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Dexedrine
dextroamphetamine
Black Box Warnings .
Abuse, Misuse, and Addiction
CNS stimulants have high potential for abuse and misuse, can lead to substance use disorder, incl. addiction; misuse and abuse can result in overdose and death, risk incr. w/ higher doses or unapproved admin. methods; assess risk for abuse, misuse, and addiction before prescribing and throughout tx; educate pts and families about risks and proper drug storage and disposal; monitor frequently for s/sx of abuse, misuse, and addiction during tx
Adult Dosing .
Dosage forms: ER CAP: 10 mg, 15 mg
Dosage Forms Discontinued in US
- [5 mg ER cap not avail. as brand; see generic]
narcolepsy
- [5-60 mg/day PO divided qd-bid]
- Start: 10 mg PO qam, may incr. by 10 mg/day qwk; Max: 60 mg/day
ADHD (off-label)
- [5-40 mg/day PO divided qd-bid]
- Start: 5 mg PO qam or bid, may incr. by 5 mg/day qwk; Max: 60 mg/day; Info: duration 6-8h; doses >40 mg/day rarely more effective
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: ER CAP: 10 mg, 15 mg
Dosage Forms Discontinued in US
- [5 mg ER cap not avail. as brand; see generic]
ADHD
- [6 yo and older]
- Dose: 5-40 mg/day PO divided qd-bid; Start: 5 mg PO qam or bid, may incr. by 5 mg/day qwk; Max: 60 mg/day; Info: duration 6-8h; doses >40 mg/day rarely more effective
narcolepsy
- [6-11 yo]
- Dose: 5-60 mg/day PO divided qd-bid; Start: 5 mg PO qam, may incr. by 5 mg/day qwk; Max: 60 mg/day
- [12 yo and older]
- Dose: 5-60 mg/day PO divided qd-bid; Start: 10 mg PO qam, may incr. by 10 mg/day qwk; Max: 60 mg/day
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [not defined]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- MAO inhibitor use w/in 14 days
- pregnancy
- breastfeeding
- cardiac dz, severe
- cardiac abnormality, structural
- cardiomyopathy
- arrhythmia, severe
- CAD
- caution: HTN
- caution: psychosis
- caution: bipolar disorder
- caution: bipolar disorder risk
- caution: Tourette syndrome
- caution: Tourette syndrome family hx
- caution: tic disorder
- caution: tic disorder family hx
- caution: seizure hx
- caution: seizure risk
- caution: substance abuse risk
Drug Interactions .
Overview
dextroamphetamine
CNS stimulant
- CYP2D6 substrate
- gastric pH sensitive
- hypertensive effects
- interferes w/ radiolabeled norepinephrine analog effect
- lowers seizure threshold
- serotonergic effects
- tachycardia
- urine pH sensitive
- add MAO inhibitor to Interaction Check if recent (14 days) use
Contraindicated
- benzphetamine
- isocarboxazid
- linezolid
- methylene blue injection
- phendimetrazine
- phenelzine
- safinamide
- selegiline transdermal
- tranylcypromine
- yohimbe
Avoid/Use Alternative
- 5-HTP
- acetazolamide
- albuterol
- aldesleukin
- alfentanil
- almotriptan
- aluminum hydroxide
- amifampridine
- amitriptyline
- amoxapine
- bromocriptine
- buprenorphine
- bupropion
- buspirone
- butorphanol
- calcium carbonate
- carbamazepine
- cimetidine
- citalopram
- clomipramine
- cocaine
- codeine
- cyclobenzaprine
- dacomitinib
- desipramine
- desvenlafaxine
- dexlansoprazole
- dexmethylphenidate
- dextromethorphan
- dichlorphenamide
- dihydrocodeine
- dihydroergotamine
- doxepin
- doxepin topical
- dronabinol
- duloxetine
- eletriptan
- ephedra
- epinephrine inhaled
- ergotamine
- escitalopram
- esomeprazole
- famotidine
- fenfluramine
- fentanyl
- fluoxetine
- fluvoxamine
- frovatriptan
- furosemide
- gepirone
- granisetron
- hydrocodone
- hydromorphone
- imipramine
- iobenguane I 131
- isoniazid
- lansoprazole
- lasmiditan
- levomilnacipran
- levorphanol
- lisdexamfetamine
- lithium
- magnesium carbonate
- magnesium hydroxide
- meperidine
- metaxalone
- methadone
- methamphetamine
- methazolamide
- methylene blue oral
- methylergonovine
- methylphenidate
- metoclopramide
- midodrine
- milnacipran
