Generic Name

Dextroamphetamine and Amphetamine mixture

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Classification

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

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