Adderall is a brand-name psychostimulant medication composed of
amphetamineAmphetamine is a psychostimulant drug that is known to produce increased wakefulness and focus in association with decreased fatigue and appetite. Amphetamine is related to drugs such as methamphetamine and dextroamphetamine, which are a group of potent drugs that act by increasing levels of...
and
dextroamphetamineDextroamphetamine is a psychostimulant drug which is known to produce increased wakefulness and focus in association with decreased fatigue and decreased appetite. Drugs with similar psychoactive properties can be referred to or described as "amphetamine analogues", "amphetamine-like", or having...
, which is thought to work by increasing the amount of
dopamineDopamine is a neurotransmitter occurring in a wide variety of animals, including both vertebrates and invertebrates. In the brain, this phenethylamine functions as a neurotransmitter, activating the five types of dopamine receptors — D
1, D
2, D
3, D
4, and...
and
norepinephrineNoradrenaline or norepinephrine is a catecholamine with dual roles as a hormone and a neurotransmitter....
in the brain. Adderall is widely reported to increase alertness, libido, concentration and overall cognitive performance while decreasing user fatigue. It is available in two formulations: immediate release (IR) and extended release (XR).
[The word XR is made from eXtended Release and the word IR is made from Instant Release.] The immediate release formulation is
indicatedIn medicine, an indication is a term describing a valid reason to use a certain test, medication, procedure, or surgery. In the United States, indications for medications are strictly regulated by the Food and Drug Administration, which includes them in the package insert under the phrase...
for use in Attention Deficit Hyperactivity Disorder (ADHD) and
narcolepsyNarcolepsy is chronic sleep disorder, or dyssomnia. The condition is characterized by excessive daytime sleepiness in which a person experiences extreme fatigue and possibly falls asleep at inappropriate times, such as while at work or at school...
, while the XR formulation is only approved for use in ADHD. In the United States, Adderall is a Schedule II drug under the Controlled Substance Act due to having
addictionThe term "addiction" is used in many contexts to describe an obsession, compulsion, or excessive psychological dependence, such as: drug addiction The term "addiction" is used in many contexts to describe an obsession, compulsion, or excessive psychological dependence, such as: drug addiction The...
potential and potent effects on
blood pressureBlood pressure is the pressure exerted by circulating blood on the walls of blood vessels, and is one of the principal vital signs. During each heartbeat, BP varies between a maximum and a minimum pressure...
.
History
Adderall is available as an instant release ("IR") as well as an extended release ("XR") drug. Adderall instant release is manufactured today by Teva and Barr Pharmaceuticals. Shire Pharmaceuticals, the creator of Adderall IR, no longer produces it. However, Shire Pharmaceuticals does continue to manufacture the extended release version of Adderall ("Adderall XR").
Shire Pharmaceuticals introduced the Adderall brand in 1996 in the form of a multi-dose, instant-release tablet derived from an original formula of the weight management drug
ObetrolObetrol is a pharmaceutical stimulant, amphetamine, used as an anorexiant to treat exogenous obesity with racemic amphetamine and methamphetamine salts...
. In 2006, Shire agreed to sell rights to the Adderall name for this instant-release medication to Duramed Pharmaceuticals Ultimately, DuraMed Pharmaceuticals was acquired by Teva Pharmaceuticals in 2008 when Teva completed its acquisition of
Barr PharmaceuticalsBarr Pharmaceuticals, Inc., was global specialty pharmaceutical company that operated in more than 30 countries worldwide and was engaged in the development, manufacture and marketing of generic and proprietary pharmaceuticals, biopharmaceuticals and active pharmaceutical ingredients...
(including Barr's Duramed Pharmaceuticals division). Therefore, following its acquisition of Duramed, Teva Pharmaceuticals is in the somewhat unusual position of manufacturing both a generic formulation of Adderall instant release (under its Barr Division) as well as "brand name" Adderall (under its DuraMed division.)
Reflecting the change in manufacturers from Shire Pharmaceuticals to Teva's DuraMed Pharmaceuticals, the "imprint" on Adderall instant release tablets has changed. One side of the instant release tablets now bears the DuraMed Pharmaceuticals imprint, a lower case letter "d" over a lower case letter "p". This is a change from the previous upper case "AD" imprint on the tablets.
The active ingredients of Adderall include a combination of
dextroamphetamineDextroamphetamine is a psychostimulant drug which is known to produce increased wakefulness and focus in association with decreased fatigue and decreased appetite. Drugs with similar psychoactive properties can be referred to or described as "amphetamine analogues", "amphetamine-like", or having...
and
racemicIn chemistry, a racemic mixture, or racemate, is one that has equal amounts of left- and right-handed enantiomers of a chiral molecule...
