Medication Treatments for ADHD - Dextroamphetamine Saccharate / Dextroamphetamine Sulfate in Treating ADHD

Written by Lewis Mehl-Madrona, MD, PhD

Dextroamphetamine saccharate/Dextroamphetamine sulfate (Dexedrine) in treating ADHD:

Dexedrine is one of the better known stimulant medications and is second only to Ritalin in the treatment of ADHD. The generic equivalent of Dexedrine is Dextroamphetamine Sulfate. Because the PDR continues to list Dexedrine under "Diet Control" medications, some insurance companies will not cover Dexedrine for the treatment of ADHD.

Important things to bear in mind when prescribing or taking Dexedrine:

1. The onset of action is 30 minutes, slower than Ritalin.
2. The coverage provided by Dexedrine is 3 1/2 to 4 1/2 hours; about an hour longer than Ritalin, especially with adult administration.
3. Dexedrine purportedly has a "smoother" onset of action and "drop-off" than Ritalin. It is usually almost completely absorbed and therefore one does not usually see the variation in onset of action that one sees with the use of Ritalin.
4. Dexedrine 5mg is about equivalent to 10mg of Ritalin. In other words it is about twice as potent as Ritalin.
5. Ingestion of Vitamin C and Dexedrine simultaneously, e.g., taking medication with orange juice, may significantly reduce Dexedrine absorption.
6. Because Dexedrine in the SR form is long acting, it is very useful for Middle and High school students who forget to take their second or third dose.
7. Dexedrine, however, has the potential side effect of reduced appetite.

Summary Drug Monograph for Dexedrine:

Clinical Pharmacology:

Amphetamines are non-catecholamine, sympathomimetic amines with CNS stimulant activity. Peripheral actions include elevations of systolic and diastolic blood pressures and weak bronchodilator and respiratory stimulant action.

There is neither specific evidence which clearly establishes the mechanism whereby Amphetamines produce mental and behavioral effects in children, nor conclusive evidence regarding how these effects relate to the condition of the central nervous system

Dexedrine (dextroamphetamine sulfate) Spansule capsules are formulated to release the active drug substance in vivo in a more gradual fashion than the standard formulation, as demonstrated by blood levels. The formulation has not been shown superior in effectiveness over the same dosage of the standard, noncontrolled-release formulations given in divided doses.

Dosage and Aministration:

Attention Deficit Disorder with Hyperactivity:

Not recommended for pediatric patients under 3 years of age.

In pediatric patients from 3 to 5 years of age, start with 2.5 mg daily, by tablet daily dosage may be raised in increments of 2.5 mg at weekly intervals until optimal response is obtained.

In pediatric patients 6 years of age and older, start with 5 mg once or twice daily, daily dosage may be raised in increments of 5 mg at weekly intervals until optimal response is obtained. Only in rare cases will it be necessary to exceed a total of 40 mg per day.

Spansule capsules may be used for once-a-day dosage wherever appropriate. With tablets, give first dose on awakening additional doses (1 or 2) at intervals of 4 to 6 hours.

Where possible drug administration should be interrupted occasionally to determine if there is a recurrence of behavioral symptoms sufficient to require continued therapy.

Warnings:

Amphetamines have a high potential for abuse. Admimistration of Amphetamines for prolonged periods of time may lead to drug dependence and should be avoided. Particular attention should be paid to patients obtaining Amphetamines for nontherapeutic use or distribution to others.