mg at weekly intervals until optimal response is obtained, up to a maximum of 60 mg/day. Give first dose on awakening; additional doses (1 or 2) at intervals of 4 to 6 hours. If bothersome adverse reactions appear (e.g., insomnia or anorexia), dosage should be reduced. Narcolepsy seldom occurs in children under 12 years of age; however, when it does, this drug may be used.

>=12 years:
Initial Dose: 10 mg per day orally upon awakening.
Maintenance Dose: The daily dosage may be raised in increments of 10 mg at weekly intervals until optimal response is obtained, up to a maximum of 60 mg/day. Give first dose on awakening; additional doses (1 or 2) at intervals of 4 to 6 hours. If bothersome adverse reactions appear (e.g., insomnia or anorexia), dosage should be reduced.

Usual Pediatric Dose for Attention Deficit Disorder

Tablets:
<3 years: Not recommended.

3 to 5 years:
Initial Dose: 2.5 mg once a day orally upon awakening.
Maintenance Dose: The daily dosage may be raised in increments of 2.5 mg at weekly intervals until optimal response is obtained. Only in rare cases will it be necessary to exceed a total of 40 mg per day in 2 to 3 divided doses. Give first dose on awakening; additional doses (1 or 2) at intervals of 4 to 6 hours.

>= 6 years:
Initial Dose: 5 mg once or twice a day orally upon awakening.
Maintenance Dose: The daily dosage may be raised in increments of 5 mg at weekly intervals until optimal response is obtained. Only in rare cases will it be necessary to exceed a total of 40 mg per day in 2 to 3 divided doses. Give first dose on awakening; additional doses (1 or 2) at intervals of 4 to 6 hours.

Extended Release Capsules:
<6 years: Not recommended.

6 to 12 years:
Initial Dose: 5 mg to 10 mg once a day orally upon awakening.
Maintenance Dose: The daily dosage may be raised in increments of 5 mg to 10 mg at weekly intervals.
Maximum Dose: 30 mg once daily upon awakening.

13 to 17 years:
Initial Dose: 10 mg once a day orally upon awakening.
Maintenance Dose: The daily dosage may be increased to 20 mg once a day orally upon awakening after one week if ADHD symptoms are not adequately controlled.
Maximum Dose: 20 mg once daily upon awakening.

Where possible, drug administration should be interrupted occasionally to determine if there is a recurrence of behavioral symptoms sufficient to require continued therapy.

Drug treatment is not indicated in all cases of Attention Deficit Disorder with Hyperactivity and should be considered only in light of the complete history and evaluation of the child. The decision to prescribe amphetamines should depend on the physician's assessment of the chronicity and severity of the child's symptoms and their appropriateness for his/her age. Prescription should not depend solely on the presence of one or more of the behavioral characteristics. When these symptoms are associated with acute stress reactions, treatment with amphetamines is usually not indicated.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Amphetamine-dextroamphetamine is contraindicated for use in patients with advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, and/or glaucoma. Use is also contraindicated in patients who are in agitated states and in patients with a history of drug abuse.

Clinical experience suggests that in psychotic children, administration of amphetamine may exacerbate symptoms of behavior disturbance and thought disorder. Data are inadequate to determine whether chronic administration of amphetamine may be associated with growth inhibition; therefore, growth should be monitored during treatment.

Misuse of amphetamine may cause serious cardiovascular adverse events and sudden death.

Sudden death has been reported in association with amphetamine treatment at usual doses in children with structural cardiac abnormalities. Therefore, amphetamine use is not recommended for children or adults with structural cardiac abnormalities.

Caution is recommended in prescribing amphetamines for patients with even mild hypertension. Blood pressure and pulse should be monitored in all patients, especially those with hypertension. Dosage reduction and/or appropriate medication may be necessary in patients who experience sustained increases in blood pressure.

The least amount feasible should be prescribed or dispensed at one time in order to minimize the possibility of overdosage.

Amphetamines have been reported to exacerbate motor and phonic tics and Tourette's syndrome. Therefore, clinical evaluation for tics and Tourette's syndrome in children and their families should precede use of stimulant medications.

Amphetamines have been extensively abused. Tolerance, extreme psychological dependence, and severe social disability have occurred. There are reports of patients who have increased the dosage to many times that recommended. Abrupt cessation following prolonged high dosage administration results in extreme fatigue and mental depression; changes are also noted on the sleep EEG. Manifestations of chronic intoxication with amphetamines include severe dermatoses, marked insomnia, irritability, hyperactivity, and personality changes. The most severe manifestation of chronic intoxication is psychosis, often clinically indistinguishable from schizophrenia. This is rare with oral amphetamines.

Dialysis

Data not available

Other Comments

Regardless of indication, amphetamines should be administered at the lowest effective dosage and dosage should be individually adjusted. Late evening doses should be avoided because of the resulting insomnia.

Adderall XR capsules may be taken with or without food. Adderall XR capsules may be swallowed whole or the capsule may be opened and the entire contents may be sprinkled on applesauce. Once sprinkled on applesauce, the drug should be consumed immediately and not stored. Patients should take the applesauce sprinkled with beads in its entirety without chewing. The dose of a single capsule should not be divided.

Amphetamine use may result in decreased appetite. Absolute weight is reported to increase over time in children treated with Adderall XR; however, the increases are smaller than expected (based on CDC normative values). These reductions in expected weight attenuate over time and are thought to be greatest in the heaviest children. A controlled trial involving adolescents receiving Adderall XR 10 mg and 20 mg reported an average weight change from baseline of -1.1 pounds and -2.8 pounds, respectively, within the initial 4 weeks of treatment. Higher doses were associated with higher weight loss in this same time period.

A 4-week controlled study reported isolated systolic blood pressure elevations >= 15 mmHg and isolated diastolic blood pressure elevations of >= 8 mmHg in 7% (11%) and 22% (25%) of adolescents with ADHD receiving Adderall XR 10 mg or 20 mg (placebo). Higher doses of Adderall XR reported similar results. A single-dose study reported isolated increases in systolic blood pressure in 12% (2/17) and 35% (8/23) of adolescents receiving 10 mg and 20 mg of Adderall XR, respectively. The increases appeared to be transient, peak at 2 to 4 hours post dose, and not associated with symptoms.

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