-amphetamine salts. In 2001, Shire Pharmaceuticals introduced an extended-release preparation of these ingredients in a variety of dosages under the brand name "Adderall XR," on which Shire retains exclusive patent rights until the patent expires, expected in 2018. However, due to issues with Shire's inability to evergreen (extend the patent life by either obtaining a new FDA indication or application of other patent life) the
patentA patent is a set of exclusive rights granted by a state to an inventor or their assignee for a limited period of time in exchange for a public disclosure of an invention....
for Adderall XR, the drug has become available in a generic form. In 2009,
Barr PharmaceuticalsBarr Pharmaceuticals, Inc., was global specialty pharmaceutical company that operated in more than 30 countries worldwide and was engaged in the development, manufacture and marketing of generic and proprietary pharmaceuticals, biopharmaceuticals and active pharmaceutical ingredients...
and Shire reached a settlement agreement permitting Barr to offer a generic form of the drug beginning April 1, 2009.
Chemistry
Adderall's effects are similar to other
CNSThe central nervous system is the part of the nervous system that functions to coordinate the activity of all parts of the bodies of bilaterian animals—that is, all animals more advanced than sponges or jellyfish. In vertebrates, the central nervous system is enclosed in the meninges. It contains...
stimulants of the same class and preparation. (See amphetamine for details.)
Urinary and stomach pH levels can have a strong effect on -amphetamine excretion and absorption. An acidic stomach and GI pH will decrease the absorption of Adderall, and acidic urine levels will decrease the reabsorption of the drug through the renal system. Co-administration of acidic substances (e.g.
citric acidCitric acid is a weak organic acid, and it is a natural preservative and is also used to add an acidic, or sour, taste to foods and soft drinks. In biochemistry, it is important as an intermediate in the citric acid cycle and therefore occurs in the metabolism of virtually all living things...
) causes decreased renal reabsorption of -amphetamine, while alkaline agents (e.g. antacids) may cause a marked increase in renal tubular reabsorption. The increased reabsorption can increase the retention of amphetamines, potentially resulting in dangerously high
serumIn blood, the serum is the component that is neither a blood cell nor a clotting factor; it is the blood plasma with the fibrinogens removed. Serum includes all proteins not used in blood clotting and all the electrolytes, antibodies, antigens, hormones, and any exogenous substances .The study of...
levels.
Adderall XR
Specifically, Adderall XR consists of the following
amphetamineAmphetamine is a psychostimulant drug that is known to produce increased wakefulness and focus in association with decreased fatigue and appetite. Amphetamine is related to drugs such as methamphetamine and dextroamphetamine, which are a group of potent drugs that act by increasing levels of...
compounds in equal proportions;
dextroamphetamineDextroamphetamine is a psychostimulant drug which is known to produce increased wakefulness and focus in association with decreased fatigue and decreased appetite. Drugs with similar psychoactive properties can be referred to or described as "amphetamine analogues", "amphetamine-like", or having...
saccharate,
dextroamphetamineDextroamphetamine is a psychostimulant drug which is known to produce increased wakefulness and focus in association with decreased fatigue and decreased appetite. Drugs with similar psychoactive properties can be referred to or described as "amphetamine analogues", "amphetamine-like", or having...
sulfate, (racemic
amphetamineAmphetamine is a psychostimulant drug that is known to produce increased wakefulness and focus in association with decreased fatigue and appetite. Amphetamine is related to drugs such as methamphetamine and dextroamphetamine, which are a group of potent drugs that act by increasing levels of...
) aspartate monohydrate, and (racemic
amphetamineAmphetamine is a psychostimulant drug that is known to produce increased wakefulness and focus in association with decreased fatigue and appetite. Amphetamine is related to drugs such as methamphetamine and dextroamphetamine, which are a group of potent drugs that act by increasing levels of...
) sulfate Breakdown rates are affected by many factors including urinary and
stomachIn most mammals, the stomach is a hollow, muscular organ of the gastrointestinal tract , between the esophagus and the small intestine. It is involved in the second phase of digestion, following mastication . The word stomach is derived from the Latin stomachus, which derives from the Greek word...
pHpH is a measure of the acidity or basicity of a solution. It is defined as the cologarithm of the activity of dissolved hydrogen ions . Hydrogen ion activity coefficients cannot be measured experimentally, so they are based on theoretical calculations...
