Drug reference

Dexamfetamine sulfate

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 390, 391

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Narcolepsy ▶BY MOUTH ▶Adult: Initially 10 mg daily in divided doses, increased in steps of 10 mg every week, maintenance dose to be given in 2–4 divided doses; maximum 60 mg per day ▶Elderly: Initially 5 mg daily in divided doses, increased in steps of 5 mg every week, maintenance dose to be given in 2–4 divided doses; maximum 60 mg per day Refractory attention deficit hyperactivity disorder (initiated under specialist supervision) ▶BY MOUTH ▶Child 6–17 years: Initially 2.5 mg 2–3 times a day, increased in steps of 5 mg once weekly if required;, usual maximum 1 mg/kg daily, up to 20 mg daily (40 mg daily has been required in some children); maintenance dose to be given in 2–4 divided doses ▶Adult: Initially 5 mg twice daily, dose is increased at weekly intervals according to response, maintenance dose to be given in 2–4 divided doses; maximum 60 mg per day l UNLICENSED USE Not licensed for use in adults for refractory attention deﬁcit hyperactivity disorder.

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Contra Indications

Advanced arteriosclerosis. anorexia . arrhythmias (life-threatening). cardiomyopathies. cardiovascular disease. cerebrovascular disorders. heart failure. history of alcohol abuse. history of drug abuse. hyperexcitability. hyperthyroidism. moderate hypertension. psychiatric disorders. psychosis. severe hypertension. structural cardiac abnormalities. suicidal tendencies CONTRA-INDICATIONS, FURTHER INFORMATION ▶Psychiatric disorders Psychiatric disorders include severe depression, schizophrenia, borderline personality disorder and uncontrolled bipolar disorder. Co-morbidity with psychiatric disorders is common in attention deﬁcit hyperactivity disorder. Manufacturer advises if new psychiatric symptoms develop or exacerbation of psychiatric disorders occurs, continue use only if beneﬁts outweigh risks.

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Cautions

History of epilepsy (discontinue if seizures occur). mild hypertension. susceptibility to angle-closure glaucoma. tics. Tourette syndrome CAUTIONS, FURTHER INFORMATION ▶Tics and Tourette syndrome Discontinue use if tics occur. ▶Growth restriction in children Monitor height and weight as growth restriction may occur during prolonged therapy (drug-free periods may allow catch-up in growth but withdraw slowly to avoid inducing depression or renewed hyperactivity).

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Prescribing And Dispensing Information

Data on safety and efﬁcacy of long-term use not complete.

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Safety

Interactions

→Appendix 1: amfetamines

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Side Effects

▶Common or very common Abdominal pain. anxiety. appetite decreased. arrhythmias. arthralgia. behaviour abnormal. depression. dry mouth. headache. mood altered. movement disorders. muscle cramps. nausea. palpitations. poor weight gain. sleep disorders. vertigo. vomiting. weight decreased ▶Rare or very rare Anaemia. angina pectoris. cardiac arrest . cerebrovascular insufﬁciency. fatigue. growth retardation. hallucination. hepatic coma. hepatic function abnormal. intracranial haemorrhage. leucopenia . mydriasis. psychosis. seizure. skin reactions. suicidal tendencies. thrombocytopenia. tic (in those at risk). vasculitis cerebral. vision disorders ▶Frequency not known Acidosis. alopecia. cardiomyopathy. chest pain. circulatory collapse. colitis ischaemic. concentration impaired. confusion. diarrhoea. dizziness. drug dependence. hyperhidrosis. hypermetabolism. hyperpyrexia. kidney injury. myocardial infarction. neuroleptic malignant syndrome. obsessive-compulsive disorder. reﬂexes increased. rhabdomyolysis. sexual dysfunction. sudden death. taste altered. tremor Overdose Amfetamines cause wakefulness, excessive activity, paranoia, hallucinations, and hypertension followed by exhaustion, convulsions, hyperthermia, and coma. See Stimulants under Emergency treatment of poisoning p. 1430.

