ADDERALL®

DRUG DESCRIPTION

What are the possible side effects of amphetamine and dextroamphetamine (Adderall, Adderall XR)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using amphetamine and dextroamphetamine and call your doctor at once if you have any of these serious side effects:

fast, pounding, or uneven heartbeats;

feeling light-headed, fainting;

increased blood pressure (severe headache, blurred vision, trouble concentrating,…

Read All Potential Side Effects and See Pictures of Adderall »

A single-entity amphetamine product combining the neutral sulfate salts of dextroamphetamine and amphetamine, with the dextro isomer of amphetamine saccharate and d, l-amphetamine aspartate monohydrate.

EACH TABLET CONTAINS:	5 mg	7.5 mg	10 mg	12.5 mg	15 mg	20 mg	30 mg
Dextroamphetamine Saccharate	1.25 mg	1.875 mg	2.5 mg	3.125 mg	3.75 mg	5 mg	7.5 mg
Amphetamine Aspartate Monohydrate	1.25 mg	1.875 mg	2.5 mg	3.125 mg	3.75 mg	5 mg	7.5 mg
Dextroamphetamine Sulfate USP	1.25 mg	1.875 mg	2.5 mg	3.125 mg	3.75 mg	5 mg	7.5 mg
Amphetamine Sulfate USP	1.25 mg	1.875 mg	2.5 mg	3.125 mg	3.75 mg	5 mg	7.5 mg
Total amphetamine base equivalence	3.13 mg	4.7 mg	6.3 mg	7.8 mg	9.4 mg	12.6 mg	18.8 mg

Inactive Ingredients:

LACTITOL, MICROCRYSTALLINE CELLULOSE, COLLOIDAL SILICON DIOXIDE, MAGNESIUM STEARATE, AND OTHER INGREDIENTS.

INDICATIONS

ADDERALL® 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 were 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.

Special Diagnostic Considerations:

Specific etiology of this syndrome is unknown, and there is no single diagnostic test. Adequate diagnosis requires the use not only of medical but of special psychological, educational, and social resources. Learning may or may not be impaired. The diagnosis must be based upon a complete history and evaluation of the child and not solely on the presence of the required number of DSM-IV® characteristics.

Need for Comprehensive Treatment Program:

ADDERALL® is indicated as an integral part of a total treatment program for ADHD that may include other measures (psychological, educational, social) for patients with this syndrome. Drug treatment may not be indicated for all children with this syndrome. Stimulants are not intended for use in the child who exhibits symptoms secondary to environmental factors and/or other primary psychiatric disorders, including psychosis. Appropriate educational placement is essential and psychosocial intervention is often helpful. When remedial measures alone are insufficient, the decision to prescribe stimulant medication will depend upon the physician’s assessment of the chronicity and severity of the child’s symptoms.

Long-Term Use:

The effectiveness of ADDERALL® for long-term use has not been systematically evaluated in controlled trials. Therefore, the physician who elects to use ADDERALL® for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient.

DOSAGE AND ADMINISTRATION

Regardless of indication, amphetamines should be administered at the lowest effective dosage and dosage should be individually adjusted according to the therapeutic needs and response of the patient. Late evening doses should be avoided because of the resulting insomnia.

Attention Deficit Hyperactivity Disorder:

Not recommended for children under 3 years of age. In children from 3 to 5 years of age, start with 2.5 mg daily; daily dosage may be raised in increments of 2.5 mg at weekly intervals until optimal response is obtained.

In children 6 years of age and older, start with 5 mg once or twice daily; daily dosage may be raised in increments of 5 mg at weekly intervals until optimal response is obtained. Only in rare cases will it be necessary to exceed a total of 40 mg per day. Give first dose on awakening; additional doses (1 or 2) at intervals of 4 to 6 hours.

Where possible, drug administration should be interrupted occasionally to determine if there is a recurrence of behavioral symptoms sufficient to require continued therapy.

Narcolepsy:

Usual dose 5 mg to 60 mg per day in divided doses, depending on the individual patient response.

Narcolepsy seldom occurs in children under 12 years of age; however, when it does, dextroamphetamine sulfate may be used. The suggested initial dose for patients aged 6-12 is 5 mg daily; daily dose may be raised in increments of 5 mg at weekly intervals until optimal response is obtained. In patients 12 years of age and older, start with 10 mg daily; daily dosage may be raised in increments of 10 mg at weekly intervals until optimal response is obtained. If bothersome adverse reactions appear (e.g., insomnia or anorexia), dosage should be reduced. Give first dose on awakening; additional doses (1 or 2) at intervals of 4 to 6 hours.

HOW SUPPLIED

ADDERALL® 5 MG: A ROUND, FLAT-FACED BEVELED EDGE, WHITE TO OFF-WHITE TABLET, “5” EMBOSSED ON ONE SIDE WITH PARTIAL BISECT AND “AD” EMBOSSED ON THE OTHER SIDE, SUPPLIED AS FOLLOWS:

100 Tablets          Unit-of-use          NDC 0555-0762-02

ADDERALL® 7.5 MG: AN OVAL, CONVEX, BLUE TABLET, “7.5” EMBOSSED ON ONE SIDE WITH A PARTIAL BISECT AND “AD” EMBOSSED ON THE OTHER SIDE WITH A FULL AND PARTIAL BISECT, SUPPLIED AS FOLLOWS:

100 Tablets          Unit-of-use          NDC 0555-0763-02

ADDERALL® 10 MG: A ROUND, CONVEX, BLUE TABLET, “10” EMBOSSED ON ONE SIDE WITH A FULL AND PARTIAL BISECT AND “AD” EMBOSSED ON THE OTHER SIDE, SUPPLIED AS FOLLOWS:

