Home Drug Guide Dextroamphetamine and Amphetamine mixture

Drug Guide

Generic Name

Dextroamphetamine and Amphetamine mixture

Brand Names Adderall, Adderall XR

Classification

Therapeutic: Central Nervous System stimulant for ADHD and Narcolepsy

Pharmacological: Sympathomimetic amines

FDA Approved Indications

  • Attention Deficit Hyperactivity Disorder (ADHD)
  • Narcolepsy

Mechanism of Action

Increases amount of dopamine and norepinephrine in the brain by promoting their release and inhibiting reuptake, leading to stimulant effects.

Dosage and Administration

Adult: As prescribed, typically 5-30 mg daily in divided doses

Pediatric: Prefixed by age, generally starting at 2.5-10 mg daily, titrated carefully under supervision

Geriatric: Use with caution, lower initial doses recommended due to potential for increased sensitivity and side effects

Renal Impairment: Adjust dose cautiously, monitor for efficacy and adverse effects

Hepatic Impairment: Use with caution; no specific adjustments well-established

Pharmacokinetics

Absorption: Well absorbed orally, peak plasma levels in 3 hours

Distribution: Crosses blood-brain barrier, extensive protein binding (~11-16%)

Metabolism: Partially metabolized in the liver, primarily via conjugation

Excretion: Excreted mainly in urine, with some unchanged drug

Half Life: Dextroamphetamine ~10 hours, Amphetamine ~9-14 hours

Contraindications

  • History of hypersensitivity to amphetamines
  • In patients with advanced arteriosclerosis, symptomatic cardiovascular disease, hypertension, hyperthyroidism, glaucoma, agitated states, or history of drug abuse

Precautions

  • Caution in patients with a history of mental health issues, tics, or tourette's syndrome
  • Use with caution in pregnancy and lactation; considered pregnancy category C

Adverse Reactions - Common

  • Insomnia (common)
  • Dry mouth (common)
  • Anorexia (common)
  • Headache (common)

Adverse Reactions - Serious

  • Cardiovascular events such as hypertension, tachycardia, or arrhythmias (rare)
  • Psychiatric effects like psychosis, paranoia, or aggressive behavior (rare)
  • Potential for dependency and abuse (serious)

Drug-Drug Interactions

  • Monoamine oxidase inhibitors (risk of hypertensive crisis)
  • Other central nervous system stimulants
  • Antihypertensive agents (may diminish their effects)

Drug-Food Interactions

  • May have enhanced effects with caffeine

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor cardiovascular status, behavioral changes, BMI, and signs of abuse

Diagnoses:

  • Risk for increased blood pressure
  • Risk for dependence

Implementation: Administer doses as prescribed, monitor pulse and blood pressure regularly, educate patient on medication adherence and potential side effects

Evaluation: Assess for effectiveness in reducing ADHD symptoms or narcolepsy episodes, monitor for adverse events

Patient/Family Teaching

  • Take medication exactly as prescribed, do not double doses
  • Report any cardiovascular symptoms, psychiatric changes, or signs of dependency
  • Avoid alcohol and other CNS depressants
  • Keep medication out of reach of children

Special Considerations

Black Box Warnings:

  • Potential for abuse and dependence
  • Serious cardiovascular events, including sudden death in patients with pre-existing structural cardiac abnormalities or other serious heart problems

Genetic Factors: Genetic factors may influence metabolism and response

Lab Test Interference: May affect growth in children, monitor height and weight periodically

Overdose Management

Signs/Symptoms: Severe hypertension, agitation, hyperthermia, seizures, coma

Treatment: Supportive care, activated charcoal to reduce absorption, benzodiazepines for seizures, monitoring of cardiac and vital signs, and sedation as needed

Storage and Handling

Storage: Store at room temperature (20-25°C), away from moisture, heat, and light

Stability: Stable for specified periods as per manufacturer instructions

🛡️ 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.