Information For Clinicians Prescribing Amphetamines
for Adults with ADD

(Mixed amphetamine salts, Adderall, dextroamphetamine, Dexedrine, Dextrostat and others)

Although Vyanse is an amphetamine, dosing and prescribing directions are different from the other amphetamines
and can be found by clicking here.

(Note: Patient information sheets are available for short acting and long acting amphetamines and for Vyvanse.)

Formulations
    Mixed amphetamine salts tablets: 5, 10, 15, 20, 25, 30 mg
    Adderall tablets: 5, 10, 15, 20, 25, 30 mg
    Adderall XR capsules: 10, 15, 20, 25, and 30 mg

Common Adult Dosages: Doses may start at 5 mg (or 10 mg XR) two to three times daily, with small periodic increases until the desired effect is obtained. It is recommended that the tablets be taken 30 to 45 minutes before meals, with doses no later than 4 pm because they may interfere with sleep if taken later.  The dose range for adults is anywhere from 20 mg a day to over 150 mg per day with most patients falling in the 40 – 60 mg per day range.  This medication should be swallow whole, never crushed or chewed.

Common Side Effects: Most commonly occurring side effects are difficulty sleeping, nervousness, tenseness of jaw, loss of appetite, weight loss, heart palpitations, fast heart beat, and increase in blood pressure. Occasional side effects include nausea, dizziness, urinary difficulties, and stomach upset. On too high a dose, some patients become overly serious and/or overly focused.  Reducing the dose usually eliminates this side effect.

Uncommon or Rare Side Effects: cold fingers and toes, blue feet, semen in urine, difficulty urinating in men associated rarely with a reduction in un-erect penis size while taking the medication, difficulty breathing, willingness to eat a wider variety of food, elimination of de-personalization and feelings of unreality (one case), major reduction in obsessive behavior.

Medical contraindications: This drug is contra-indicated for use in patients with glaucoma, uncontrolled hypertension, heart problems, or a history of Tourette's syndrome.  Patients with a history of seizure disorders may experience an increase in the number, duration, and/or severity of seizures. Some patients have experienced paranoia (suspiciousness) and psychotic symptoms from taking amphetamines, so these medications should be used with caution in patients with a previous history of these symptoms.

Alcohol: Taking with alcohol will reduce coordination, speed of reflexes.

Blood pressure medications: It may increase the blood pressure and heart rate in spite of your taking blood pressure medications. .

MAOIs: Do not take with an MAOI antidepressant medication such as Parnate or Nardil.

Antidepressants: Patients taking tricyclic antidepressants such as amitriptyline (Elavil) or imipramine (Tofranil) etc. may require some dosage adjustments for these medications.

Other medications: Warfarin (Coumadin), phenobarbital, phenytoin (Dilantin), primidone (Mysoline).

Over the counter cough and cold preparations and diet aids. Avoid medications that contain ingredients such as phenylephrine (nose sprays and eye drops), pseudoephedrine (Sudafed, Actifed, and others), and phenylpropanolamine (Dimetapp, Dexatrim, and others), and health food store preparations containing Ma Huang. These may increase the side effects of nervousness and insomnia with further increases in blood pressure and heart rate and in some cases cause a major psychotic episode or even a stroke.

Food: Fatty foods interfere with the absorption of amphetamines.  Acid drinks and Vitamin C increase their excretion and reduce its effects.

Missed doses should be taken as soon as possible, but not closer than 4 hours apart. Do not double up doses.

Discontinuation symptoms: Aside from some temporary tiredness and the return of ADD symptoms that had been controlled by the medication, discontinuation or withdrawal symptoms are very rare.

Storage: Always keep tablets dry, tightly capped, and at room temperature. Keep away from direct heat, light, and moisture. Keep out of reach of children and pets. Discontinued medication must be carefully discarded.