100 Tablets          Unit-of-use          NDC 0555-0764-02

ADDERALL® 12.5 MG: A ROUND, FLAT-FACED BEVELED EDGE, ORANGE TABLET, “12.5” EMBOSSED ON ONE SIDE AND “AD” EMBOSSED ON THE OTHER SIDE WITH A FULL AND PARTIAL BISECT, SUPPLIED AS FOLLOWS:

100 Tablets          Unit-of-use          NDC 0555-0765-02

ADDERALL® 15 MG: AN OVAL, CONVEX, ORANGE TABLET, “15” EMBOSSED ON ONE SIDE WITH A PARTIAL BISECT AND “AD” EMBOSSED ON THE OTHER SIDE WITH A FULL AND PARTIAL BISECT, SUPPLIED AS FOLLOWS:

100 Tablets          Unit-of-use          NDC 0555-0766-02

ADDERALL® 20 MG: A ROUND, CONVEX, ORANGE TABLET, “20” EMBOSSED ON ONE SIDE WITH A FULL AND PARTIAL BISECT AND “AD” EMBOSSED ON THE OTHER SIDE, SUPPLIED AS FOLLOWS:

100 Tablets          Unit-of-use          NDC 0555-0767-02

ADDERALL® 30 MG: A ROUND, FLAT-FACED BEVELED EDGE, ORANGE TABLET, “30” EMBOSSED ON ONE SIDE WITH A FULL AND PARTIAL BISECT AND “AD” EMBOSSED ON THE OTHER SIDE, SUPPLIED AS FOLLOWS:

100 Tablets          Unit-of-use          NDC 0555-0768-02

DISPENSE IN A TIGHT, LIGHT-RESISTANT CONTAINER.
STORE AT 20° TO 25°C (68° TO 77°F) [SEE USP CONTROLLED ROOM TEMPERATURE].

MANUFACTUREDBY: DSMPHARMACEUTICALS INC.,5900 NW GREENVILLE BLVD.,GREENVILLE, NC 27834 FOR
BARR LABORATORIES, INC., POMONA, NY 10970
Revised MARCH 2007
FDA rev date: 6/7/2007

Last reviewed on RxList: 10/4/2010

Adderall Side Effects & Drug Interactions

SIDE EFFECTS

Cardiovascular:

Palpitations, tachycardia, elevation of blood pressure, sudden death, myocardial infarction. There have been isolated reports of cardiomyopathy associated with chronic amphetamine use.

Central Nervous System:

Psychotic episodes at recommended doses, overstimulation, restlessness, dizziness, insomnia, euphoria, dyskinesia, dysphoria, depression, tremor, headache, exacerbation of motor and phonic tics and Tourette’s syndrome, seizures, stroke.

Gastrointestinal:

Dryness of the mouth, unpleasant taste, diarrhea, constipation, other gastrointestinal disturbances. Anorexia and weight loss may occur as undesirable effects.

Allergic:

Urticaria, rash, hypersensitivity reactions including angioedema and anaphylaxis. Serious skin rashes, including Stevens Johnson Syndrome and toxic epidermal necrolysis have been reported.

Endocrine:

Impotence, changes in libido.

Drug Abuse and Dependence

ADDERALL® is a Schedule II controlled substance.

Amphetamines have been extensively abused. Tolerance, extreme psychological dependence, and severe social disability have occurred. There are reports of patients who have increased the dosage to levels many times higher than recommended. Abrupt cessation following prolonged high dosage administration results in extreme fatigue and mental depression; changes are also noted on the sleep EEG. Manifestations of chronic intoxication with amphetamines include severe dermatoses, marked insomnia, irritability, hyperactivity, and personality changes. The most severe manifestation of chronic intoxication is psychosis, often clinically indistinguishable from schizophrenia.

DRUG INTERACTIONS

Acidifying agents

-Gastrointestinal acidifying agents (guanethidine, reserpine, glutamic acid HCl, ascorbic acid, fruit juices, etc.) lower absorption of amphetamines.

Urinary acidifying agent

-(ammonium chloride, sodium acid phosphate, etc.) increase the concentration of the ionized species of the amphetamine molecule, thereby increasing urinary excretion. Both groups of agents lower blood levels and efficacy of amphetamines.

Adrenergic blocker

-Adrenergic blockers are inhibited by amphetamines.

Alkalinizing agents

-Gastrointestinal alkalinizing agents (sodium bicarbonate, etc.) increase absorption of amphetamines. Co-administration of ADDERALL® and gastrointestinal alkalizing agents, such as antacids, should be avoided. Urinary alkalinizing agents (acetazolamide, some thiazides) increase the concentration of the non-ionized species of the amphetamine molecule, thereby decreasing urinary excretion. Both groups of agents increase blood levels and therefore potentiate the actions of amphetamines.

Antidepressants, tricyclic

-Amphetamines may enhance the activity of tricyclic or sympathomimetic agents; d-amphetamine with desipramine or protriptyline and possibly other tricyclics cause striking and sustained increases in the concentration of d-amphetamine in the brain; cardiovascular effects can be potentiated.

MAO inhibitors

-MAOI antidepressants, as well as a metabolite of furazolidone, slow amphetamine metabolism. This slowing potentiates amphetamines, increasing their effect on the release of norepinephrine and other monoamines from adrenergic nerve endings; this can cause headaches and other signs of hypertensive crisis. A variety of neurological toxic effects and malignant hyperpyrexia can occur, sometimes with fatal results.

Antihistamines

-Amphetamines may counteract the sedative effect of antihistamines.

Antihypertensives

-Amphetamines may antagonize the hypotensive effects of antihypertensives.

Chlorpromazine

-Chlorpromazine blocks dopamine and norepinephrine receptors, thus inhibiting the central stimulant effects of amphetamines, and can be used to treat amphetamine poisoning.

Ethosuximide

-Amphetamines may delay intestinal absorption of ethosuximide.

