Nurses Compass
Drug Guide
Amphetamine Sulfate
Classification
Therapeutic: Central nervous system stimulant, ADHD agent, Narcolepsy agent
Pharmacological: Sympathomimetic amine, Adrenergic agonist
FDA Approved Indications
- Attention deficit hyperactivity disorder (ADHD)
- Narcolepsy
Mechanism of Action
Amphetamine increases the release of norepinephrine and dopamine in the central nervous system and inhibits their reuptake, leading to increased concentration of these neurotransmitters in the synaptic cleft, which results in stimulant effects and increased alertness.
Dosage and Administration
Adult: Variable depending on indication; typically starting at 5 mg once or twice daily, titrated as needed.
Pediatric: Starting dose for children with ADHD generally 5 mg once or twice daily, titrated carefully.
Geriatric: Use with caution; dosing usually starts at lower end due to potential for increased side effects.
Renal Impairment: Adjust dose according to clinical response and tolerability.
Hepatic Impairment: Use with caution; no specific dose adjustment established.
Pharmacokinetics
Absorption: Rapid absorption from gastrointestinal tract.
Distribution: Widely distributed throughout body, crosses the blood-brain barrier.
Metabolism: Partially metabolized in the liver.
Excretion: Primarily excreted by the kidneys, with urinary excretion influenced by urinary pH.
Half Life: Approximately 9-14 hours.
Contraindications
- Hypersensitivity to amphetamines.
- Advanced arteriosclerosis.
- Symptomatic cardiovascular disease.
- Use with caution in patients with history of drug abuse, psychiatric disorders, or who are pregnant/lactating.
Precautions
- Monitor blood pressure and heart rate.
- Assess for history of psychiatric conditions, including agitation, anxiety, or psychosis.
- Use with caution in children and the elderly.
Adverse Reactions - Common
- Insomnia (Common)
- Dry mouth (Common)
- Anorexia (Common)
- Increased heart rate (Common)
- Anxiety, agitation (Common)
Adverse Reactions - Serious
- Cardiovascular events (hypertension, tachycardia, palpitations) (Uncommon)
- Serious psychiatric effects (psychosis, paranoia, hallucinations) (Uncommon)
- Potential for abuse and dependence (Serious)
Drug-Drug Interactions
- Monoamine oxidase inhibitors (MAOIs), leading to hypertensive crisis.
- Other sympathomimetics or serotonergic drugs, to increase risk of cardiovascular effects or serotonin syndrome.
Drug-Food Interactions
- Avoid acidic foods or beverages that can acidify urine and increase amphetamine excretion, reducing effectiveness.
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor vital signs, behavioral and mental status, growth in pediatric patients.
Diagnoses:
- Ineffective coping related to potential side effects or dependence.
- Risk of cardiovascular complications.
Implementation: Administer as prescribed, typically before meals.
Evaluation: Assess therapeutic response, side effects, growth, and potential abuse.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Report any signs of cardiovascular issues, psychiatric changes, or new behaviors.
- Avoid alcohol and illicit drugs.
- Proper storage out of reach of children.
Special Considerations
Black Box Warnings:
- Potential for abuse and dependence.
- Serious cardiovascular events, including sudden death in patients with underlying heart disease.
Genetic Factors: Genetic variations in metabolism may affect response and side effects.
Lab Test Interference: May cause false positives in urine drug screens.
Overdose Management
Signs/Symptoms: Hyperactivity, agitation, hallucinations, hypertension, tachycardia, hyperthermia, seizures, coma.
Treatment: Supportive care, benzodiazepines for agitation or seizures, manage cardiovascular symptoms, activated charcoal if within hour of ingestion.
Storage and Handling
Storage: Store at room temperature, away from light and moisture.
Stability: Stable under recommended conditions for the shelf life as specified by manufacturer.