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Adderall, Adderall XR Fact Sheet

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Medication Name (brand): 
Adderall, Adderall XR
Medication Name (generic): 
Mixed Amphetamine and Dextroamphetamine Salts
FDA Indication(s): 

ADHD (adults and children >3 years for IR, >6 years for XR); narcolepsy (adults and children >6 years).

Dosing: 
  • Supplied as:
    • 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg tablets as Adderall (Teva) and generic.
    • 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg ER capsules as Adderall XR (Shire) and generic.
    • C-II controlled substance.
  • Each dose contains a mixture of salts (25% each): dextroamphetamine sulfate; dextroamphetamine saccharate; d-, l-amphetamine aspartate monohydrate; and d-, l-amphetamine sulfate (resulting in a 75:25 ratio of dextro and levo isomers of amphetamine).
  • Rule of thumb for both preparations: initial dose should be 0.5 mg/kg but shoot for a target dose of 1.0 mg/kg–1.2 mg/kg.
  • ADHD (children >3 years):
    • IR: start at 2.5–5 mg BID, max of 40 mg/day divided BID.
    • XR: start 5 mg–10 mg QAM, increase gradually to max of 30 mg/day, or 40 mg/day QAM in adolescents.
  • ADHD (adults):
    • IR: start at 5 QAM–BID, max of 40 mg/day divided BID.
    • XR: start 20 mg QAM, increase to max of 60 mg/day QAM.
  • May convert from IR to XR at same total daily dose, given QAM.
Cost: 
  • Cost (for one month supply at 40 mg/day, priced Jan 2014):
    • Mixed amphetamine and dextroamphetamine salts (generic): $55.58; $238.90 (XR)
    • Adderall: $296.94 ; $459.39 (XR)
Side Effects: 
  • Most common (most bothersome in bold): insomnia, headache, decreased appetite, abdominal pain, weight loss, agitation.
Drug Interactions: 
  • Avoid use with MAOIs, antacids. Caution with pressors (additive effects).
Pharmokinetics: 
  • Metabolized primarily through CYP2D6; t ½: 9−14 hours. Duration of action: 6–8 hours (IR). 8–10 hours (XR).
Clinical Pearls: 
  • Adderall may provide more of a “kick” and therefore feel more immediately effective than methylphenidate preparations. Roughly twice as potent (per mg) as methylphenidate.
  • XR may be swallowed whole or opened and sprinkled on applesauce. Use immediately; do not divide contents.
  • Dextroamphetamine and mixed amphetamine salts are the only stimulants approved for children <6 years (approved for children >3 years).
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