Amphetamine/dextroamphetamine: 7 things you should know

Medically reviewed by Carmen Pope, BPharm. Last updated on July 3, 2023.

1. How it works

• Amphetamine-dextroamphetamine is a combination medicine containing a mixture of amphetamine and dextroamphetamine salts and isomers. These act in the brain to increase the release of neurotransmitters (chemicals that help send messages around the brain).
• Amphetamine-dextroamphetamine belongs to the class of medicines known as central nervous system stimulants.

2. Upsides

• Used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) to increase attention and decrease hyperactivity and impulsiveness.
• Also used to treat narcolepsy (spontaneous, uncontrollable, falling asleep).
• When given for ADHD, amphetamine-dextroamphetamine should be used in conjunction with other treatment options, such as psychotherapy, education about the disorder, and social integration advice.
• Generic amphetamine-dextroamphetamine is available (may be called mixed amphetamine salts, MAS, or M. amphet salts).

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Insomnia, decreased appetite, blurred vision, and abdominal pain.
• May also cause heart palpitations, constipation and other GI disturbances, weight loss, changes in libido, alopecia (hair loss), elevated blood pressure and muscle twitching, stiffness, or tightness.
• May affect blood circulation in the fingers or toes causing ulceration or tissue breakdown.
• May cause dependence and tolerance and be subject to abuse. May cause a withdrawal syndrome on abrupt discontinuation (symptoms include extreme fatigue, depression, and sleep disturbances). Taper off slowly under medical advice.
• High potential for abuse. May be sought after by drug abusers or people with addiction disorders. Misuse may cause sudden death or cardiovascular events. Overdosage has resulted in psychosis which is indistinguishable from schizophrenia.
• May exacerbate pre-existing psychiatric disorders such as bipolar disorder, psychotic disorder, or mania; and increase anxiety, tension, and agitation.
• Interaction or overdosage may cause serotonin syndrome (symptoms include mental status changes [such as agitation, hallucinations, coma, delirium]), fast heart rate, dizziness, flushing, muscle tremor, rigidity, and stomach symptoms (including nausea, vomiting, and diarrhea).
• May impair judgment or reaction skills; exercise caution before driving or operating machinery until the full effects of amphetamine-dextroamphetamine are known. Avoid alcohol.
• Reports indicate some temporary slowing of growth may occur when regular amphetamine-dextroamphetamine is given to children aged 7 through 10 years. Doctors should monitor height and weight and consider treatment interruption if growth suppression is suspected.
• May increase the risk of seizures and peripheral circulatory problems and cause visual problems.
• May not be suitable for people with certain heart conditions, as the risk of sudden death is increased even with usual dosages. May also not be suitable for people with thyroid disease, glaucoma, psychiatric disease, a history of drug abuse, a tic disorder, seizures, liver or kidney disease, or circulation problems.
• May interact with several other drugs including other antidepressants, medications used to treat heart disease, blood thinners, decongestants, tramadol, and proton pump inhibitors.
• Extreme fatigue and depression have been reported when amphetamine-dextroamphetamine has been stopped suddenly, particularly in those who have been taking more than the recommended dose.
• Rare cases of priapism (painful erections more than 6 hours in duration) have been reported.
• Should not be used during pregnancy unless the potential benefit justifies the risk. There are no well-controlled studies investigating its use in humans during pregnancy. Case reports document severe congenital bone deformity and other birth defects; animal studies have reported long-term neurochemical and behavioral alterations in pups exposed to amphetamines in utero.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Amphetamine-dextroamphetamine is a stimulant-type medicine used to treat ADHD and narcolepsy. Its use is limited by its addiction potential and risk of abuse.

