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High potential for abuse; prolonged use may lead to drug dependence. Misuse may cause sudden death and serious cardiovascular (CV) adverse reactions.
Treatment of ADHD.
Amphetamine-Naive/Switching from Another Medication: 20mg qam
Switching from Amphetamine Immediate-Release: Give the same total daily dose, qdTitrate at weekly intervals as indicated
Amphetamine-Naive/Switching from Another Medication:6-12 Years: Initial: 10mg qam or 5mg qam when lower initial dose is appropriateTitrate: Adjust daily dosage in increments of 5mg or 10mg at weekly intervalsMax: 30mg/day13-17 Years: Initial: 10mg qamTitrate: May increase to 20mg/day after 1 week if symptoms are not controlled
Switching from Amphetamine Immediate-Release: ≥6 Years:Give the same total daily dose, qdTitrate at weekly intervals as indicated
Give upon awakening; avoid pm doses due to potential for insomniaTake w/ or w/o foodTake caps whole or sprinkle entire contents on applesauce. Consume sprinkled applesauce immediately w/o chewing the sprinkled beadsDo not divide the dose of a single cap or take anything <1 cap/day
Cap, Extended-Release: 5mg, 10mg, 15mg, 20mg, 25mg, 30mg
Advanced arteriosclerosis, symptomatic CV disease, moderate to severe HTN, hyperthyroidism, glaucoma, agitated states, history of drug abuse, during or w/in 14 days following MAOI use.
Sudden death, stroke, and MI reported in adults. Sudden death reported in children and adolescents w/ structural cardiac abnormalities or other serious heart problems. Avoid use in patients w/ known serious structural cardiac and heart rhythm abnormalities, cardiomyopathy, coronary artery disease, or other serious cardiac problems. May cause modest increase in BP and HR. May exacerbate symptoms of behavior disturbance and thought disorder in patients w/ preexisting psychotic disorder. Caution in patients w/ comorbid bipolar disorder; may cause induction of mixed/manic episode. May cause treatment-emergent psychotic/manic symptoms in children and adolescents w/o a prior history of psychotic illness or mania; consider discontinuation if such symptoms occur. Aggressive behavior or hostility reported; monitor for appearance or worsening. May cause long-term suppression of growth in children; may need to d/c if patients are not growing or gaining weight as expected. May lower convulsive threshold; d/c if seizures develop. Associated w/ peripheral vasculopathy, including Raynaud's phenomenon. Difficulties w/ accommodation and blurring of vision reported. Exacerbation of motor and phonic tics and Tourette's syndrome reported. May significantly elevate plasma corticosteroid levels or interfere w/ urinary steroid determinations. Where possible, interrupt occasionally to determine the need for continued therapy.
Dry mouth, loss of appetite, insomnia, headache, abdominal pain, weight loss, agitation, anxiety, N/V, dizziness, tachycardia, nervousness, asthenia, diarrhea, UTI.
See Contraindications. Avoid w/ GI alkalinizing agents (eg, sodium bicarbonate, antacids). Urinary alkalinizing agents (eg, acetazolamide, some thiazides) may increase blood levels and potentiate effects. GI acidifying agents (eg, guanethidine, reserpine, ascorbic acid) and urinary acidifying agents (eg, ammonium chloride, sodium acid phosphate, methenamine salts) may lower blood levels and efficacy. May reduce CV effects of adrenergic blockers. May counteract sedative effects of antihistamines. May antagonize effects of antihypertensives. May inhibit hypotensive effect of veratrum alkaloids. May delay intestinal absorption of phenobarbital, phenytoin, and ethosuximide. May enhance activity of TCAs or sympathomimetic agents. Increased d-amphetamine levels in the brain w/ desipramine or protriptyline and possibly other tricyclics. May potentiate analgesic effect of meperidine. May enhance the adrenergic effect of norepinephrine. Chlorpromazine and haloperidol may inhibit central stimulant effects. Lithium carbonate may inhibit anorectic and stimulatory effects. Norepinephrine may enhance the adrenergic effect. Use in cases of propoxyphene overdose may potentiate CNS stimulation and cause fatal convulsions. Monitor for changes in clinical effect when coadministered w/ proton pump inhibitors.
Category C, not for use in nursing.
Sympathomimetic amine; has not been established. Thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space.
Absorption: Tmax=7 hrs. Distribution: Found in breast milk. Metabolism: CYP2D6 (oxidation); 4-hydroxy-amphetamine and norephedrine (active metabolites). Elimination: Urine (normal pH) (30-40%, unchanged; 50%, α-hydroxy-amphetamine derivatives). (20mg single dose) d-amphetamine: T1/2=10 hrs (adults), 11 hrs (13-17 yrs of age), 9 hrs (6-12 yrs of age). l-amphetamine: T1/2=13 hrs (adults), 13-14 hrs (13-17 yrs of age), 11 hrs (6-12 yrs of age).
Assess for advanced arteriosclerosis, symptomatic CV disease, moderate to severe HTN, hyperthyroidism, hypersensitivity or idiosyncrasy to sympathomimetic amines, glaucoma, agitation, history of drug abuse, psychiatric history, history of seizure, tics or Tourette's syndrome, hepatic/renal dysfunction, pregnancy/nursing status, and possible drug interactions.
Monitor for CV abnormalities, exacerbations of behavior disturbances and thought disorder, psychotic or manic symptoms, aggressive behavior, hostility, seizures, visual disturbances, exacerbation of motor and phonic tics and Tourette's syndrome, and other adverse reactions. Monitor BP and HR. Monitor height and weight in children. Observe carefully for signs and symptoms of peripheral vasculopathy; further clinical evaluation (eg, rheumatology referral) may be appropriate for certain patients.
Inform about benefits and risks of treatment, appropriate use, and about the potential for abuse/dependence. Advise about serious CV risks. Inform that treatment-emergent psychotic or manic symptoms may occur. Instruct to report signs/symptoms of peripheral vasculopathy, including Raynaud's phenomenon. Advise parents or guardians of pediatric patients to monitor growth and weight during treatment. Advise to notify physician if pregnant or planning to become pregnant. Advise to avoid breastfeeding. Advise to use caution when engaging in potentially hazardous activities (eg, operating machinery or vehicles).
25°C (77°F); excursions permitted to 15-30°C (59-86°F).