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Adderall
GENERIC NAME(S): Dextroamphetamine-Amphetamine
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Adderall and Mydayis are trade names for a combination drug called mixed amphetamine salts containing four salts of amphetamine. The mixture is composed of equal parts racemic amphetamine and dextroamphetamine, which produces a (3:1) ratio between dextroamphetamine and levoamphetamine, the two enantiomers of amphetamine. Both enantiomers are stimulants but differ enough to give Adderall an effects profile distinct from those of racemic amphetamine or dextroamphetamine, which are marketed as Evekeo and Dexedrine/Zenzedi, respectively. Adderall is used in the treatment of attention deficit hyperactivity disorder (ADHD) and narcolepsy. It is also used illicitly as an athletic performance enhancer, cognitive enhancer, appetite suppressant, and recreationally as a euphoriant. It is a central nervous system (CNS) stimulant of the phenethylamine class.
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Adderall is generally well-tolerated and effective in treating symptoms of ADHD and narcolepsy. At therapeutic doses, Adderall causes emotional and cognitive effects such as euphoria, change in sex drive, increased wakefulness, and improved cognitive control. At these doses, it induces physical effects such as a faster reaction time, fatigue resistance, and increased muscle strength. In contrast, much larger doses of Adderall can impair cognitive control, cause rapid muscle breakdown, provoke panic attacks, or induce a psychosis (e.g., paranoia, delusions, hallucinations). The side effects of Adderall vary widely among individuals, but most commonly include insomnia, dry mouth, loss of appetite, and weight loss. The risk of developing an addiction or dependence is insignificant when Adderall is used as prescribed at fairly low daily doses, such as those used for treating ADHD; however, the routine use of Adderall in larger daily doses poses a significant risk of addiction or dependence due to the pronounced reinforcing effects that are present at high doses. Recreational doses of amphetamine are generally much larger than prescribed therapeutic doses, and carry a far greater risk of serious adverse effects.
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The two amphetamine enantiomers that compose Adderall (levoamphetamine and dextroamphetamine) alleviate the symptoms of ADHD and narcolepsy by increasing the activity of the neurotransmitters norepinephrine and dopamine in the brain, which results in part from their interactions with human trace amine-associated receptor 1 (hTAAR1) and vesicular monoamine transporter 2 (VMAT2) in neurons. Dextroamphetamine is a more potent CNS stimulant than levoamphetamine, but levoamphetamine has slightly stronger cardiovascular and peripheral effects and a longer elimination half-life than dextroamphetamine. The levoamphetamine component of Adderall has been reported to improve the treatment response in some individuals relative to dextroamphetamine alone. Adderall's active ingredient, amphetamine, shares many chemical and pharmacological properties with the human trace amines, particularly phenethylamine and N-methylphenethylamine, the latter of which is a positional isomer of amphetamine. In 2020, Adderall was the 22nd most commonly prescribed medication in the United States, with more than 26 million prescriptions.
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How Does Adderall Work?
Adderall increases activity in the central nervous system and stimulates the release of dopamine and other neurotransmitters, such as serotonin and noradrenaline (norepinephrine).
Amphetamines bring balance to people with ADHD who tend to have lower levels of dopamine, the key chemical in the brain’s reward center. The result is improved focus, higher energy levels and less fidgeting, impulsivity, restlessness and aggression.
Adderall’s ability to stimulate the brain also helps people with narcolepsy stay awake.
How to Take Adderall
If your doctor decides Adderall is right for you, they will determine the lowest effective dosage for your specific needs. Adderall comes in regular dosage and extended-release form, called Adderall XR.
Adderall comes in the following dosages: 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg and 30 mg.
Adderall XR comes in the following dosages: 5 mg, 10 mg, 15 mg, 20 mg, 25 mg and 30 mg. Adderall XR isn’t approved for treating narcolepsy.
Every patient’s body chemistry is different, so your doctor may need to adjust the dose over time.
Adderall Dosage Recommendation for ADHD
Your doctor will usually prescribe regular Adderall or Adderall XR at a lower dose, usually once or twice daily for adults for regular Adderall. Because Adderall XR is a longer-lasting form, it is often prescribed just once a day.
Adderall Immediate Release
Adderall immediate-release tablets are usually taken two to three times a day.
The typical starting dose for patients ages 6 and older is 5 mg once or twice daily. Medical providers may increase the dose by 5 mg weekly until the medicine starts to work. The dose rarely exceeds 40 mg per day.
Your first dose is typically taken when you wake up in the morning, and any subsequent doses are taken four to six hours apart.
In children from 3 to 5 years of age, the starting dose is 2.5 mg. Medical providers may increase the dose 2.5 mg every week until it is working.
Both Adderall and Adderall XR capsules may be taken whole, with or without food.
You can safely open Adderall XR capsules and sprinkle the drug beads onto applesauce or yogurt for immediate consumption. However, if you open the Adderall XR capsules, do not chew and destroy the drug beads, as it will ruin the extended-release mechanism.
Adderall Extended Release
Children 6 to 12 years old typically start on 5 mg or 10 mg daily. The medical provider may increase the dose by 5 to 10 mg each week until it starts to work.
Children 13 to 17 years old typically start at 10 mg daily. After the first week, the dose may be increased to 20 mg.
Adults 18 years or older start at 20 mg once a day. The medical provider may increase the dose each week until it starts to work.
Use Adderall at the same time each day to help get the most benefits from it, and make sure you follow your doctor’s instructions carefully, including any dosage adjustments they make.
Adderall Dosage Recommendation for Narcolepsy
Adderall is not recommended for treating narcolepsy in children under age 6, and Adderall XR is not approved for treating narcolepsy.
For children and adults ages 12 and above, the U.S. Food and Drug Administration recommends a starting dosage of 10 mg per day, divided and given in two doses.
For children ages 6-12, their physician may begin with a dose of 5 mg per day, increasing it by 5 mg per week until they reach the optimum dose.
INDICATIONS
Adderall® (Dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate and amphetamine sulfate tablets (Mixed salts of a single entity amphetamine product)) is indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) and Narcolepsy.
Attention Deficit Hyperactivity Disorder (ADHD)
A diagnosis of Attention Deficit Hyperactivity Disorder (ADHD; DSM-IV) implies the presence of hyperactive-impulsive or inattentive symptoms that caused impairment and was present before age 7 years. The symptoms must cause clinically significant impairment, e.g., in social, academic, or occupational functioning, and be present in two or more settings, e.g., school (or work) and at home. The symptoms must not be better accounted for by another mental disorder. For the Inattentive Type, at least six of the following symptoms must have persisted for at least 6 months: lack of attention to details/careless mistakes; lack of sustained attention; poor listener; failure to follow through on tasks; poor organization; avoids tasks requiring sustained mental effort; loses things; easily distracted; forgetful. For the Hyperactive-Impulsive Type, at least six of the following symptoms must have persisted for at least 6 months: fidgeting/squirming; leaving seat; inappropriate running/climbing; difficulty with quiet activities; “on the go;” excessive talking; blurting answers; can't wait turn; intrusive. The Combined Type requires both inattentive and hyperactive-impulsive criteria to be met.
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