- mirtazapine
- morphine
- nalbuphine
- naratriptan
- nefazodone
- nizatidine
- nortriptyline
- oliceridine
- omeprazole
- ondansetron
- opium
- oxycodone
- oxymorphone
- ozanimod
- palonosetron
- pantoprazole
- paroxetine
- pentazocine
- potassium citrate
- procarbazine
- protriptyline
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- rabeprazole
- rasagiline
- remifentanil
- rizatriptan
- SAMe
- selegiline
- sertraline
- simethicone
- sodium bicarbonate
- sodium citrate
- sodium zirconium cyclosilicate
- St. John's wort
- sufentanil
- sumatriptan
- tapentadol
- terbinafine
- topiramate
- tramadol
- trazodone
- trimipramine
- venlafaxine
- vilazodone
- vonoprazan
- vortioxetine
- ziprasidone
- zolmitriptan
- zonisamide
Monitor/Modify Tx
- abiraterone acetate
- acebutolol
- adagrasib
- albuterol inhaled
- aliskiren
- amiloride
- amlodipine
- angiotensin II
- arformoterol inhaled
- armodafinil
- asciminib
- atenolol
- atomoxetine
- atropine
- atropine ophthalmic
- axitinib
- azilsartan medoxomil
- benazepril
- benztropine
- berotralstat
- betamethasone
- betaxolol
- bevacizumab
- bismuth subsalicylate
- bisoprolol
- brigatinib
- budesonide
- bumetanide
- cabozantinib
- caffeine
- caffeine citrate
- candesartan cilexetil
- cannabis
- capivasertib
- captopril
- carfilzomib
- carvedilol
- celecoxib
- chlorothiazide
- chlorthalidone
- cinacalcet
- clevidipine
- clonidine
- copanlisib
- corticotropin
- cortisone
- cyclosporine
- danazol
- daprodustat
- darbepoetin alfa
- deflazacort
- desflurane
- desmopressin
- dexamethasone
- diclofenac
- diclofenac topical
- dicyclomine
- diethylpropion
- diflunisal
- diltiazem
- dobutamine
- dopamine
- doxapram
- doxazosin
- droxidopa
- eliglustat
- enalapril
- enalaprilat
- enzalutamide
- ephedrine injection
- ephedrine oral
- epinephrine
- eplerenone
- epoetin alfa
- erenumab
- esketamine
- esmolol
- estetrol (contraceptive)
- estradiol (contraceptive)
- ethacrynic acid
- ethinyl estradiol (contraceptive)
- etodolac
- etrasimod
- fedratinib
- felodipine
- fenoldopam
- fenoprofen
- fingolimod
- fludrocortisone
- flurbiprofen
- formoterol inhaled
- fosinopril
- fostamatinib
- fruquintinib
- givosiran
- glycopyrrolate
- guanfacine
- hoodia
- hydralazine
- hydrochlorothiazide
- hydrocortisone
- hyoscyamine
- ibrutinib
- ibuprofen
- indapamide
- indomethacin
- iohexol
- iopamidol
- irbesartan
- isoflurane
- isoproterenol
- isradipine
- ketamine
- ketoprofen
- ketorolac
- labetalol
- lanreotide
- leflunomide
- lenvatinib
- levalbuterol inhaled
- levonordefrin
- levothyroxine
- licorice
- lifileucel
- liothyronine
- lisinopril
- lorlatinib
- losartan
- lumacaftor/ivacaftor
- luspatercept
- magnesium salicylate
- meclofenamate
- mefenamic acid
- meloxicam
- methoxy polyethylene glycol-epoetin beta
- methscopolamine
- methyldopa
- methylprednisolone
- metolazone
- metoprolol
- minoxidil
- mirabegron
- modafinil
- moexipril
- nabumetone
- nadolol
- naphazoline ophthalmic
- naproxen
- naxitamab
- nebivolol
- nicardipine
- nifedipine
- nilotinib
- nimodipine
- niraparib
- nisoldipine
- norepinephrine
- olmesartan medoxomil
- olodaterol inhaled
- orphenadrine
- osilodrostat
- oxaprozin
- oxymetazoline nasal
- oxytocin
- pazopanib
- perindopril
- pexidartinib
- phenoxybenzamine
- phentermine
- phentolamine
- phenylephrine
- phenylephrine injection
- phenylephrine nasal
- phenylephrine ophthalmic
- phenylephrine rectal
- pindolol
- piroxicam
- ponatinib
- ponesimod
- potassium acid phosphate
- pralsetinib
- prazosin
- prednisolone
- prednisone
- propranolol
- pseudoephedrine
- quetiapine
- quinapril
- ramipril
- ramucirumab
- regorafenib
- ripretinib
- rolapitant
- ropinirole
- rotigotine transdermal
- salmeterol inhaled
- salsalate
- selpercatinib
- sevoflurane
- siponimod
- solriamfetol
- sorafenib
- sotalol
- spironolactone
- sulindac
- sunitinib
- tacrolimus