Haloperidol

-Haloperidol blocks dopamine receptors, thus inhibiting the central stimulant effects of amphetamines.

Lithium carbonate

-The anorectic and stimulatory effects of amphetamines may be inhibited by lithium carbonate.

Meperidine

-Amphetamines potentiate the analgesic effect of meperidine.

Methenamine therapy

-Urinary excretion of amphetamines is increased, and efficacy is reduced, by acidifying agents used in methenamine therapy.

Norepinephrine

-Amphetamines enhance the adrenergic effect of norepinephrine.

Phenobarbital

-Amphetamines may delay intestinal absorption of phenobarbital; co-administration of phenobarbital may produce a synergistic anticonvulsant action.

Phenytoin

-Amphetamines may delay intestinal absorption of phenytoin; co-administration of phenytoin may produce a synergistic anticonvulsant action.

Propoxyphene

-In cases of propoxyphene overdosage, amphetamine CNS stimulation is potentiated and fatal convulsions can occur.

Veratrum alkaloids

-Amphetamines inhibit the hypotensive effect of veratrum alkaloids.

Drug/Laboratory Test Interactions:

Amphetamines can cause a significant elevation in plasma corticosteroid levels. This increase is greatest in the evening. Amphetamines may interfere with urinary steroid determinations.

Last reviewed on RxList: 10/4/2010

Adderall Warnings & Precautions

WARNINGS

Serious Cardiovascular Events

Sudden Death and Pre-existing Structural Cardiac Abnormalities or Other Serious Heart Problems

Children and Adolescents

Sudden death has been reported in association with CNS stimulant treatment at usual doses in children and adolescents with structural cardiac abnormalities or other serious heart problems.

Although some structural heart problems alone may carry an increased risk of sudden death, stimulant products generally should not be used in children or adolescents with known structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or other serious cardiac problems that may place them at increased vulnerability to the sympathomimetic effects of a stimulant drug (see CONTRAINDICATIONS).

Adults

Sudden deaths, stroke, and myocardial infarction have been reported in adults taking stimulant drugs at usual doses for ADHD. Although the role of stimulants in these adult cases is also unknown, adults have a greater likelihood than children of having serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, or other serious cardiac problems. Adults with such abnormalities should also generally not be treated with stimulant drugs (see CONTRAINDICATIONS).

Hypertension and other Cardiovascular Conditions

Stimulant medications cause a modest increase in average blood pressure (about 2-4 mmHg) and average heart rate (about 3-6 bpm) [see ADVERSE REACTIONS], and individuals may have larger increases. While the mean changes alone would not be expected to have short-term consequences, all patients should be monitored for larger changes in heart rate and blood pressure. Caution is indicated in treating patients whose underlying medical conditions might be compromised by increases in blood pressure or heart rate, e.g., those with pre-existing hypertension, heart failure, recent myocardial infarction, or ventricular arrhythmia (see CONTRAINDICATIONS).

Assessing Cardiovascular Status in Patients being Treated with Stimulant Medications

Children, adolescents, or adults who are being considered for treatment with stimulant medications should have a careful history (including assessment for a family history of sudden death or ventricular arrhythmia) and physical exam to assess for the presence of cardiac disease, and should receive further cardiac evaluation if findings suggest such disease (e.g. electrocardiogram and echocardiogram). Patients who develop symptoms such as exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease during stimulant treatment should undergo a prompt cardiac evaluation.

Psychiatric Adverse Events

Pre-Existing Psychosis

Administration of stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with pre-existing psychotic disorder.

Bipolar Illness

Particular care should be taken in using stimulants to treat ADHD patients with comorbid bipolar disorder because of concern for possible induction of mixed/manic episode in such patients. Prior to initiating treatment with a stimulant, patients with comorbid depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.

Emergence of New Psychotic or Manic Symptoms

Treatment emergent psychotic or manic symptoms, e.g., hallucinations, delusional thinking, or mania in children and adolescents without prior history of psychotic illness or mania can be caused by stimulants at usual doses. If such symptoms occur, consideration should be given to a possible causal role of the stimulant, and discontinuation of treatment may be appropriate. In a pooled analysis of multiple short-term, placebo-controlled studies, such symptoms occurred in about 0.1% (4 patients with events out of 3482 exposed to methylphenidate or amphetamine for several weeks at usual doses) of stimulant-treated patients compared to 0 in placebo-treated patients.

Aggression

Aggressive behavior or hostility is often observed in children and adolescents with ADHD, and has been reported in clinical trials and the postmarketing experience of some medications indicated for the treatment of ADHD. Although there is no systematic evidence that stimulants cause aggressive behavior or hostility, patients beginning treatment for ADHD should be monitored for the appearance of or worsening of aggressive behavior or hostility.

Long-Term Suppression of Growth

Careful follow-up of weight and height in children ages 7 to 10 years who were randomized to either methylphenidate or non-medication treatment groups over 14 months, as well as in naturalistic subgroups of newly methylphenidate-treated and non-medication treated children over 36 months (to the ages of 10 to 13 years), suggests that consistently medicated children (i.e., treatment for 7 days per week throughout the year) have a temporary slowing in growth rate (on average, a total of about 2 cm less growth in height and 2.7 kg less growth in weight over 3 years), without evidence of growth rebound during this period of development. Published data are inadequate to determine whether chronic use of amphetamines may cause a similar suppression of growth, however, it is anticipated that they will likely have this effect as well. Therefore, growth should be monitored during treatment with stimulants, and patients who are not growing or gaining weight as expected may need to have their treatment interrupted.

Seizures

There is some clinical evidence that stimulants may lower the convulsive threshold in patients with prior history of seizure, in patients with prior EEG abnormalities in absence of seizures, and very rarely, in patients without a history of seizures and no prior EEG evidence of seizures. In the presence of seizures, the drug should be discontinued.

