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Adderall XR
dextroamphetamine/ amphetamine
Black Box Warnings .
Abuse, Misuse, and Addiction
CNS stimulants have high potential for abuse and misuse, can lead to substance use disorder, incl. addiction; misuse and abuse can result in overdose and death, risk incr. w/ higher doses or unapproved admin. methods; assess risk for abuse, misuse, and addiction before prescribing and throughout tx; educate pts and families about risks and proper drug storage and disposal; monitor frequently for s/sx of abuse, misuse, and addiction during tx
Adult Dosing .
Dosage forms: ER CAP: 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg
Special Note
- [equivalency or interchangeability info]
- Info: Adderall XR may be switched from Adderall at equivalent total daily dose; not interchangeable w/ Mydayis, do not substitute on a mg to mg basis
ADHD
- [20 mg PO qam]
- Start: 20 mg PO qam, may incr. by 10 mg/day qwk; Max: 60 mg/day; Info: duration 10-12h; may convert from IR to ER at same total daily dose qam; doses >20 mg/day rarely more effective; may open cap, but do not crush/chew contents
renal dosing
- [see below]
- eGFR 15-29: 15 mg qam; eGFR <15: avoid use
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: ER CAP: 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg
Special Note
- [equivalency or interchangeability info]
- Info: Adderall XR may be switched from Adderall at equivalent total daily dose in pts >6 yo; not interchangeable w/ Mydayis, do not substitute on a mg to mg basis
ADHD
- [6-12 yo]
- Dose: 10 mg PO qam; Start: 5-10 mg PO qam, may incr. by 5-10 mg/day qwk; Max: 30 mg/day; Info: duration 10-12h; may convert from IR to ER at same total daily dose qam; may open cap, but do not crush/chew contents
- [13-17 yo]
- Dose: 10-20 mg PO qam; Start: 10 mg PO qam, may incr. by 10 mg/day qwk; Max: 40 mg/day; Info: duration 10-12h; may convert from IR to ER at same total daily dose qam; doses >20 mg/day rarely more effective; may open cap, but do not crush/chew contents
renal dosing
- [see below]
- eGFR 15-29: 5 mg qam in pts 6-17 yo, max 20 mg/day in pts 6-12 yo; eGFR <15: avoid use
- HD/PD: not defined
hepatic dosing
- [not defined]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- MAO inhibitor use w/in 14 days
- pregnancy
- breastfeeding
- eGFR <15 (ER form)
- cardiac dz, severe
- cardiac abnormality, structural
- cardiomyopathy
- arrhythmia, severe
- CAD
- caution: peds pts (ER form)
- caution: eGFR 15-29 (ER form)
- caution: HTN
- caution: psychosis
- caution: bipolar disorder
- caution: bipolar disorder risk
- caution: Tourette syndrome
- caution: Tourette syndrome family hx
- caution: tic disorder
- caution: tic disorder family hx
- caution: seizure hx
- caution: seizure risk
- caution: substance abuse risk
Drug Interactions .
Overview
amphetamine
CNS stimulant
- CYP2D6 substrate
- gastric pH sensitive
- hypertensive effects
- lowers seizure threshold
- serotonergic effects
- tachycardia
- urine pH sensitive
- add MAO inhibitor to Interaction Check if recent (14 days) use
dextroamphetamine
CNS stimulant
- CYP2D6 substrate
- gastric pH sensitive
- hypertensive effects
- lowers seizure threshold
- serotonergic effects
- tachycardia
- urine pH sensitive
- add MAO inhibitor to Interaction Check if recent (14 days) use
Contraindicated
- diethylpropion
Avoid/Use Alternative
- buprenorphine
- bupropion
- calcium carbonate
- chlorpromazine
- cimetidine
- citalopram
- cocaine
- cyclobenzaprine
- dacomitinib
- desvenlafaxine
- dexlansoprazole
- dextromethorphan
- dihydrocodeine
- dihydroergotamine
- doxepin
- doxepin topical
- dronabinol
- duloxetine
- ergotamine
- escitalopram
- esomeprazole
- famotidine
- fenfluramine
- fluphenazine
- fluvoxamine
- hydrocodone
- hydromorphone
- imipramine
- lansoprazole
- lasmiditan
- levomilnacipran
- levorphanol
- magnesium carbonate
- magnesium hydroxide
- mavorixafor
- methadone
- methamphetamine
- milnacipran
- nalbuphine
- nefazodone
- nizatidine
- omeprazole
- oxycodone
- palonosetron
- pantoprazole
- potassium citrate
- procarbazine
- quinidine (antiarrhythmic)
- rabeprazole
- selegiline
- sertraline
- simethicone
- sodium bicarbonate