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Pregnancy

Avoid (retrospective evidence of uncertain signiﬁcance suggesting possible embryotoxicity).

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Breast Feeding

Signiﬁcant amount in milk—avoid.

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Renal Impairment

Use with caution.

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Monitoring Requirements

▶Monitor growth in children. ▶Monitor for aggressive behaviour or hostility during initial treatment. ▶Pulse, blood pressure, psychiatric symptoms, appetite, weight and height should be recorded at initiation of therapy, following each dose adjustment, and at least every 6 months thereafter.

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Dose and formulations

Directions For Administration

▶In children Tablets can be halved.

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Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: modiﬁed-release capsule, oral suspension, oral solution Oral solution ▶Dexamfetamine sulfate (Non-proprietary) Dexamfetamine sulfate 1 mg per 1 ml Dexamfetamine 5mg/5ml oral solution sugar free sugar-free | 150 ml P £114.49 DT = £114.49 b Modified-release capsule ▶Dexedrine (Imported (United States)) Dexamfetamine sulfate 5 mg Dexedrine 5mg Spansules | 100 capsule P s b Dexamfetamine sulfate 10 mg Dexedrine 10mg Spansules | 100 capsule P s b Dexamfetamine sulfate 15 mg Dexedrine 15mg Spansules | 100 capsule P s b Tablet ▶Dexamfetamine sulfate (Non-proprietary) Dexamfetamine sulfate 5 mg Dexamfetamine 5mg tablets | 28 tablet P £24.75 DT = £24.72 b ▶Amfexa (Flynn Pharma Ltd) Dexamfetamine sulfate 5 mg Amfexa 5mg tablets | 30 tablet P £19.89 b Dexamfetamine sulfate 10 mg Amfexa 10mg tablets | 30 tablet P £39.78 DT = £39.78 b Dexamfetamine sulfate 20 mg Amfexa 20mg tablets | 30 tablet P £79.56 DT = £79.56 b

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Clinical care

Treatment Cessation

Avoid abrupt withdrawal.

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Patient And Carer Advice

Driving and skilled tasks Drugs and Driving Prescribers and other healthcare professionals should advise patients if treatment is likely to affect their ability to perform skilled tasks (e.g. driving). This applies especially to drugs with sedative effects; patients should be warned that these effects are increased by alcohol. General information about a patient’s ﬁtness to drive is available from the Driver and Vehicle Licensing Agency at www.dvla.gov.uk. For information on 2015 legislation regarding driving whilst taking certain controlled drugs, including amfetamines, see Drugs and driving under Guidance on prescribing p. 1.

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Dose text by age group

Adult

Initially 10 mg daily in divided doses, increased

First-line fragment. Read the complete Indications and Dose section above.

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Adult

Initially 5 mg twice daily, dose is increased at

First-line fragment. Read the complete Indications and Dose section above.

PDF page 390

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Dexamfetamine sulfate

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 390, 391

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 390

Contra Indications

PDF page 390

Cautions

PDF page 390

Prescribing And Dispensing Information

Data on safety and efﬁcacy of long-term use not complete.

PDF page 390

Safety

Interactions

→Appendix 1: amfetamines

PDF page 390

Side Effects

PDF page 390

Pregnancy

Avoid (retrospective evidence of uncertain signiﬁcance suggesting possible embryotoxicity).

PDF page 390

Breast Feeding

Signiﬁcant amount in milk—avoid.

PDF page 390

Renal Impairment

Use with caution.

PDF page 390

Monitoring Requirements

PDF page 390

Dose and formulations

Directions For Administration

▶In children Tablets can be halved.

PDF page 390

Medicinal Forms

PDF pages 390, 391

Clinical care

Treatment Cessation

Avoid abrupt withdrawal.

PDF page 390

Patient And Carer Advice

PDF page 390

Dose text by age group

Adult

Initially 10 mg daily in divided doses, increased

First-line fragment. Read the complete Indications and Dose section above.

PDF page 390

Adult

Initially 5 mg twice daily, dose is increased at

First-line fragment. Read the complete Indications and Dose section above.

PDF page 390

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.