Visual Disturbance

Difficulties with accommodation and blurring of vision have been reported with stimulant treatment.

PRECAUTIONS

General:

The least amount of amphetamine feasible should be prescribed or dispensed at one time in order to minimize the possibility of overdosage. ADDERALL® should be used with caution in patients who use other sympathomimetic drugs.

Tics:

Amphetamines have been reported to exacerbate motor and phonic tics and Tourette’s syndrome. Therefore, clinical evaluation for tics and Tourette’s syndrome in children and their families should precede use of stimulant medications.

Information for Patients:

Amphetamines may impair the ability of the patient to engage in potentially hazardous activities such as operating machinery or vehicles; the patient should therefore be cautioned accordingly.

Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with amphetamine or dextroamphetamine and should counsel them in its appropriate use. A patient Medication Guide is available for ADDERALL®.

The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. The complete text of the Medication Guide is reprinted at the end of this document.

Carcinogenesis/Mutagenesis and Impairment of Fertility:

No evidence of carcinogenicity was found in studies in which d,l-amphetamine (enantiomer ratio of 1:1) was administered to mice and rats in the diet for 2 years at doses of up to 30 mg/kg/day in male mice, 19 mg/kg/day in female mice, and 5 mg/kg/day in male and female rats. These doses are approximately 2.4, 1.5, and 0.8 times, respectively, the maximum recommended human dose of 30 mg/day [child] on a mg/m2 body surface area basis.

Amphetamine, in the enantiomer ratio present in ADDERALL® (immediate-release)(d- to l- ratio of 3:1), was not clastogenic in the mouse bone marrow micronucleus test in vivo and was negative when tested in the E. coli component of the Ames test in vitro. d, l-Amphetamine (1:1 enantiomer ratio) has been reported to produce a positive response in the mouse bone marrow micronucleus test, an equivocal response in the Ames test, and negative responses in the in vitro sister chromatid exchange and chromosomal aberration assays.

Amphetamine, in the enantiomer ratio present in ADDERALL® (immediate-release)(d- to l- ratio of 3:1), did not adversely affect fertility or early embryonic development in the rat at doses of up to 20 mg/kg/day (approximately 5 times the maximum recommended human dose of 30 mg/day on a mg/m2 body surface area basis).

Pregnancy

Teratogenic Effects:

Pregnancy Category C.

Amphetamine, in the enantiomer ratio present in ADDERALL® (d- to l- ratio of 3:1), had no apparent effects on embryofetal morphological development or survival when orally administered to pregnant rats and rabbits throughout the period of organogenesis at doses of up to 6 and 16 mg/kg/day, respectively. These doses are approximately 1.5 and 8 times, respectively, the maximum recommended human dose of 30 mg/day [child] on a mg/m2 body surface area basis. Fetal malformations and death have been reported in mice following parenteral administration of d-amphetamine doses of 50 mg/kg/day (approximately 6 times that of a human dose of 30 mg/day [child] on a mg/m2 basis) or greater to pregnant animals. Administration of these doses was also associated with severe maternal toxicity.

A number of studies in rodents indicate that prenatal or early postnatal exposure to amphetamine (d- or d,l-), at doses similar to those used clinically, can result in long-term neurochemical and behavioral alterations. Reported behavioral effects include learning and memory deficits, altered locomotor activity, and changes in sexual function.

There are no adequate and well-controlled studies in pregnant women. There has been one report of severe congenital bony deformity, tracheo-esophageal fistula, and anal atresia (vater association) in a baby born to a woman who took dextroamphetamine sulfate with lovastatin during the first trimester of pregnancy. Amphetamines should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nonteratogenic Effects:

Infants born to mothers dependent on amphetamines have an increased risk of premature delivery and low birth weight. Also, these infants may experience symptoms of withdrawal as demonstrated by dysphoria, including agitation, and significant lassitude.

Usage in Nursing Mothers:

Amphetamines are excreted in human milk. Mothers taking amphetamines should be advised to refrain from nursing.

Pediatric Use:

Long-term effects of amphetamines in children have not been well established. Amphetamines are not recommended for use in children under 3 years of age with Attention Deficit Hyperactivity Disorder described under INDICATIONS AND USAGE.

Geriatric Use:

ADDERALL® has not been studied in the geriatric population.

Last reviewed on RxList: 10/4/2010

Adderall Overdosage & Contraindications

OVERDOSE

Individual patient response to amphetamines varies widely. Toxic symptoms may occur idiosyncratically at low doses.

Symptoms:

Manifestations of acute overdosage with amphetamines include restlessness, tremor, hyperreflexia, rapid respiration, confusion, assaultiveness, hallucinations, panic states, hyperpyrexia and rhabdomyolysis.

Fatigue and depression usually follow the central stimulation.

Cardiovascular effects include arrhythmias, hypertension or hypotension and circulatory collapse.

Gastrointestinal symptoms include nausea, vomiting, diarrhea, and abdominal cramps. Fatal poisoning is usually preceded by convulsions and coma.

Treatment:

Consult with a Certified Poison Control Center for up to date guidance and advice. Management of acute amphetamine intoxication is largely symptomatic and includes gastric lavage, administration of activated charcoal, administration of a cathartic and sedation. Experience with hemodialysis or peritoneal dialysis is inadequate to permit recommendation in this regard. Acidification of the urine increases amphetamine excretion, but is believed to increase risk of acute renal failure if myoglobinuria is present. If acute, severe hypertension complicates amphetamine overdosage, administration of intravenous phentolamine has been suggested. However, a gradual drop in blood pressure will usually result when sufficient sedation has been achieved. Chlorpromazine antagonizes the central stimulant effects of amphetamines and can be used to treat amphetamine intoxication.

CONTRAINDICATIONS

Advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, known hypersensitivity or idiosyncrasy to the sympathomimetic amines, glaucoma.

Agitated states.