, weight, gender, other medications being taken, and age. Alkalinity increases bioavailability and acidity causes the drug to be excreted sooner. Manufacturers claim that the mixture of salts in Adderall XR makes its effects smoother (that is, makes softer highs and lows).
Dosing and administration
Adderall is marketed as either an immediate-release tablet, Adderall, or an extended-release capsule, Adderall XR. Doses of immediate-release Adderall are available in 5, 7.5, 10, 12.5, 15, 20, and 30 mg. Adderall XR is available in 5, 10, 15, 20, 25, and 30 mg doses.
Adderall XR utilizes the
MicrotrolMicrotrol is an extended-release drug delivery system. It is used in certain medications like Adderall and incorporates two types of beads. The first dissolves immediately, releasing half of the medication, while the second type dissolves much more slowly releasing the remaining medication four...
extended-release delivery system, incorporating two types of beads. The first dissolves immediately, releasing half of the medication, while the second type dissolves much more slowly releasing the remaining medication four hours later. Maximum
plasmaBlood plasma is the yellow liquid component of blood, in which the blood cells in whole blood would normally be suspended. It makes up about 55% of the total blood volume. It is mostly water and contains dissolved proteins, glucose, clotting factors, mineral ions, hormones and carbon dioxide...
concentration is achieved in seven hours, compared to instant-release Adderall, which reaches maximum plasma concentration within three hours. As a result of its high
bioavailabilityIn pharmacology, bioavailability is used to describe the fraction of an administered dose of unchanged drug that reaches the systemic circulation, one of the principal pharmacokinetic properties of drugs. By definition, when a medication is administered intravenously, its bioavailability is 100%...
, Adderall XR's effectiveness is not altered by food absorption in the gastrointestinal tract. However, mean plasma concentration is prolonged by 2.5 hours (using a 900 calorie standard high-fat meal as the control). Medications that alter urinary pH will cause variations in amount and method of excretion and usage should be monitored when taken concurrently with Adderall.
Manufacturer's claims of instant release have been disputed. A US patent granted for Adderall was a pharmaceutical composition patent listing a rapid immediate release oral dosage form. No claim of increased or smooth drug delivery was made. A recent
double-blindThe blind method is a part of the scientific method, used to prevent research outcomes from being influenced by either the placebo effect or the observer bias. To blind a person involved in research is to prevent them from knowing certain information about the process...
,
placeboA placebo is a sham medical intervention. In one common placebo procedure, a patient is given an inert sugar pill, told that it may improve his/her condition, but not told that it is in fact inert...
-controlled
crossover studyA crossover study is a longitudinal study in which subjects receive a sequence of different treatments . While crossover studies can be observational studies, many important crossover studies are controlled experiments, which are discussed in this article...
, conducted among children, indicated that patients behaved similarly to other immediate release amphetamines. The authors found that sustained-release dexamphetamine (the main isomeric-amphetamine component of Adderall) had a longer duration of action, though -amphetamine was less effective in the first few hours.
Use as treatment for Attention-Deficit Hyperactivity Disorder (ADHD)
Adderall is commonly prescribed as a psychostimulant treatment for children and adults with
Attention-Deficit Hyperactivity DisorderAttention-deficit hyperactivity disorder is a neurobehavioral developmental disorder. ADHD is primarily characterized by "the co-existence of attentional problems and hyperactivity, with each behavior occurring infrequently alone." While symptoms may appear to be innocent and merely annoying...
(ADHD). Depending on dosage, the beneficial effects of stimulant medications can last several hours, allowing improved performance throughout the day. Compared to the similar medication
methylphenidateMethylphenidate is the most commonly prescribed psychostimulant and is indicated in the treatment of attention-deficit hyperactivity disorder, Postural Orthostatic Tachycardia Syndrome and narcolepsy, although off-label uses include treating lethargy, depression, neural insult, and obesity.In...
(sold under the brand name Ritalin and others) studies have suggested that Adderall is generally more potent and has a longer period of efficacy, especially at lower doses. For those who experience adverse side effects to Ritalin or for whom Ritalin has become ineffective, Adderall is often recommended as a substitute.
Other uses
Apart from its most typical application in the treatment of ADHD, Adderall has also been used successfully to manage severe cases of treatment-resistant
depressionMajor depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and loss of interest or pleasure in normally enjoyable activities...
