Home Drug Guide Dextroamphetamine Sulfate

Drug Guide

Generic Name

Dextroamphetamine Sulfate

Brand Names Dexedrine Spansule, Dexampex, Dexedrine, Ferndex, Dextrostat

Classification

Therapeutic: Central Nervous System Stimulant for ADHD and narcolepsy

Pharmacological: Amphetamine

FDA Approved Indications

  • ADHD in children and adults
  • Narcolepsy

Mechanism of Action

Increases release of norepinephrine and dopamine in the CNS, resulting in elevated levels of these neurotransmitters in synaptic clefts, which improves attention and reduces impulsivity and hyperactivity in ADHD.

Dosage and Administration

Adult: Typically 5 mg once or twice daily, titrated as needed. Max dose varies.

Pediatric: Starting at 2.5 mg once or twice daily, titrated.

Geriatric: Use with caution; start at lower doses due to increased sensitivity and comorbidities.

Renal Impairment: Adjust dose accordingly; monitor closely.

Hepatic Impairment: Use with caution; no specific dose adjustments established.

Pharmacokinetics

Absorption: Rapid absorption after oral administration; peak levels in 3 hours.

Distribution: Widely distributed, crosses the blood-brain barrier.

Metabolism: Partially metabolized in the liver; extensive first-pass effect.

Excretion: Primarily excreted in urine; clearance affected by urinary pH.

Half Life: General 9-11 hours, but can vary.

Contraindications

  • History of hypersensitivity to amphetamines
  • Use with MAO inhibitors within 14 days
  • History of cardiovascular disease, arteriosclerosis, hypertension, hyperthyroidism, agitated states, glaucoma, or during or within 14 days following the administration of an MAO inhibitor.

Precautions

  • Monitor for abuse and dependence; use with caution in patients with a history of drug abuse.
  • Potential for adverse psychiatric effects. Use cautiously in patients with psychosis.

Adverse Reactions - Common

  • Anxiety, restlessness (Common)
  • Insomnia (Common)
  • Dry mouth (Common)
  • Loss of appetite (Common)

Adverse Reactions - Serious

  • Cardiovascular events such as hypertension, arrhythmias (Rare)
  • Psychosis, new or worsening (Rare)
  • Dependence or abuse potential (Common)

Drug-Drug Interactions

  • MAO inhibitors (risk of hypertensive crisis)
  • Alpha-adrenergic blockers (reduce effect)
  • Warfarin (altered anticoagulant effect)

Drug-Food Interactions

  • Avoid acidic foods and beverages which can increase excretion and reduce efficacy

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor cardiovascular status, behavioral changes, signs of abuse, and therapeutic response.

Diagnoses:

  • Risk for activity intolerance related to cardiovascular effects
  • Risk for dependency
  • Imbalanced nutrition: less than body requirements related to anorexia.

Implementation: Administer as prescribed; monitor BP, HR, and behavioral effects. Educate patients about potential for dependence.

Evaluation: Evaluate for therapeutic effectiveness, adverse effects, and signs of misuse or abuse.

Patient/Family Teaching

  • Take exactly as prescribed; do not increase dose.
  • Report chest pain, shortness of breath, or palpitations.
  • Avoid alcohol and other CNS depressants.
  • Counsel on potential for dependence.

Special Considerations

Black Box Warnings:

  • Potential for abuse and dependence; high potential for misuse.
  • Risks of sudden death in patients with underlying structural cardiac abnormalities.

Genetic Factors: Genetic polymorphisms affecting dopamine transporter may influence response.

Lab Test Interference: May affect growth and development testing in children.

Overdose Management

Signs/Symptoms: Severe agitation, hallucinations, hyperreflexia, seizures, hyperthermia, arrhythmias, coma.

Treatment: Supportive care, sedation with benzodiazepines, cooling measures, correction of acid-base and electrolyte imbalances, activated charcoal if ingestion was recent.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.