Patients with a history of drug abuse.

During or within 14 days following the administration of monoamine oxidase inhibitors (hypertensive crises may result).

Last reviewed on RxList: 10/4/2010

Adderall Clinical Pharmacology

CLINICAL PHARMACOLOGY

Pharmacodynamics

Amphetamines are non-catecholamine sympathomimetic amines with CNS stimulant activity. The mode of therapeutic action in Attention Deficit Hyperactivity Disorder (ADHD) is not known. Amphetamines are thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space.

Pharmacokinetics

ADDERALL® tablets contain d-amphetamine and l-amphetamine salts in the ratio of 3:1. Following administration of a single dose 10 or 30 mg of ADDERALL® to healthy volunteers under fasted conditions, peak plasma concentrations occurred approximately 3 hours post-dose for both d-amphetamine and l-amphetamine. The mean elimination half-life (t½) for d-amphetamine was shorter than the t½ of the l-isomer (9.77-11 hours vs. 11.5-13.8 hours). The PK parameters (Cmax, AUC0-inf) of d-and l-amphetamine increased approximately three-fold from 10 mg to 30 mg indicating dose-proportional pharmacokinetics.

The effect of food on the bioavailability of ADDERALL® has not been studied.

Metabolism and Excretion:

Amphetamine is reported to be oxidized at the 4 position of the benzene ring to form 4-hydroxyamphetamine, or on the side chain a or ß carbons to form alpha-hydroxy-amphetamine or norephedrine, respectively. Norephedrine and 4-hydroxy-amphetamine are both active and each is subsequently oxidized to form 4-hydroxy-norephedrine. Alpha-hydroxy-amphetamine undergoes deamination to form phenylacetone, which ultimately forms benzoic acid and its glucuronide and the glycine conjugate hippuric acid. Although the enzymes involved in amphetamine metabolism have not been clearly defined, CYP2D6 is known to be involved with formation of 4-hydroxy-amphetamine. Since CYP2D6 is genetically polymorphic, population variations in amphetamine metabolism are a possibility.

Amphetamine is known to inhibit monoamine oxidase, whereas the ability of amphetamine and its metabolites to inhibit various P450 isozymes and other enzymes has not been adequately elucidated. In vitro experiments with human microsomes indicate minor inhibition of CYP2D6 by amphetamine and minor inhibition of CYP1A2, 2D6, and 3A4 by one or more metabolites. However, due to the probability of auto-inhibition and the lack of information on the concentration of these metabolites relative to in vivo concentrations, no predications regarding the potential for amphetamine or its metabolites to inhibit the metabolism of other drugs by CYP isozymes in vivo can be made.

With normal urine pHs approximately half of an administered dose of amphetamine is recoverable in urine as derivatives of alpha-hydroxy-amphetamine and approximately another 30%-40% of the dose is recoverable in urine as amphetamine itself. Since amphetamine has a pKa of 9.9, urinary recovery of amphetamine is highly dependent on pH and urine flow rates. Alkaline urine pHs result in less ionization and reduced renal elimination, and acidic pHs and high flow rates result in increased renal elimination with clearances greater than glomerular filtration rates, indicating the involvement of active secretion. Urinary recovery of amphetamine has been reported to range from 1% to 75%, depending on urinary pH, with the remaining fraction of the dose hepatically metabolized. Consequently, both hepatic and renal dysfunction have the potential to inhibit the elimination of amphetamine and result in prolonged exposures. In addition, drugs that effect urinary pH are known to alter the elimination of amphetamine, and any decrease in amphetamine’s metabolism that might occur due to drug interactions or genetic polymorphisms is more likely to be clinically significant when renal elimination is decreased, (See PRECAUTIONS).

Last reviewed on RxList: 10/4/2010

Adderall Medication Guide

PATIENT INFORMATION

MEDICATION GUIDE

ADDERALL®
AMPHETAMINE ASPARTATE; AMPHETAMINE SULFATE; DEXTROAMPHETAMINE SACCHARATE; DEXTROAMPHETAMINE SULFATE

READ THE MEDICATION GUIDE THAT COMES WITH ADDERALL® BEFORE YOU OR YOUR CHILD STARTS TAKING IT AND EACH TIME YOU GET A REFILL. THERE MAY BE NEW INFORMATION. THIS MEDICATION GUIDE DOES NOT TAKE THE PLACE OF TALKING TO YOUR DOCTOR ABOUT YOU OR YOUR CHILD’S TREATMENT WITH ADDERALL®.

WHAT IS THE MOST IMPORTANT INFORMATION I SHOULD KNOW ABOUT ADDERALL®?

THE FOLLOWING HAVE BEEN REPORTED WITH USE OF ADDERALL® AND OTHER
STIMULANT MEDICINES.

1. HEART-RELATED PROBLEMS:

sudden death in patients who have heart problems or heart defects

stroke and heart attack in adults

increased blood pressure and heart rate

TELL YOUR DOCTOR IF YOU OR YOUR CHILD HAVE ANY HEART PROBLEMS, HEART DEFECTS, HIGH BLOOD PRESSURE, OR A FAMILY HISTORY OF THESE PROBLEMS.
YOUR DOCTOR SHOULD CHECK YOU OR YOUR CHILD CAREFULLY FOR HEART PROBLEMS BEFORE STARTING ADDERALL®.
YOUR DOCTOR SHOULD CHECK YOUR OR YOUR CHILD’S BLOOD PRESSURE AND HEART RATE REGULARLY DURING TREATMENT WITH ADDERALL®.

CALL YOUR DOCTOR RIGHT AWAY IF YOU OR YOUR CHILD HAVE ANY SIGNS OF HEART PROBLEMS SUCH AS CHEST PAIN, SHORTNESS OF BREATH, OR FAINTING WHILE TAKING ADDERALL®.