5. Tips

• Administer with or without food. Avoid alcohol.
• Best administered in the morning, soon after awakening. Avoid administration of late evening doses due to the risk of insomnia. Take exactly as directed by your doctor and never increase the dosage without his or her advice.
• Slow-release capsules may be swallowed whole or the capsule opened and the contents sprinkled on applesauce and swallowed without chewing.
• Monitor growth in children during treatment. Tell your doctor if you think your child is not growing well compared to other children or if his/her behavior has not improved or worsened. Weight, blood pressure, and circulation in the hands and feet should also be monitored.
• Ensure your child partakes in other psychological, educational, or social treatment measures as recommended by your doctor as these are also an important part of ADHD treatment.
• Amphetamine-dextroamphetamine should not be stopped suddenly unless it is an emergency. Sudden discontinuation may precipitate a withdrawal reaction. Symptoms may include extreme tiredness, depression, or agitation.
• Seek medical advice if symptoms persist or worsen despite treatment, or if psychotic symptoms (such as hearing voices or signs of paranoia) or hallucinations develop.
• Seek urgent medical help if you experience chest pain, shortness of breath, or fainting while taking amphetamine-dextroamphetamine, or other worrying symptoms such as unexplained nausea or vomiting or a fast heartbeat.
• Do not drive or operate machinery if amphetamine-dextroamphetamine impairs your judgment or reaction skills. Alcohol may contribute to these effects and should be avoided.
• Seek medical advice if any new numbness, pain, skin color change, sensitivity, or unexplained wounds occur in your fingers or toes.
• Keep out of reach of children and pets. Keep your medicine in a safe, private storage area, out of view of any person that may illegally misuse it.
• Do not use if pregnant or breastfeeding unless specifically recommended by your doctor.

6. Response and effectiveness

• The time-to-peak effect is about 3 hours for the immediate-release tablets and 7 hours for the slow-release capsules.

7. Interactions

Medicines that interact with amphetamine-dextroamphetamine may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with amphetamine-dextroamphetamine. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with amphetamine-dextroamphetamine include:

• anticoagulants (blood thinners), such as warfarin, or other drugs that have blood-thinning effects such as aspirin or NSAIDs
• anticonvulsants, such as phenytoin, phenobarbital, or primidone
• antidepressants, such as tricyclic antidepressants (eg, amitriptyline), monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine), or SSRIs (eg, fluoxetine, sertraline)
• antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, olanzapine, quetiapine, ziprasidone)
• any medication that may cause drowsiness, such as benzodiazepines (eg, diazepam, lorazepam), first-generation antihistamines (such as doxylamine or promethazine), metoclopramide, or opioids (such as codeine, morphine)
• beta-blockers, such as atenolol, labetalol, or metoprolol
• cold, flu, or allergy medications that contain decongestants such as phenylephrine or pseudoephedrine
• diuretics such as furosemide
• medications that increase or decrease the pH of the stomach or urinary tracts, such as PPIs (eg, omeprazole, pantoprazole), sodium bicarbonate, acetazolamide, ascorbic acid, or ammonium chloride
• medications that inhibit CYP2D6 enzymes
• heart medications such as doxazosin, prazosin, clonidine, or methyldopa
• HIV medications (fosamprenavir, ritonavir)
• other medications that affect serotonin, such as amphetamines, fentanyl, lithium, tramadol, triptans (eg, almotriptan, eletriptan, or sumatriptan), or St. John's Wort
• propoxyphene.

Avoid drinking alcohol or taking illegal or recreational drugs while taking amphetamine-dextroamphetamine.

Note that this list is not all-inclusive and includes only common medications that may interact with amphetamine-dextroamphetamine. You should refer to the prescribing information for amphetamine-dextroamphetamine for a complete list of interactions.

References

• Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate, Amphetamine Sulfate [Package Insert]. Revised 03/2022. Rhodes Pharmaceuticals L.P. https://www.drugs.com/pro/dextroamphetamine-saccharate-amphetamine-aspartate-dextroamphetamine-sulfate-amphetamine-sulfate.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use amphetamine/dextroamphetamine only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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