- sodium zirconium cyclosilicate
- sufentanil
- sumatriptan
- tapentadol
- terbinafine
- thioridazine
- topiramate
- zonisamide
Monitor/Modify Tx
- abiraterone acetate
- acebutolol
- adagrasib
- albuterol inhaled
- amiloride
- amlodipine
- angiotensin II
- aprocitentan
- arformoterol inhaled
- armodafinil
- asciminib
- atenolol
- atogepant
- atomoxetine
- atropine
- atropine ophthalmic
- axitinib
- azilsartan medoxomil
- benazepril
- benztropine
- berotralstat
- betamethasone
- betaxolol
- bevacizumab
- bisoprolol
- brigatinib
- budesonide
- bumetanide
- cabozantinib
- caffeine citrate
- candesartan cilexetil
- cannabis
- capivasertib
- captopril
- carfilzomib
- carvedilol
- celecoxib
- chlorothiazide
- chlorthalidone
- cinacalcet
- clevidipine
- clonidine
- corticotropin
- cortisone
- cyclosporine
- danazol
- darbepoetin alfa
- deflazacort
- desmopressin
- dexamethasone
- diclofenac
- diclofenac topical
- dicyclomine
- diflunisal
- dobutamine
- dopamine
- doxapram
- doxazosin
- droxidopa
- eliglustat
- enalapril
- enalaprilat
- enzalutamide
- ephedrine injection
- ephedrine oral
- epinephrine
- eplerenone
- epoetin alfa
- eptinezumab
- erenumab
- esketamine
- esmolol
- estetrol (contraceptive)
- estradiol (contraceptive)
- ethacrynic acid
- ethinyl estradiol (contraceptive)
- etodolac
- etrasimod
- fedratinib
- felodipine
- fenoprofen
- fingolimod
- fludrocortisone
- flurbiprofen
- formoterol inhaled
- fosinopril
- fostamatinib
- fremanezumab
- fruquintinib
- galcanezumab
- givosiran
- glycopyrrolate
- guanfacine
- hoodia
- hydralazine
- hydrochlorothiazide
- hyoscyamine
- ibrutinib
- ibuprofen
- indapamide
- indomethacin
- iohexol
- irbesartan
- isoflurane
- isoproterenol
- isradipine
- ketamine
- ketoprofen
- ketorolac
- labetalol
- lanreotide
- leflunomide
- lenvatinib
- levalbuterol inhaled
- levothyroxine
- licorice
- lifileucel
- liothyronine
- liraglutide
- lisinopril
- lorlatinib
- losartan
- lumacaftor/ivacaftor
- luspatercept
- mefenamic acid
- meloxicam
- methoxy polyethylene glycol-epoetin beta
- methscopolamine
- methyldopa
- methylprednisolone
- methyltestosterone
- metolazone
- metoprolol
- minoxidil
- mirabegron
- modafinil
- moexipril
- naproxen
- naxitamab
- nebivolol
- nicardipine
- nifedipine
- nimodipine
- niraparib
- nisoldipine
- norepinephrine
- olmesartan medoxomil
- olodaterol inhaled
- orphenadrine
- osilodrostat
- oxaprozin
- oxymetazoline nasal
- oxytocin
- pazopanib
- perindopril
- pexidartinib
- phenoxybenzamine
- phentermine
- phentolamine
- phenylephrine
- phenylephrine injection
- phenylephrine nasal
- phenylephrine ophthalmic
- phenylephrine rectal
- pindolol
- piroxicam
- ponatinib
- ponesimod
- potassium acid phosphate
- pralsetinib
- prazosin
- prednisolone
- prednisone
- propranolol
- pseudoephedrine
- quetiapine
- quinapril
- ramipril
- ramucirumab
- regorafenib
- rimegepant
- ripretinib
- ritonavir
- rolapitant
- ropinirole
- rotigotine transdermal
- salmeterol inhaled
- salsalate
- selpercatinib
- sevoflurane
- siponimod
- solriamfetol
- sorafenib
- sotalol
- spironolactone
- tacrolimus
- tagraxofusp
- terazosin
- teriflunomide
- testosterone
- thyroid
- timolol
- tipranavir
- tivozanib
- tolmetin
- torsemide
- trametinib
- trandolapril
- triamcinolone
- triamterene
- trospium
- ubrogepant
- vadadustat
- valsartan
- vamorolone
- vandetanib
- vasopressin
- verapamil
- vilanterol inhaled
- viloxazine
- voclosporin
- zavegepant
- ziv-aflibercept
Caution Advised
- ascorbic acid (vitamin C)
- benzoic acid
- brivaracetam
- busulfan
- cannabidiol
- cenobamate
- chlorambucil
- clobazam
- clonazepam
- clorazepate
- clozapine
- diazepam
- eslicarbazepine acetate
- ethosuximide
- felbamate
- fosphenytoin
- gabapentin
- ganaxolone
- ginseng, Asian
- grapefruit
- hydroxychloroquine
- L-glutamine
- lacosamide
- lamotrigine
- levetiracetam
- lorazepam
- magnesium citrate
- methsuximide
- midazolam
- oxcarbazepine
- perampanel
- phenobarbital
- phenytoin
- polyethylene glycol
- polyethylene glycol/electrolytes
- pregabalin
- primidone
- promethazine
- rose hip
- rufinamide
- sodium acid phosphate
- sodium picosulfate
- stiripentol
- sulfate bowel prep
- tiagabine
- treosulfan
- valproic acid
- vigabatrin
Adverse Reactions .