2. MENTAL (PSYCHIATRIC) PROBLEMS:
ALL PATIENTS

new or worse behavior and thought problems

new or worse bipolar illness

new or worse aggressive behavior or hostility

CHILDREN AND TEENAGERS

new psychotic symptoms (such as hearing voices, believing things that are not true, are suspicious) or new manic symptoms

TELL YOUR DOCTOR ABOUT ANY MENTAL PROBLEMS YOU OR YOUR CHILD HAVE, OR ABOUT A FAMILY HISTORY OF SUICIDE, BIPOLAR ILLNESS, OR DEPRESSION.

Call your doctor right away if you or your child have any new or worsening mental symptoms or problems while taking ADDERALL®, especially seeing or hearing things that are not real, believing things that are not real, or are suspicious.

WHAT IS ADDERALL®?

ADDERALL® IS A CENTRAL NERVOUS SYSTEM STIMULANT PRESCRIPTION MEDICINE. IT IS USED FOR THE TREATMENT OF ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD). ADDERALL® MAY HELP INCREASE ATTENTION AND DECREASE IMPULSIVENESS AND HYPERACTIVITY IN PATIENTS WITH ADHD.
ADDERALL® SHOULD BE USED AS A PART OF A TOTAL TREATMENT PROGRAM FOR ADHD THAT MAY INCLUDE COUNSELING OR OTHER THERAPIES.
ADDERALL® IS ALSO USED IN THE TREATMENT OF A SLEEP DISORDER CALLED NARCOLEPSY.

ADDERALL® IS A FEDERALLY CONTROLLED SUBSTANCE (CII) BECAUSE IT CAN BE ABUSED OR LEAD TO DEPENDENCE. KEEP ADDERALL® IN A SAFE PLACE TO PREVENT MISUSE AND ABUSE. SELLING OF GIVING AWAY ADDERALL® MAY HARM OTHERS AND IS AGAINST THE LAW.

Tell your doctor if you or your child have (or have a family history of) ever abused or been dependent on alcohol, prescription medicines or street drugs.

WHO SHOULD NOT TAKE ADDERALL®?

ADDERALL® SHOULD NOT BE TAKEN IF YOU OR YOUR CHILD:

have heart disease or hardening of the arteries

have moderate to severe high blood pressure

have hyperthyroidism

have an eye problem called glaucoma

are very anxious, tense, or agitated

have a history of drug abuse

are taking or have taken within the past 14 days an anti-depression medicine called a monoamine oxidase inhibitor or MAOI.

are sensitive to, allergic to, or had a reaction to other stimulant medicines

ADDERALL® IS NOT RECOMMENDED FOR USE IN CHILDREN LESS THAN 3 YEARS OLD.
ADDERALL® MAY NOT BE RIGHT FOR YOU OR YOUR CHILD. BEFORE STARTING ADDERALL® TELL YOUR OR YOUR CHILD’S DOCTOR ABOUT ALL HEALTH CONDITIONS (OR A FAMILY HISTORY OF) INCLUDING:

heart problems, heart defects, high blood pressure

mental problems including psychosis, mania, bipolar illness, or depression

tics or Tourette’s syndrome

liver or kidney problems

thyroid problems

seizures or have had an abnormal brain wave test (EEG)

TELL YOUR DOCTOR IF YOU OR YOUR CHILD ARE PREGNANT, PLANNING TO BECOME PREGNANT,OR BREASTFEEDING.

CAN ADDERALL® BE TAKEN WITH OTHER MEDICINES?

PRESCRIPTION AND NONPRESCRIPTION MEDICINES, VITAMINS, AND HERBAL SUPPLEMENTS. ADDERALL® AND SOME MEDICINES MAY INTERACT WITH EACH OTHER AND CAUSE SERIOUS SIDE EFFECTS. SOMETIMES THE DOSES OF OTHER MEDICINES WILL NEED TO BE ADJUSTED WHILE TAKING ADDERALL®.
YOUR DOCTOR WILL DECIDE WHETHER ADDERALL® CAN BE TAKEN WITH OTHER MEDICINES.
ESPECIALLY TELL YOUR DOCTOR IF YOU OR YOUR CHILD TAKE:

anti-depression medicines including MAOIs

blood pressure medicines

seizure medicines

blood thinner medicines

cold or allergy medicines that contain decongestants

stomach acid medicines

KNOW THE MEDICINES THAT YOU OR YOUR CHILD TAKE. KEEP A LIST OF YOUR MEDICINES WITH YOU TO SHOW YOUR DOCTOR AND PHARMACIST.

DO NOT START ANY NEW MEDICINE WHILE TAKING ADDERALL® WITHOUT TALKING TO YOUR DOCTOR FIRST.

HOW SHOULD ADDERALL® BE TAKEN?

Take ADDERALL® exactly as prescribed. Your doctor may adjust the dose until it is right for you or your child.

ADDERALL® tablets are usually taken two to three times a day. The first dose is usually taken when you first wake in the morning. One or two more doses may be taken during the day, 4 to 6 hours apart.

ADDERALL® can be taken with or without food.

From time to time, your doctor may stop ADDERALL® treatment for a while to check ADHD symptoms.

Your doctor may do regular checks of the blood, heart, and blood pressure while taking ADDERALL®. Children should have their height and weight checked often while taking ADDERALL®. ADDERALL® treatment may be stopped if a problem is found during these check-ups.

If you or your child take too much ADDERALL® or overdoses, call your doctor or poison control center right away, or get emergency treatment.

WHAT ARE POSSIBLE SIDE EFFECTS OF ADDERALL®?

SEE “WHAT IS THE MOST IMPORTANT INFORMATION I SHOULD KNOW ABOUT ADDERALL®?” FOR INFORMATION ON REPORTED HEART AND MENTAL PROBLEMS.

