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Amphetamine/dextroamphetamine FDA Alerts

The FDA Alerts below may be specifically about amphetamine/dextroamphetamine or relate to a group or class of drugs which include amphetamine/dextroamphetamine.

MedWatch Safety Alerts are distributed by the FDA and published by Drugs.com. Following is a list of possible medication recalls, market withdrawals, alerts and warnings.

Recent FDA Alerts for amphetamine/dextroamphetamine

FDA Updating Warnings to Improve Safe Use of Prescription Stimulants Used to Treat ADHD and Other Conditions

What safety concern is FDA announcing?

To address continuing concerns of misuse, abuse, addiction, and overdose of prescription stimulants, the U.S. Food and Drug Administration (FDA) is requiring updates to the Boxed Warning and other information to ensure the prescribing information is made consistent across the entire class of these medicines. The current prescribing information for some prescription stimulants does not provide up to date warnings about the harms of misuse and abuse, and particularly that most individuals who misuse prescription stimulants get their drugs from other family members or peers. Further, individuals who are prescribed stimulants are often faced with requests to share their medication. Sharing these medicines with others can lead to development of substance use disorder and addiction in those with whom these drugs are shared.

Prescription stimulants can be an important treatment option for disorders for which they are indicated. However, even when prescribed to treat an indicated disorder, their use can lead to misuse or abuse. Misuse and abuse, also called nonmedical use, can include taking your own medicine differently than prescribed or using someone else’s medicine. For this reason, sharing prescription stimulants with those for whom they are not prescribed is an important concern and a major contributor to nonmedical use and addiction. Misuse and abuse of prescription stimulants can result in overdose and death, and this risk is increased with higher doses or unapproved methods of taking the medicine such as snorting or injecting.

What is FDA doing?

We are requiring the Boxed Warning, FDA’s most prominent warning, to be updated and we are adding other information to the prescribing information for all prescription stimulants. We are adding information that patients should never share their prescription stimulants with anyone, and the Boxed Warning information will describe the risks of misuse, abuse, addiction, and overdose consistently across all medicines in the class. The Boxed Warning also will advise heath care professionals to monitor patients closely for signs and symptoms of misuse, abuse, and addiction.

Information on these risks is being required in several sections of the prescribing information, including the Warnings and Precautions, Drug Abuse and Dependence, Overdosage, and Patient Counseling sections. We are also requiring updates to the existing patient Medication Guides to help educate patients and caregivers about these risks.

What is a prescription stimulant and how can it help me?

Prescription stimulants are used to treat attention deficit/hyperactivity disorder (ADHD), binge-eating disorder, and uncontrollable episodes of deep sleep called narcolepsy. Prescription stimulants may help decrease impulsivity and hyperactivity, and increase attention in patients with ADHD; help reduce the number of excessive overeating episodes in patients with binge-eating disorder; and help promote wakefulness in patients with narcolepsy. These medicines have benefits when used appropriately, but they also have serious risks, including the risk of misuse and abuse, addiction, overdose, and death. Examples of common prescription stimulants include Adderall (amphetamine/dextroamphetamine), Concerta (methylphenidate), Dexedrine (dextroamphetamine), and Ritalin (methylphenidate).

What should health care professionals do?

Assess patient risk of misuse, abuse, and addiction before prescribing stimulant medicines. Counsel patients not to share their prescribed stimulant with anyone else. Educate patients and their families on these serious risks, proper storage of the medicine, and proper disposal of any unused medicine. Throughout treatment, regularly assess and monitor them for signs and symptoms of nonmedical use, addiction, and potential diversion, which may be evidenced by more frequent renewal requests than warranted by the prescribed dosage.

What should patients and caregivers do?

Always take your prescription stimulant exactly as prescribed by your health care professional. Do not take more of the medicine or take it more often than prescribed. Never provide any of your prescription stimulant medicine to anyone else as it can have serious risks for those for whom it was not prescribed. Store your prescription stimulant medicines securely, out of sight and reach of children and in a location not accessible by others, including visitors to the home. Immediately dispose of unused or expired prescription stimulants properly or take them to a drug take-back site, location, or program. Talk to your health care professional if your use of prescription stimulants has resulted in problems with your health, relationships, responsibilities, or the law, or if you are struggling with misusing these or other medicines. Go to an emergency room or call 911 if you experience symptoms of stimulant overdose, including new tremors or change in existing tremors, seizures, restless or aggressive behavior, overactive reflexes, fast breathing, fast or irregular pulse rate, confusion, stomach cramps, or more serious symptoms such as heart attack or stroke. Talk to your health care professional if you have questions or concerns about risks of taking prescription stimulants.

What did FDA find?

