Names and pronunciation
Adderall XR, Mydayis
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Drug reference
Adderall XR, Mydayis
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Func. class.: CNS stimulant
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Chem. class.: Amphetamine Controlled Substance Schedule II
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ACTION: Causes the release of DOPa- mine and norepinephrine in the brain
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USES: Narcolepsy, ADHD
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CONTRAINDICATIONS Hypersensitivity to sympathomimetic D amines, hyperthyroidism, glaucoma, severe arteriosclerosis
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Black Box Warning: Substance abuse Precautions: Pregnancy, breastfeeding, children <3 yr, depression, Tourette’s syn- drome, cardiomyopathy, bipolar disorder, abrupt discontinuation, acute MI, benzyl alcohol, salicylate hypersensitivity, hyper- cortisolism, obesity, psychosis, seizure disorder, hypertension, anxiety, anorexia nervosa Black Box Warning: Cardiac disease: VS, B/P product may reverse antihyper- tensives, check patients with cardiac disease often Black Box Warning: Substance abuse: use for prolonged periods may lead to de- pendence; sudden death or serious CV events can occur from misuse, chronic in- toxication (insomnia, irritability, personality changes) • CBC, urinalysis; with diabetes blood glucose, urine glucose; insulin changes may be required because eating will decrease • Height, growth rate in children (growth rate may be decreased), weight • Toxicity: symptoms may vary in chil- dren; anxiety, headache, flushing, vomit- ing, rhabdomyolysis, tremor, hyperre- flexia, confusion, euphoria, tachycardia • ADHD: change in behavior, growth re- tardation in children • Mental status: mood, sensorium, affect, stimulation, insomnia, irritability • Tolerance or dependency: increased amount may be used to get same effect; will develop after long-term use • Pregnancy/breastfeeding: no well-con- trolled studies; use only if benefit out- weighs fetal risk; avoid breastfeeding, excreted in breast milk
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SIDE EFFECTS CNS: Hyperactivity, insomnia, restless- ness, talkativeness, dizziness, headache, chills, stimulation, dysphoria, irritability, aggressiveness, tremor, dependence, addiction CV: Palpitations, tachycardia, hyperten- sion, decrease in heart rate, dysrhythmias GI: Anorexia, dry mouth, diarrhea, con- stipation, weight loss, metallic taste GU: Impotence, change in libido INTEG: Urticaria MISC: Rhabdomyolysis
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INTERACTIONS Increase: Hypertensive crisis risk— MAOIs or within 14 days of MAOIs Increase: Serotonin syndrome, neurolep- tic malignant syndrome—SSRIs, SNRIs, serotonin-receptor agonists; do not use concurrently Increase: Amphetamine effect— acetaZOLAMIDE Increase: CNS effect—haloperidol, tricy- clics, phenothiazines Decrease: absorption of barbiturates, phenytoin Decrease: dextroamphetamine effect— ascorbic acid, ammonium chloride Decrease: effect of—adrenergic block- ers, antidiabetics, antihypertensives, anti- histamines Drug/Herb • Serotonin syndrome—St. John’s wort • Decrease: stimulant effect—eucalyptus Drug/Food Increase: amine effect—caffeine (cola, coffee, tea) Drug/Lab Increase: plasma corticosteroids, urinary steroids
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DOSAGE AND ROUTES ADHD Adults: PO (immediate-release Ad- derall) Initially, 5 mg daily or bid. If di- vided doses are required, give first dose upon awakening and the subsequent doses (1 or 2) at 4- to 6-hr intervals. Ti- trate by no more than 5 mg/day at weekly intervals to the minimum effective dose; doses greater than 60 mg/day are not usu- ally needed Child/adolescent ≥6 yr: PO (immediate- release Adderall): 5 mg daily or bid. May titrate daily dose in 5-mg increments at weekly intervals to minimum effective dose. Daily dose may be given in 1 to 3 divided doses at 4- to 6-hr intervals, 40 mg daily Child 3-5 yr: (immediate-release Ad- derall) PO: 2.5 mg daily in the morning. May titrate daily dose in 2.5-mg incre- ments at weekly intervals to minimum ef- fective dose. Daily dose may be given in 1 to 3 divided doses at 4- to 6-hr intervals Adults: PO (extended-release capsules – Adderall XR) When initiating treatment for the first time or switching from another ADHD medication, the recommended dose is 20 mg daily upon awakening Adolescents: PO (extended-release capsules – Adderall XR) 10 mg daily in the morning for both initial therapy and when converting to extended-release amphetamine, dextroamphetamine from another stimulant medication. May titrate to 20 mg daily after 1 wk if ADHD symp- toms are not adequately controlled Child 6-12 yr: PO (extended-release capsules – Adderall XR) 5 to 10 mg daily in the morning for initial treatment. If converting to extended-release (ER) amphetamine, dextroamphetamine from a different stimulant medication, begin with 10 mg daily. May titrate daily dose in 5- to 10-mg increments at weekly inter- vals to the minimum effective dose. Max: 40 mg/day PO ER capsules Adults: PO (extended-release cap- sules – Mydayis) Initially, 12.5 mg daily in the morning upon awakening; take consistently with or without food. Initial doses of 25 mg daily may be considered for some patients. Dose may be increased by 12.5-mg increments no sooner than weekly. Max: 50 mg/day Adolescent ≥13 yr: PO Initially, 12.5 mg daily in the morning upon awakening; take consistently with or without food. Dose may be increased by 12.5-mg increments no sooner than weekly. Max: 25 mg/day Narcolepsy ≥12 PO Adult/adolescent/child yr: (immediate-release tablets – Adderall): 10 mg daily in the morning. If divided doses are required, give first dose upon awakening and the subsequent doses (1 or 2) at 4- to 6-hr intervals. Titrate by no more than 10 mg/day at weekly intervals to the minimum effective dose. Maximum: 60 mg/day Child 6-11 yr: PO (immediate-release tablets – Adderall): 5 mg daily in the morning. Titrate daily dose in 5-mg increments at weekly intervals to mini- mum effective dose. Daily dose may be given in 1 to 3 divided doses at 4- to 6-hour intervals. Max: 60 mg/day
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Available forms: Many products, check with manufacturer Administer • At least 6 hr prior to bedtime to avoid sleeplessness • Use calibrated measuring device for oral solution • Store all products at room temperature
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Assess:
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Evaluate: • Therapeutic response: decreased CNS stimulation (ADHD); decreased drowsi- ness (narcolepsy)
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To decrease caffeine consumption; may increase irritability, stimulation • To avoid OTC products unless dis- cussed with provider • To tell parents that change in behavior may occur at beginning treatment; irrita- bility, hostility • Seizures: that those with a seizure disor- der may have decreased seizure threshold D • To taper product over several weeks; depression, increased sleeping, lethargy may occur • To get needed rest; patient will feel more tired at end of day
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PHARMACOKINETICS Immediate release: Onset unknown, peak 3 hr, duration 4-6 hr Extended release: Onset unknown, peak 7-8 hr, duration unknown Half-life immediate release 9-14 hr; extended release 10-14 hr
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