ADDERALL® MAY AFFECT YOUR OR YOUR CHILD’S ABILITY TO DRIVE OR DO OTHER DANGEROUS ACTIVITIES. TALK TO YOUR DOCTOR IF YOU OR YOUR CHILD HAVE SIDE EFFECTS THAT ARE BOTHERSOME OR DO NOT GO AWAY.
THIS IS NOT A COMPLETE LIST OF POSSIBLE SIDE EFFECTS. ASK YOUR DOCTOR OR PHARMACIST FOR MORE INFORMATION.

HOW SHOULD I STORE ADDERALL®

Store ADDERALL® in a safe place at room temperature, 20° to 25°C (68° to 77°F).

Keep ADDERALL® and all medicines out of the reach of children.

GENERAL INFORMATION ABOUT ADDERALL®

MEDICINES ARE SOMETIMES PRESCRIBED FOR PURPOSES OTHER THAN THOSE LISTED IN A MEDICATION GUIDE. DO NOT USE ADDERALL® FOR A CONDITION FOR WHICH IT WAS NOT PRESCRIBED. DO NOT GIVE ADDERALL® TO OTHER PEOPLE, EVEN IF THEY HAVE THE SAME CONDITION. IT MAY HARM THEM AND IT IS AGAINST THE LAW. THIS MEDICATION GUIDE SUMMARIZES THE MOST IMPORTANT INFORMATION ABOUT ADDERALL®. IF YOU WOULD LIKE MORE INFORMATION, TALK WITH YOUR DOCTOR. YOU CAN ASK YOUR DOCTOR OR PHARMACIST FOR INFORMATION ABOUT ADDERALL® THAT WAS WRITTEN FOR HEALTHCARE PROFESSIONALS. FOR MORE INFORMATION ABOUT ADDERALL®, PLEASE CONTACT BARR LABORATORIES, INC. AT 1-800-BARRLAB(227- 7522).

WHAT ARE THE INGREDIENTS IN ADDERALL®?

ACTIVE INGREDIENT: DEXTROAMPHETAMINE SACCHARATE, AMPHETAMINE ASPARTATE MONOHYDRATE, DEXTROAMPHETAMINE SULFATE, USP, AMPHETAMINE SULFATE, USP

INACTIVE INGREDIENTS: LACTITOL, MICROCRYSTALLINE CELLULOSE, COLLOIDAL SILICON DIOXIDE, MAGNESIUM STEARATE, AND OTHER INGREDIENTS.

THIS MEDICATION GUIDE HAS BEEN APPROVED BY THE U.S. FOOD AND DRUG

Adderall Consumer

IMPORTANT NOTE: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your health care professional. Always seek the advice of your health care professional if you have any questions about this product or your medical condition. This information is not intended as individual medical advice and does not substitute for the knowledge and judgment of your health care professional. This information does not contain any assurances that this product is safe, effective, or appropriate for you.

AMPHETAMINE/DEXTROAMPHETAMINE – ORAL

(am-FET-a-meen/DEX-troe-am-FET-a-meen)

COMMON BRAND NAME(S): Adderall

WARNING: Misuse or abuse of amphetamine may result in serious (possibly fatal) heart and blood pressure problems. Amphetamine-type medications can be habit-forming. Use only as directed. With prolonged use, drug dependence may occur, and withdrawal symptoms may occur after stopping the drug. Consult your doctor or pharmacist for more details.

USES: This combination medication is used as part of a total treatment program to control attention deficit hyperactivity disorder (ADHD). It may help to increase the ability to pay attention, stay focused, and control behavior problems.

This product is a combination of stimulants (amphetamine and dextroamphetamine). It is thought to work by restoring the balance of certain natural substances (neurotransmitters) in the brain.

This drug may also be used to treat certain sleeping disorders (narcolepsy). It should not be used to treat tiredness or to hold off sleep in people who do not have a sleep disorder.

HOW TO USE: Read the Medication Guide provided by your pharmacist before you start using amphetamine/dextroamphetamine and each time you get a refill. If you have any questions, consult your doctor or pharmacist.

Take this medication by mouth, usually when you first wake up in the morning or as directed by your doctor. If additional doses are prescribed, take them 4-6 hours apart. Taking this medication less than 6 hours before bedtime may cause trouble sleeping. Take this medication exactly as prescribed.

The dosage is based on your medical condition and response to therapy. Your doctor may adjust your dose to find the dose that is best for you. Follow your doctor's instructions carefully.

Use this medication regularly and exactly as prescribed in order to get the most benefit from it. To help you remember, use it at the same time each day.

This medication may cause withdrawal reactions, especially if it has been used regularly for a long time (more than a few weeks) or in high doses. In such cases, withdrawal symptoms (such as severe tiredness, mood changes including depression, and sleep problems) may occur if you suddenly stop using this medication. To prevent withdrawal reactions, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details, and report any withdrawal reactions immediately.

Though it is unlikely to occur, this medication can also result in abnormal drug-seeking behavior (addiction/habit-forming). Do not increase your dose, take it more frequently or use it for a longer period of time than prescribed. Properly stop the medication when so directed. This will lessen the chances of becoming addicted.

When used for a long period, this medication may not work as well and may require different dosing. Talk with your doctor if this medication stops working well.

If you are using this drug for ADHD, your doctor may recommend “drug holidays” when the medication is stopped for a short time to observe any changes in behavior.

Inform your doctor if your condition does not improve or if it worsens.

Adderall Consumer (continued)

SIDE EFFECTS: Loss of appetite, weight loss, dry mouth, stomach upset/pain, nausea/vomiting, dizziness, headache, diarrhea, fever, nervousness, and trouble sleeping may occur. If any of these effects persist or worsen, notify your doctor promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor immediately if any of these unlikely but serious side effects occur: mental/mood/behavior changes (e.g., agitation, aggression, mood swings, depression, abnormal thoughts), uncontrolled movements, continuous chewing movements/teeth grinding, outbursts of words/sounds, change in sexual ability/desire.

