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# Adderall (Amphetamine/Dextroamphetamine)
## Overview
Adderall is a central nervous system (CNS) stimulant combining four amphetamine salts. It facilitates the release of norepinephrine and dopamine from presynaptic terminals and inhibits their reuptake, enhancing neurotransmission in the prefrontal cortex.
## Primary Indications
* Attention-Deficit/Hyperactivity Disorder (ADHD)
* Narcolepsy
## Adult Dosing
* **ADHD:**
* **IR (Immediate Release):** Start 5 mg 1–2 times daily. Titrate by 5 mg weekly. Max: 40 mg/day.
* **XR (Extended Release):** Start 20 mg once daily in the morning. Max: 60 mg/day.
* **Narcolepsy:** 5–60 mg/day in divided doses (IR only).
## Pediatric Dosing
* **ADHD (Ages 3–5):** Start 2.5 mg/day (IR). May titrate by 2.5 mg weekly.
* **ADHD (Ages 6+):**
* **IR:** Start 5 mg 1–2 times daily. Max: 40 mg/day.
* **XR:** Start 10 mg once daily. Max: 30 mg/day (ages 6–12); 40 mg/day (ages 13–17).
## Dose Adjustments
* **Renal Impairment:** No formal adjustment guidelines exist, but caution is advised in severe impairment.
* **Hepatic Impairment:** No specific guidelines; use caution.
* **Titration:** Always utilize the lowest effective dose.
## Contraindications
* Known hypersensitivity to amphetamines.
* Advanced arteriosclerosis, symptomatic cardiovascular disease, or moderate-to-severe hypertension.
* Hyperthyroidism.
* Glaucoma.
* History of drug abuse.
* Use within 14 days of MAO inhibitors (risk of hypertensive crisis).
## Adverse Effects
* **Common:** Insomnia, decreased appetite, xerostomia (dry mouth), headache, tachycardia, anxiety.
* **Serious:** Sudden cardiac death (in patients with underlying cardiac abnormalities), hallucinations/psychosis, peripheral vasculopathy (Raynaud’s phenomenon), serotonin syndrome (if combined with other serotonergic agents).
## Key Drug Interactions
* **MAOIs:** Absolute contraindication; hypertensive crisis risk.
* **SSRIs/SNRIs/Triptans:** Increased risk of Serotonin Syndrome.
* **CYP2D6 Inhibitors:** May increase amphetamine serum levels.
* **Antacids/PPIs:** Alkalinizing agents increase amphetamine absorption, potentially increasing toxicity risk.
## Monitoring
* **Baseline:** Cardiovascular history, blood pressure, heart rate, weight, and height (pediatrics).
* **Ongoing:** Monitor BP, HR, weight, and psychiatric status (new onset anxiety, tics, or psychosis) at every follow-up.
## Clinical Pearls
* **Dosing Timing:** Administer morning doses to mitigate insomnia. XR capsules may be opened and sprinkled on applesauce, but do not crush or chew beads.
* **Drug Holidays:** Consider periodic "drug holidays" to assess symptom persistence and minimize growth suppression in children.
* **Diversion:** Amphetamines are Schedule II controlled substances with significant potential for abuse and physical dependence.
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*Disclaimer: This information is for educational purposes only. Clinical practice protocols vary by institution. Always consult the latest FDA-approved package insert and verified drug databases or institutional clinical pharmacists before prescribing or administering medication.*