We reviewed the medical literature published from January 2006 to May 2020 on misuse and abuse, also called nonmedical use, of prescription stimulants and associated adverse events. Overall, the most common source of prescription stimulants for nonmedical use in the general population came from friends or family members, with estimates generally ranging from 56 percent to 80 percent, usually provided for free. Nonmedical use from their own prescription accounted for approximately 10 percent to 20 percent of people who report having used stimulants nonmedically in the past year. Less commonly reported sources included drug dealers or strangers accounting for 4 percent to 7 percent of people who report having used stimulants nonmedically in the past year, and the internet accounting for 1 percent to 2 percent.

Our review found that nonmedical use has remained relatively stable over the past two decades, despite the increasing number of prescription stimulants dispensed. However, the past-year prevalence of nonmedical use of these medicines varies across specific subpopulations and is highest in the following groups: young adults ages 18 to 25 (estimates ranged from 4.1 percent to 7.5 percent), college students (4.3 percent), and adolescents and young adults diagnosed with ADHD (estimates ranged from 14 percent to 32 percent). According to the available data, people who use prescription stimulants for nonmedical reasons have a higher risk of developing a substance use disorder than those who do not. The most serious harms were more commonly observed with nonmedical use by a non-oral route such as snorting or injecting.

What is my risk?

All medicines have side effects even when used correctly as prescribed. It is important to know that people respond differently to all medicines depending on their health, the diseases they have, genetic factors, other medicines they are taking, and many other factors. As a result, we cannot determine how likely it is that someone will experience these side effects when taking prescription stimulants. However, it is harmful to take prescription stimulants or other medicines in ways other than exactly as prescribed by your health care professional. Talk to your health care professional if you have questions or concerns about the risks of taking prescription stimulant medicines.

How do I report side effects from prescription stimulants?

To help FDA track safety issues with medicines, we urge patients and health care professionals to report side effects involving prescription stimulants or other medicines to the FDA MedWatch program, using the information in the “Contact FDA” box at the bottom of this page.

How can I get new safety information on medicines I’m prescribing or taking?

You can sign up for email alerts about Drug Safety Communications on medicines or medical specialties of interest to you.

Table of Prescription Stimulant Label changes

Key Prescription Stimulant Label Updates (PDF - 236KB)

Facts about Prescription Stimulants

  • Prescription stimulants can help patients: with ADHD stay focused longer, listen better, and fidget less; with a binge-eating disorder, reduce the number of excessive overeating episodes; and with narcolepsy, stay awake during the day.
  • Prescription stimulants also carry serious risks, including misuse and abuse, substance abuse disorder and addiction, overdose, and death.
  • There are two main categories of prescription stimulants: immediate-release and extended-release. Immediate-release stimulants are usually taken two or three times a day, and extended-release stimulants are taken once a day.
  • Prescription stimulants are available in many different formulations, including tablets, capsules, and liquid form.
  • Common side effects of prescription stimulants include loss of appetite, trouble sleeping, headache, stomachache, irritability, fast heart rate, and high blood pressure.
  • Store your prescription stimulants securely, out of sight and reach of children, and in a location not accessible by others, including visitors to the home. Do not share these medicines with anyone else, and immediately dispose of unused or expired prescription stimulants properly or take them to a drug take-back site, location, or program.

Additional Information for Health Care Professionals

  • To address continuing concerns of misuse, abuse, and addiction of prescription stimulants, FDA is requiring updates to the Boxed Warning and other information to ensure the prescribing information is made consistent across the entire class of these medicines. The current prescribing information in some prescription stimulants does not provide up to date warnings about the harms of misuse and abuse, and particularly that most individuals who misuse prescription stimulants get their drugs from other family members or peers. Further, individuals who are prescribed stimulants are often faced with requests to share their medication. Sharing these medicines with others can lead to development of substance use disorder and addiction in those with whom these drugs are shared.
  • Counsel patients not to give any of their medicine to anyone else and monitor for signs and symptoms of diversion such as requesting refills more frequently than needed. As many as half of youth with valid prescriptions for these medicines are approached by peers and other individuals in the person’s peer group to sell or give away their medicine.
  • Throughout treatment with prescription stimulants, regularly assess and monitor for signs and symptoms of nonmedical use and addiction.
  • Keep careful records of prescribing information, including quantity, frequency, and renewal requests, as required by state and federal laws.
  • Educate patients and caregivers on the importance of proper storage and disposal of prescription stimulants.
  • Advise patients and caregivers that taking a prescription stimulant other than how it is prescribed, or together with alcohol or other controlled substances, could increase the risk of overdose and death.
  • Inform patients and caregivers how to recognize the signs and symptoms of an overdose.
  • Counsel patients that nonmedical use of prescription stimulants can cause anxiety, nervousness, loss of appetite, and sleep deprivation—all of which can interfere with studying and performance on exams.
  • Encourage patients to read the Medication Guide they receive with their filled prescription(s). This important information will be included, as well as additional information about the medicine.
  • To help FDA track safety issues with medicines, report adverse events involving prescription stimulants or other medicines to the FDA MedWatch program, using the information in the “Contact FDA” box at the bottom of this page.
  • You can sign up for email alerts about Drug Safety Communications on medicines and medical specialties of interest to you.

