Nurses Compass
Drug Guide
Dextroamphetamine Sulfate
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/ANursing 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.