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.

Extended Release Capsules:
Initial Dose: 10 mg per once a day orally upon awakening.
Maintenance Dose: The daily dosage may be increased in increments of 10 mg at weekly intervals, up to 60 mg once a day upon awakening. If bothersome adverse reactions appear (e.g., insomnia or anorexia), the dosage should be reduced.

Oral Solution:
Usual dose: 5 mg to 60 mg per day in divided doses depending on individual patient response.

Usual Pediatric Dose for Narcolepsy

Note: Narcolepsy seldom occurs in children under 12 years of age. However, when it does, dextroamphetamine sulfate may be used.

Tablets:
Less than 6 years: Not recommended.

6 to 12 years:
Initial Dose: 5 mg daily 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 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.

Greater than or equal to 12 years:
Initial Dose: 10 mg daily upon awakening.
Maintenance Dose: The daily dosage may be raised in increments of 10 mg at weekly intervals until an optimal response is obtained up to a maximum of 60 mg/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.

Extended Release Capsules:
Less than 6 years: Not recommended.

6 to 12 years:
Initial Dose: 5 mg once a day 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 once daily. If bothersome adverse reactions appear (e.g., insomnia or anorexia), dosage should be reduced.

Greater than or equal to 12 years:
Initial Dose: 10 mg once a day upon awakening.
Maintenance Dose: The daily dosage may be raised in increments of 10 mg at weekly intervals until an optimal response is obtained up to a maximum of 60 mg once daily. If bothersome adverse reactions appear (e.g., insomnia or anorexia), dosage should be reduced.

Usual Pediatric Dose for Attention Deficit Disorder

Tablets:
Less than 3 years: Not recommended.

3 to 5 years:
Initial Dose: 2.5 mg orally per day upon awakening.
Maintenance Dose: The daily dosage may be raised in increments of 2.5 mg at weekly intervals until an 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. If bothersome adverse reactions appear (e.g., insomnia or anorexia), dosage should be reduced.

Greater than of equal to 6 years:
Initial Dose: 5 mg once or twice daily
Maintenance Dose: The daily dosage may be raised in increments of 5 mg at weekly intervals until an optimal response is obtained. Only in rare cases will it be necessary to exceed a total of 40 mg per day in 2 or 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.

Extended Release Capsules:
Less than 6 years: Not recommended.

Greater than or equal to 12 years:
Initial Dose: Patients who are being switched from dextroamphetamine tablets may be converted to the same total dose where appropriate, taken once daily upon awakening.
Maintenance Dose: The daily dosage may be raised in increments of 10 mg at weekly intervals until an optimal response is obtained. Only in rare cases will it be necessary to exceed a total of 40 mg once daily. If bothersome adverse reactions appear (e.g., insomnia or anorexia), dosage should be reduced.

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

Long term effects of amphetamines in pediatric patients have not been well established.

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.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

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

Caution is recommended in prescribing amphetamines for patients with even mild hypertension.

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

Clinical experience suggests that in psychotic children, administration of amphetamines may exacerbate symptoms of behavior disturbance and thought disorder.

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.

Data are inadequate to determine whether chronic administration of amphetamines may be associated with growth inhibition; therefore, growth should be monitored during treatment.

Dialysis

Data not available

Other Comments

Amphetamines should be administered at the lowest effective dosage and dosage should be individually adjusted. Late evening doses (particularly with the extended release capsule) should be avoided because of the resulting insomnia.

Patients should have blood pressure and pulse monitored regularly.

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