Related Information


Teva's Adderall 30 mg Tablets: Counterfeit Product - Contains Wrong Active Ingredients

ISSUE: FDA is warning consumers and health care professionals about a counterfeit version of Teva Pharmaceutical Industries' Adderall 30 milligram tablets that is being purchased on the Internet. FDA’s preliminary laboratory tests revealed that the counterfeit version of Teva’s Adderall 30 mg tablets contained the wrong active ingredients. Adderall contains four active ingredients – dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate. Instead of these active ingredients, the counterfeit product contained tramadol and acetaminophen, which are ingredients in medicines used to treat acute pain.

BACKGROUND: Adderall, which is approved to treat attention deficit hyperactivity disorders (ADHD) and narcolepsy, is a prescription drug classified as a controlled substance – a class of drugs for which special controls are required for dispensing by pharmacists. The counterfeit Adderall tablets are round, white and do not have any type of markings, such as letters or numbers. Authentic Adderall 30 mg tablets produced by Teva are round, orange/peach, and scored tablets with "dp" embossed on one side and "30" on the other side of the tablet.

See the FDA News Release for pictures of the product.

RECOMMENDATION: Anyone who believes they have the counterfeit version of Teva’s Adderall 30 mg tablets should not take or should stop taking the product. Consumers should talk to their health care professional about their condition and options for treatment.

Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program:


[05/29/2012 – News Release - FDA] 


Dextroamphetamine, Amphetamine 20mg Tablets

Dextroamphetamine Saccharate/Amphetamine Aspartate/Dextroamphetamine Sulfate/Amphetamine Sulfate (Mixed Salts of a Single Entity Amphetamine Product)

Barr Laboratories, Inc. issued a voluntary recall of Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate (Mixed Salts of a Single Entity Amphetamine Product) 20mg Tablets, 100 count bottles, lot number 311756. The product is being recalled because the affected lot may contain some tablets exceeding weight requirements which may lead to super-potent tablets.

Clinically significant adverse reactions to a supratherapeutic dose could include cardiovascular, neurologic, psychiatric and gastrointestinal reactions. Customers who have this lot in their possession are instructed to cease using the product and return it to their pharmacy/distributor.

[08/13/2009 - Press Release - Barr Laboratories, Inc.]

    

Stimulant Medications used in Children with Attention-Deficit/Hyperactivity Disorder - Communication about an Ongoing Safety Review

Products involved include: Focalin, Focalin XR (dexmethylphenidate HCl ); Dexedrine, Dexedrine Spansules, Dextroamphetamine ER, Dextrostat (dextroamphetamine sulfate); Vyvanse (lisdexamfetamine dimesylate); Desoxyn (methamphetamine); Concerta, Daytrana, Metadate CD, Metadate ER, Methylin, Methylin ER, Ritalin, Ritalin-LA, Ritalin-SR (methylphenidate); Adderall, Adderall XR (mixed salts amphetamine); Cylert (pemoline) and generics.

FDA notified healthcare professionals that it is providing its perspective on study data published in the American Journal of Psychiatry on the potential risks of stimulant medications used to treat Attention-Deficit/Hyperactivity Disorder (ADHD) in children. This study, funded by the FDA and the National Institute of Mental Health (NIMH), compared the use of stimulant medications in 564 healthy children from across the United States who died suddenly to the use of stimulant medications in 564 children who died as passengers in a motor vehicle accident.The study authors concluded that there may be an association between the use of stimulant medications and sudden death in healthy children. Given the limitations of this study's methodology, the FDA is unable to conclude that these data affect the overall risk and benefit profile of stimulant medications used to treat ADHD in children. FDA believes that this study should not serve as a basis for parents to stop a child's stimulant medication. Parents should discuss concerns about the use of these medicines with the prescribing healthcare professional. Any child who develops cardiovascular symptoms (such as chest pain, shortness of breath or fainting) during stimulant medication treatment should immediately be seen by a doctor.

FDA is continuing its review of the strengths and limitations of this and other epidemiological studies that evaluate the risks of stimulant medications used to treat ADHD in children. FDA and the Agency for Healthcare Research and Quality are sponsoring a large epidemiological study that will provide further information about the potential risks associated with stimulant medication use in children. The data collection for this study will be complete later in 2009.

[06/15/2009 - Communication About An Ongoing Safety Review - FDA]
[06/15/2009 - News Release - FDA]
[06/15/2009 - Stimulant Medications Prescribing Information, Medication Guides - FDA]

    

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