- tagraxofusp
- telmisartan
- terazosin
- terbutaline
- teriflunomide
- testosterone
- thioridazine
- thyroid
- timolol
- tipranavir
- tivozanib
- tolmetin
- torsemide
- trametinib
- trandolapril
- triamcinolone
- triamterene
- valsartan
- vamorolone
- vandetanib
- vasopressin
- verapamil
- vilanterol inhaled
- viloxazine
- voclosporin
- ziv-aflibercept
Caution Advised
- ascorbic acid (vitamin C)
- benzoic acid
- brivaracetam
- busulfan
- cannabidiol
- cenobamate
- chlorambucil
- clobazam
- clonazepam
- clorazepate
- clozapine
- diazepam
- eslicarbazepine acetate
- ethosuximide
- felbamate
- fosphenytoin
- gabapentin
- ganaxolone
- ginseng, Asian
- hydroxychloroquine
- lacosamide
- lamotrigine
- levetiracetam
- lindane topical
- lorazepam
- magnesium citrate
- methsuximide
- midazolam
- oxcarbazepine
- perampanel
- phenobarbital
- phenytoin
- polyethylene glycol
- polyethylene glycol/electrolytes
- pregabalin
- primidone
- promethazine
- rose hip
- rufinamide
- sodium acid phosphate
- sodium phosphate (bowel prep)
- sodium picosulfate
- stiripentol
- sulfate bowel prep
- tiagabine
- valproic acid
- vigabatrin
Adverse Reactions .
Serious Reactions
- dependency
- abuse
- psychosis
- mania
- aggressive behavior
- sudden death (pts w/ severe cardiac dz)
- MI
- HTN
- cardiomyopathy (long-term use)
- seizures
- priapism
- peripheral vasculopathy
- Raynaud phenomenon
- growth suppression (long-term use in peds pts)
- rhabdomyolysis
- intestinal ischemia
- withdrawal sx if abrupt D/C (prolonged use)
Common Reactions
- anorexia
- xerostomia
- insomnia
- headache
- weight loss
- emotional lability
- dizziness
- diarrhea
- tachycardia
- constipation
- libido changes
- tic exacerbation
- impotence
- palpitations
- BP elevated
- visual disturbance
- restlessness
Safety/Monitoring .
Monitoring Parameters
cardiac eval. at baseline; BP, HR; height, weight in peds at baseline, then periodically
Look/Sound-Alike Drug Names
Dexedrine confused with: Adderall; Decadron
dextroamphetamine confused with: dextroamphetamine/amphetamine; dextromethorphan
dextroamphetamine mixed salts extended release confused with: dexmethylphenidate hydrochloride extended release
Pregnancy/Lactation .
Pregnancy
Clinical Summary
avoid use during pregnancy; no known risk of teratogenicity based on limited human data; risk of vasoconstriction and decr. placental perfusion based on drug's mechanism of action; possible risk of neonatal complications, incl. premature delivery, low birth wt, and neonatal withdrawal sx, based on limited human data in pts dependent on amphetamines
Pregnancy Registry
encourage pts to enroll in National Pregnancy Registry for Psychostimulants at 1-866-961-2388 or www.womensmentalhealth.org/research/pregnancyregistry/
Lactation
Clinical Summary
avoid use while breastfeeding; no known risk of infant harm based on limited human data, though drug excreted into milk; may interfere w/ infant nutrition based on drug's mechanism of action; no human data available, though theoretical decr. milk production based on decr. prolactin levels
Pharmacology .
Metabolism: liver; CYP450: 2D6 substrate
Excretion: urine; Half-life: 12h; Info: pH-dependent excretion
Subclass: Attention Deficit Hyperactivity Disorder (ADHD) ; Narcolepsy/Somnolence ; Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs)
Mechanism of Action
exact mechanism of action unknown; stimulates CNS activity; blocks reuptake and increases release of norepinephrine and dopamine in extraneuronal space (sympathomimetic)
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: Amneal Pharmaceuticals LLC
DEA/FDA: Schedule II
Approximate Retail Price
from http://www.goodrx.com/dexedrine-spansule
oral capsule, extended release:
- 5 mg (60 ea): $1,444.00
- 10 mg (60 ea): $1,444.00
- 15 mg (30 ea): $727.00
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