Serious Reactions
- dependency
- abuse
- psychosis
- mania
- aggressive behavior
- sudden death (pts w/ severe cardiac dz)
- MI
- HTN
- cardiomyopathy (long-term use)
- seizures
- hypersensitivity rxn
- anaphylaxis
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- priapism
- peripheral vasculopathy
- Raynaud phenomenon
- growth suppression (long-term use in peds pts)
- weight loss (ER form use in peds pts)
- rhabdomyolysis
- intestinal ischemia
- withdrawal sx if abrupt D/C (prolonged use)
Common Reactions
- anorexia
- xerostomia
- insomnia
- headache
- abdominal pain
- weight loss
- emotional lability
- anxiety
- nausea
- vomiting
- agitation
- dizziness
- nervousness
- diarrhea
- tachycardia
- fatigue
- asthenia
- fever
- infection
- dyspepsia
- constipation
- libido changes
- somnolence
- speech disturbance
- dyspnea
- diaphoresis
- dysmenorrhea
- impotence
- palpitations
- BP elevated
- visual disturbance
- restlessness
- tooth disorder
- photosensitivity
- tics
Safety/Monitoring .
Monitoring Parameters
cardiac eval, eGFR at baseline; BP, HR; height, weight in peds at baseline, then periodically
Look/Sound-Alike Drug Names
Adderall XR confused with: Adderall
dextroamphetamine/amphetamine confused with: dextroamphetamine
Pregnancy/Lactation .
Pregnancy
Clinical Summary
avoid use during pregnancy; no known risk of teratogenicity based on limited human data; risk of vasoconstriction and decr. placental perfusion based on drug's mechanism of action; possible risk of neonatal complications, incl. premature delivery, low birth wt, and neonatal withdrawal sx, based on limited human data in pts dependent on amphetamines
Pregnancy Registry
encourage pts to enroll in National Pregnancy Registry for Psychiatric Medications at 1-866-961-2388 or www.womensmentalhealth.org/research/pregnancyregistry/
Lactation
Clinical Summary
avoid use while breastfeeding; no known risk of infant harm based on limited human data, though drug excreted into milk; may interfere w/ infant nutrition based on drug's mechanism of action; no human data available, though theoretical decr. milk production based on decr. prolactin levels
Pharmacology .
Metabolism: liver; CYP450: 2D6 substrate; Info: active metabolites
Excretion: urine; Half-life: 9-14h; Info: pH-dependent excretion
Subclass: Attention Deficit Hyperactivity Disorder (ADHD) ; Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs)
Mechanism of Action
exact mechanism of action unknown; stimulates CNS activity; blocks reuptake and increases release of norepinephrine and dopamine in extraneuronal space (sympathomimetic)
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: Takeda Pharmaceuticals North America, Inc.
DEA/FDA: Schedule II
Approximate Retail Price
from http://www.goodrx.com/adderall-xr
oral capsule, extended release:
- 5 mg (30 ea): $229.00
- 10 mg (30 ea): $229.00
- 15 mg (30 ea): $228.00
- 20 mg (30 ea): $229.00
- 25 mg (30 ea): $228.00
- 30 mg (30 ea): $229.00
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