. Individuals who show little or no response to typical antidepressants, including SSRIs and
tricyclic antidepressantTricyclic antidepressants are a class of psychoactive drugs used primarily as antidepressants, which were first discovered in the early 1950s, and subsequently introduced later in the decade...
s, are more likely to respond to psychostimulant therapy. These patients, however, are the exception rather than the norm among those with depression and this is not an
FDAThe Food and Drug Administration is a Government agency of the United States Department of Health and Human Services and is responsible for regulating and supervising the safety of foods, tobacco products, dietary supplements, Medication drugs, vaccines, Biopharmaceutical, blood transfusion,...
-approved indication.
Other recognized uses include the treatment of:
- Idiopathic Central Nervous System Hypersomnia established by recognized diagnostic criteria
- Drug-induced brain dysfunction
- Epilepsy
- Narcolepsy
- Senile apathetic behavior
- Psychiatric differential diagnosis of depression
- Obesity
Generic forms
Both Adderall and Adderall XR have generic preparations available for dispensing. There is much discussion by prescribed users of Adderall and Adderall XR, on whether any of the Generics are equivalent in symptom reduction, as compared to original Shire Adderall. The issue is further compounded with TEVA now owning the Branded Name "Adderall" as well as the Generic rights after TEVA acquired Barr. TEVA will be using the Barr generic formula for all its Generic and Branded Adderall. Shire will stop Manufacturing of Adderall in both IR and XR forms. By early 2010, there is expected to be no availability of the original Shire formula on the market.
Mechanism of action
With respect to central stimulant actions, the S(+) isomer (i.e., dextroamphetamine) is several times more potent than its R(-)enantiomer (i.e., levoamphetamine); this is not necessarily the case with other actions produced by amphetamine, particularly those produced in the periphery such as its cardiovascular actions. Dextroamphetamine induces more euphoria, whereas levoamphetamine induces more depression. The overall greater potency of the dextro form to central actions suggests that this form may have a higher potential for abuse.
Adderall’s inclusion of levoamphetamine provides the pharmaceutical with a quicker onset and longer clinical effect compared to pharmaceuticals exclusively formulated of dextroamphetamine.
Although it seems the human brain has a preference for dextroamphetamine over levoamphetamine, it has been reported that certain children have a better clinical response to levoamphetamine. Amphetamines are believed to exert their effects by binding to the monoamine transporters and increasing extracellular levels of the biogenic amines
dopamineDopamine is a neurotransmitter occurring in a wide variety of animals, including both vertebrates and invertebrates. In the brain, this phenethylamine functions as a neurotransmitter, activating the five types of dopamine receptors — D
1, D
2, D
3, D
4, and...
,
norepinephrineNoradrenaline or norepinephrine is a catecholamine with dual roles as a hormone and a neurotransmitter....
, and
serotoninSerotonin is a monoamine neurotransmitter. It is found extensively in the gastrointestinal tract of animals, and about 80 to 90 percent of the human body's total serotonin is located in the enterochromaffin cells in the gut, where it is used to regulate intestinal movements...
.
It is hypothesized that -amphetamine acts primarily on the dopaminergic (DA) systems, while -amphetamine is comparatively norepinephrinergic (NE). The primary reinforcing and behavioral-stimulant effects of amphetamine, however, are linked to enhanced dopaminergic activity, primarily in the
mesolimbic dopaminergic pathwayDopaminergic pathways are neural pathways in the brain which transmit the neurotransmitter dopamine from one region of the brain to another. There are eight dopaminergic pathways, but the four major ones are:* mesolimbic pathway* mesocortical pathway...
. Amphetamine binds to the dopamine transporter (DAT) and blocks the transporter's ability to clear DA from the
synapticSynaptic may refer to:*anything related to a synapse or to synapsis*Synaptic , a graphical package management program for APT See also*Synaptics, the main laptop touchpad manufacturer...
space. In addition, amphetamine is transported into the cell, which leads to dopamine efflux (DA is transported out of the cell and into the synaptic space via reverse transport of the DAT).
Amphetamine also possesses the ability to inhibit the enzymes
monoamine oxidaseMonoamine oxidases are enzymes that catalyze the oxidation of monoamines. They are found bound to the outer membrane of mitochondria in most cell types in the body. The enzyme was discovered by Mary Hare in the liver, and received the name of tyramine oxidase...
A and B (MAO-A and MAO-B) in high doses. MAO-A is responsible for the break down of serotonin, dopamine, norepinephrine, and epinephrine. MAO-B is responsible for breaking down dopamine (more potently than MAO-A) and phenylethylamine (PEA), which has actions similar to amphetamine itself, and is thought to be involved in feelings of lust, confidence, obsession, and sexuality. