Dextroamphetamine and amphetamine (oral)

Overview

Prescribed as a combination medicine, Dextroamphetamine and amphetamine is effective in treatment patients with attention deficit hyperactivity disorder (ADHD) and patients who have been diagnosed with narcolepsy.

Attention deficit hyperactivity disorder is a fairly common condition and is often displayed in the patient's behavior. Typically, patients with ADHD have trouble focusing and may be unable to pay attention to things for long periods of times. In addition to this, ADHD may cause patients to act impulsively or to behave in a hyperactive manner. As ADHD affects functioning and behavior, it can affect every part of the patient's life. Their education, work, social activities and personal relationships can all suffer if ADHD is undiagnosed and/or untreated.

Believed to be caused by problems with the brain's neurotransmitters, ADHD can be treated with Dextroamphetamine and amphetamine. As this medication affects the serotonin, norepinephrine and dopamine neurotransmitters, it can help patients to control their behavior more easily, calm racing thoughts and reduce impulsive or hyperactive behavior. As a result, patients tend to perform better at work or school and are able to build and maintain functional and mutually rewarding relationships.

Although the role of neurotransmitters is believed to be one of the causes of ADHD, the complete cause of the disorder is still unknown. Whilst Dextroamphetamine and amphetamine is an effective treatment for patients, it is often prescribed in conjunction with educational, psychological and social therapies.

If patients are suffering from narcolepsy, they are typically unable to control the onset of sleep. Patients may be extremely sleep or drowsy for extended periods of time and they may also report instances of sleep paralysis and hallucinations. In some cases, patients with narcolepsy also suffer from cataplexy. This involves a loss of muscle control and may be triggered by strong emotions. Due to the sudden nature of cataplexy, patients may be unable to perform numerous tasks safely if the condition isn't treated.

Without effective treatment, narcolepsy can be extremely distressing for the patient. The need to sleep for excessive periods means that many patients miss schooling or are unable to work. In addition to this, patients may find it difficult to socialize or perform day-to-day tasks due to the condition.

As Dextroamphetamine and amphetamine is a stimulant, it helps patients with narcolepsy to stay alert for longer periods of time. It is believed that Dextroamphetamine and amphetamine is effective for narcoleptic patients because it increases levels of dopamine in the brain. In addition to this, Dextroamphetamine and amphetamine also has an impact on serotonin and norepinephrine which are known to be wake-promoting chemicals. By affecting these neurotransmitters, Dextroamphetamine and amphetamine increases alertness and reduces the excessive sleepiness and fatigue which characterizes narcolepsy.

Conditions Treated

  • Attention deficit hyperactivity disorder (ADHD)
  • Narcolepsy

Type Of Medicine

  • Central nervous system stimulant

Side Effects

When taking Dextroamphetamine and amphetamine, patients may notice some side-effects occurring, particularly when they first start taking the medication. The following side-effects often diminish over time and may not need medical attention:

  • Anxiety
  • Loss or lack of strength
  • Dry mouth
  • Pain in stomach
  • Weight loss
  • Decreased interest in sexual activity
  • Unusual or false sense of well-being
  • Constipation
  • Inability to have or keep an erection
  • Twisting, twitching or uncontrolled repetitive movements of the lips, arms, face, tongue or legs
  • Loss in sexual desire, ability, performance or drive

Although the above side-effects are likely to reduce once the patient has been taking Dextroamphetamine and amphetamine for some time, patients should seek medical advice if they are concerned about any adverse effects. If side-effects are particularly severe or do not diminish, they should contact their physician.

If patients experience the following side-effects when taking Dextroamphetamine and amphetamine, they should seek medical advice or assistance:

  • Bladder pain
  • Cloudy or bloody urine
  • Difficulty urinating
  • Irregular, pounding or fast heartbeat or pulse
  • Increased urination
  • Pain or burning when urinating
  • Pain in side or lower back
  • Cold or flu-like symptoms
  • Hoarseness or cough
  • Chills or fever
  • Loosening, blistering or peeling of the skin
  • Pain in chest
  • Confusion
  • Chest discomfort
  • Convulsions
  • Difficulty breathing
  • Dark-colored urine
  • Difficulty speaking
  • Diarrhea
  • Dizziness
  • Difficulty swallowing
  • Faintness
  • Double vision
  • Headache
  • Loss of bladder control
  • Inability to move legs, arms or facial muscles
  • Itching
  • Inability to speak
  • Muscle or joint pain
  • Large, hive-like swelling on the eyelids, face, lips, throat, tongue, hands, feet, legs or sex organs
  • Muscle spasms or cramps
  • Sweating
  • Muscle stiffness or pain
  • Swelling of the lower legs or feet
  • Muscle spasm or jerking of extremities
  • Chest tightness
  • Nausea
  • Discomfort or pain in the jaw, arms, neck or back
  • Red skin lesions, sometimes with a purple center
  • Troubled or labored breathing
  • Irritated, red eyes
  • Tics or uncontrolled repeated movements
  • Feeling, hearing or seeing things that are not there
  • Uncontrolled vocal outbursts
  • Rash on skin
  • Sudden loss of consciousness
  • Unusual weakness or tiredness
  • Slow speech
  • Sore throat
  • White spots, ulcers or sores on the lips or in the mouth
  • Vomiting

The presence of these side-effects does not necessarily mean that patients will need to stop taking their medication but they do warrant medical attention. By consulting with their physician, patients can confirm that they have been prescribed the appropriate dose of Dextroamphetamine and amphetamine and that their medication is not having any unwanted, potential harmful effects.

Additionally, patients should seek medical advice if they experience any side-effects which are not listed above.

Dosage

When patients are given prescription medicines, their doctor will provide instructions regarding when to take their medication and how much they should take. There are, however, standard dosing regimes for Dextroamphetamine and amphetamine and these may be applicable to some patients.

When standard Dextroamphetamine and amphetamine tablets are prescribed to patients with ADHD, a typical dose may be 5mg to be taken once or twice daily. If children between the ages 3-5 years are given Dextroamphetamine and amphetamine, however, they will be given a smaller dose. Typically, children of this age are prescribed 2.5mg of standard Dextroamphetamine and amphetamine tablets to be taken once daily.

Alternatively, if patients are prescribed extended-release Dextroamphetamine and amphetamine tablets for ADHD, they may be given a dose of 20mg to be taken once per day. For patients between the ages of 13-17 years, a dose of 10mg per day may be given. Children between the ages of 6-12 years may also be prescribed 10mg per day but, if their dose needs to be increased, they will not usually be prescribed more than 30mg per day.

When taking extended-release Dextroamphetamine and amphetamine tablets, patients are usually advised to take their medication in the morning. Patients are not usually advised to take any Dextroamphetamine and amphetamine tablet in the evening as it may disrupt their sleeping pattern.

If Dextroamphetamine and amphetamine is prescribed for the treatment of narcolepsy, patients are usually given a dose of 10mg per day, divided into two doses. If children between the ages of six and 12 years are treated for this condition, they are usually prescribed a dose of 5mg per day.

Although these are standard dosages strategies for treatment with Dextroamphetamine and amphetamine, every patient will be prescribed individual dosage instructions when they are given the medication. Normally, doctors will monitor the effects of the medication and increase the patient's dose if it is necessary to do so. Patients should never change the dose of the medication themselves and should always follow their doctor's treatment instructions.

If patients miss a dose of Dextroamphetamine and amphetamine, they should take their medication as soon as possible. If their next dose is due soon, however, they should skip the missed dose and continue taking their medication as normal. Patients should not take a double dose of Dextroamphetamine and amphetamine, even if they have missed a previous dose.

If patients are unsure how to take their medicine or are unsure how to proceed after missing a dose of Dextroamphetamine and amphetamine, they should seek medical advice from their physician or pharmacist.

Potential Drug Interactions

When taking any medication, it's important to be aware that drugs can interact with one another. Due to this, physicians may not prescribe Dextroamphetamine and amphetamine to patients who are already taking:

  • Clorgyline
  • Furazolidone
  • Iproniazid
  • Toloxatone
  • Isocarboxazid
  • Selegiline
  • Linezolid
  • Safinamide
  • Methylene Blue
  • Procarbazine
  • Moclobemide
  • Pargyline
  • Nialamide
  • Phenelzine
  • Rasagiline
  • Sibutramine
  • Tranylcypromine

Furthermore, physicians will not usually prescribe Dextroamphetamine and amphetamine to patients who are taking the following medications:

  • Benzthiazide
  • Acetazolamide
  • Chlorothiazide
  • Trichlormethiazide
  • Chlorpromazine
  • Safinamide
  • Diazoxide
  • Hydroxytryptophan
  • Donepezil
  • Hydrochlorothiazide
  • Furazolidone
  • Hydroflumethiazide
  • Polythiazide
  • Sodium Bicarbonate
  • Xipamide

Although the use of Dextroamphetamine and amphetamine in conjunction with the above medications is not usually advised, doctors may be willing to prescribe it if they feel that the benefits to the patient outweigh the risks.

If Dextroamphetamine and amphetamine is prescribed with the above medications, doctors may alter the patient's dose to try and prevent interactions occurring. In addition to this, doctors may prescribe specific treatment instructions so that medications are taken at different times of the day.

When patients are taking Dextroamphetamine and amphetamine, they following medication may increase the risk of side-effects occurring:

  • Guanethidine

If patients do experience adverse effects when taking this combination of medications, they should contact their physician for advice. Often, additional medications can be given to reduce side-effects.

As well as interacting with other prescription medications, Dextroamphetamine and amphetamine could interact with supplements, vitamins and over-the-counter medications. Patients should tell their doctor if they consume any of these substances before they begin treatment.

Once patients have begun taking Dextroamphetamine and amphetamine, they should seek medical advice before purchasing or taking over-the-counter medicines, supplements or vitamins.

Warnings

Before prescribing Dextroamphetamine and amphetamine, doctors will discuss the patient's medical history with them to ensure that the medication is right for them. There are some conditions which may prevent Dextroamphetamine and amphetamine from being prescribed. These include:

If patients have a history of any of these conditions and are still prescribed Dextroamphetamine and amphetamine, their dose of medication may be altered to prevent their existing medical conditions from being worsened.

Pediatric patients may be prescribed Dextroamphetamine and amphetamine but patients under 6 years of age are not usually treated with extended-release tablets and children under the age of 3 years are not usually prescribed Dextroamphetamine and amphetamine at all.

Dextroamphetamine and amphetamine can sometimes cause slow growth in patients. If young patients are prescribed this medication, their doctor will check their height and weight at regular intervals.

If patients are due to undergo any medical tests, they should inform the relevant healthcare practitioners that they are taking Dextroamphetamine and amphetamine. This medication may affect the results of any tests which are conducted and should, therefore, be taking into account.

Dextroamphetamine and amphetamine may cause patients to develop Raynaud's disease. This is characterized by pain or tingling in the fingers or toes. Patients may also experience a feeling of coldness in their extremities, skin color changes or pale fingers and toes. As the condition affects the blood circulation in the toes and fingers, patients will need to notify their doctor if they develop these symptoms. In addition to this, patients should seek medical help if they develop unexplained ulcers or sores on their fingers or toes.

When taking Dextroamphetamine and amphetamine, patients should have regular check-ups with their doctor. This will enable their physician to modify their dose, if necessary, and confirm that the medication is working appropriately.

Patients should not take Dextroamphetamine and amphetamine alongside a monoamine oxidise (MAO) inhibitor. Furthermore, patients should not take Dextroamphetamine and amphetamine within two weeks of ceasing treatment with an MAO inhibitor. If they do, patients may experience severe convulsions, sudden increase in body temperature, restlessness, confusion, intestinal or stomach symptoms, agitation and/or very high blood pressure. If patients experience these symptoms while taking Dextroamphetamine and amphetamine, they should seek urgent medical help.

When patients are taking Dextroamphetamine and amphetamine, they should not take any other medications unless their doctor has advised them to. This includes medications which can be purchased. Medications for asthma, appetite control, allergies, colds, coughs, hay fever or sinus problems, in particular, can have strong interactions with Dextroamphetamine and amphetamine and may cause harmful side-effects to occur.

Patients could develop serious blood vessel or heart problems when taking Dextroamphetamine and amphetamine. This is more likely to occur if the patient has a family history of heart disease. If patients develop symptoms, such as, difficulty breathing, fainting and/or chest pain when taking this medication, they should obtain immediate medical help.

In some cases, Dextroamphetamine and amphetamine may cause patient's behavior to change. If patients or their family notice changes including hostility, irritability, aggression and/or agitation, they should inform their physician. In addition to this, unusual thoughts or hallucinations should be reported to the patient's physician and medical help should be sought quickly if these appear to worsen or have developed suddenly.

When patients begin taking Dextroamphetamine and amphetamine, they should avoid driving, operating heavy machinery or carrying out tasks which require a high level of attention and alertness. It may take some time for patients to get used to the medication and they should determine how Dextroamphetamine and amphetamine affects them before they perform these tasks.

Patients may feel a false sense of well-being when taking Dextroamphetamine and amphetamine. Patients may also experience lightheadedness and/or dizziness. In addition to this, patients may experience vision problems or blurred vision when taking this medication. If these side-effects are concerning or do not subside, patients should seek medical advice. Patients should not drive or carry out potentially dangerous tasks if they are affected by these types of side-effects.

In some instances, Dextroamphetamine and amphetamine can be habit-forming. Patients who have taken this medication for a long period of time may be more likely to develop a dependency to it. If patients notice the following symptoms, they should seek help from their doctor:

  • Desire to increase their dose to obtain the same effect
  • Withdrawal symptoms after stopping the medication
  • Strong need or desire to continue taking Dextroamphetamine and amphetamine

Withdrawal symptoms may include stomach cramps, nausea, stomach pain, vomiting, trembling, depression and/or unusual weakness or tiredness.

If patients think they may be developing a dependency on their medication, they should contact their doctor for further advice. Even if patients feel dependent on Dextroamphetamine and amphetamine, they should never take more than they have been prescribed. Taking too much Dextroamphetamine and amphetamine can have harmful effects on the patient's heart and could cause sudden death to occur.

It is not yet known if Dextroamphetamine and amphetamine can cause harm to an unborn fetus but studies have suggested it could. Due to this, pregnant patients will not usually be prescribed this medication. If they are given Dextroamphetamine and amphetamine, the risks to them and their unborn baby should be discussed prior to them taking any medication.

Taking Dextroamphetamine and amphetamine when breastfeeding can be harmful to the infant. If patients are breastfeeding, they should not be prescribed this medication and an alternative should be provided.

If patients experience the symptoms of an allergic reaction when taking Dextroamphetamine and amphetamine, they should seek immediate medical help. These symptoms may include:

  • Difficulty breathing
  • Wheezing
  • Itching
  • Hives
  • Rash on skin
  • Swelling of the mouth, throat and/or lips

Storage

Unless patients are advised otherwise, Dextroamphetamine and amphetamine should be kept at room temperature and in a closed container. If pediatric patients are prescribed this medication, their parent, guardian or caregiver should store the medication on their behalf and assist with administering each dose of medicine.

Usually, Dextroamphetamine and amphetamine should be kept out of direct light and away from heat or moisture. If young children and/or pets are in the home, it's vital that this medication is kept out of their reach.

If patients are advised to stop taking Dextroamphetamine and amphetamine or if their medication reaches its use-by date, it should be disposed of carefully. Instead of throwing medication out with household waste, patients should contact their physician's office or pharmacy and use the 'take-back' service provided.

Summary

Although there are side-effects associated with this medication, Dextroamphetamine and amphetamine can be extremely effective for patients with ADHD or narcolepsy. As these conditions tend to have a debilitating effect on the patient's life, successful treatment can be life-changing for both the patient and their families.

By prescribing a relatively low starting dose and monitoring patients thoroughly, physicians can ensure that patients are tolerating the medication well and that it is having the desired effect.