Seek immediate medical attention if any of these rare but very serious side effects occur: shortness of breath, chest pain, fainting, severe headache, fast/pounding/irregular heartbeat, jaw/left arm pain, seizures, swelling of the ankles/feet, extreme tiredness, blurred vision, weakness on one side of the body, slurred speech, confusion.

A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US –

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: Before taking this medication, tell your doctor or pharmacist if you are allergic to it; or to sympathomimetic drugs (e.g., epinephrine, pseudoephedrine); or if you have any other allergies.

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: certain mental/mood conditions (e.g., agitation, psychosis), heart/blood vessel disease (e.g., irregular heartbeat, coronary artery disease, angina, heart failure, cardiomyopathy), problems with heart structure (e.g., valve problems), history of heart attack or stroke, moderate or severe high blood pressure (hypertension), overactive thyroid (hyperthyroidism), a certain eye problem (glaucoma), personal or family history of regular use/abuse of drugs/alcohol.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: personal or family history of uncontrolled movements or outbursts of words/sounds (e.g., due to Tourette's syndrome), family history of sudden death/irregular heartbeat/rhythm, mild high blood pressure (hypertension), kidney disease, liver disease, family/personal history of mental/mood disorders (e.g., bipolar disorder, depression, psychotic disorder, suicidal thoughts), seizures.

This drug may make you dizzy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages.

Before having surgery, tell your doctor or dentist that you are taking this medication.

Caution is advised when using this drug in children because it may affect weight, growth rate, and final height. The doctor may recommend temporarily stopping the medication from time to time to avoid this risk. Consult your doctor or pharmacist for more details. This drug is not recommended for use in children under 3.

This medication should be used only when clearly needed during pregnancy. Infants born to mothers dependent on this medication may have birth defects, be born too soon (premature delivery), and have low birth weight. They may also have withdrawal symptoms. Tell your doctor immediately if you notice possible mood changes, agitation, or unusual tiredness in your newborn. Discuss the risks and benefits with your doctor.

This medication passes into breast milk and may have undesirable effects on a nursing infant. Breast-feeding is not recommended while using this drug. Consult your doctor before breast-feeding.

Adderall Consumer (continued)

DRUG INTERACTIONS: Your healthcare professionals (e.g., doctor or pharmacist) may already be aware of any possible drug interactions and may be monitoring you for it. Do not start, stop or change the dosage of any medicine before checking with them first.

This drug should not be used with the following medications because very serious interactions may occur: MAO inhibitors.

Avoid taking MAO inhibitors (e.g., furazolidone, isocarboxazid, linezolid, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) within 2 weeks before, during, and after treatment with this medication. In some cases, a serious, possibly fatal drug interaction may occur.

If you are currently using any of these medications listed above, tell your doctor or pharmacist before starting this medication.

Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: certain antidepressants (e.g., tricyclic antidepressants such as nortriptyline and imipramine, SSRIs such as fluoxetine and paroxetine, and SSNRIs such as venlafaxine), alpha blockers (e.g., prazosin), certain antihistamines (e.g., diphenhydramine), beta blockers (e.g., atenolol, metoprolol), drugs for high blood pressure (e.g., clonidine, guanabenz, methyldopa), certain drugs for mental/mood conditions (e.g., antipsychotics such as chlorpromazine/haloperidol, lithium), certain pain medicines (e.g., meperidine, propoxyphene), certain anti-seizure drugs (e.g., ethosuximide, phenytoin, phenobarbital), stimulants (e.g., norepinephrine, phenylephrine), veratrum alkaloids (e.g., cevadine, veratridine).

Certain foods and drugs can affect the amount of acid in your stomach/intestines or urine. This can affect how well your body absorbs and uses this medication. Tell your doctor if you take any of these products: ammonium chloride, antacids, anti-ulcer medicine (e.g., H2 blockers such as famotidine and ranitidine, proton pump inhibitors such as omeprazole and lansoprazole), ascorbic acid (vitamin C), aspirin, carbonic anhydrase inhibitors (e.g., acetazolamide), fruit juices, glutamic acid, guanethidine, methenamine, reserpine, sodium acid phosphate, sodium bicarbonate, certain “water pills” (diuretics, including some thiazides).

Also report the use of drugs which might increase seizure risk (decrease seizure threshold) when combined with this medication such as bupropion, isoniazid (INH), phenothiazines (e.g., thioridazine), theophylline, tramadol, or tricyclic antidepressants (e.g., amitriptyline), among others. Consult your doctor or pharmacist for details.

Check the labels on all your medicines (e.g., cough-and-cold products, diet aids) because they may contain ingredients that could increase your heart rate or blood pressure. Ask your pharmacist about the safe use of these products.

Avoid drinking large amounts of beverages containing caffeine (e.g., coffee, tea, colas) or eating large amounts of chocolate. Caffeine can increase the side effects of this medication.

This medication may affect the results of certain lab tests (blood and urine steroid levels). Tell your doctor or laboratory personnel if you are taking this medication.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include: severe mental/mood changes, seizures, severe or persistent headache, severe restlessness, fast breathing.

NOTES: Do not share this medication with others. It is against the law.

Laboratory and/or medical tests (e.g., blood pressure, heart rate, growth monitoring in children) may be performed to check for side effects. Consult your doctor for more details.

MISSED DOSE: If you miss a dose, use it as soon as you remember in the morning hours. If it is less than 6 hours until bedtime, or if it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE: Store at room temperature at 77 degrees F (25 degrees C) in a tightly closed container. Brief storage between 59-86 degrees F (15-30 degrees C) is permitted. Do not store in the bathroom. Protect from light and moisture. Keep all medicines away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

Information last revised July 2009 Copyright(c) 2009 First DataBank, Inc.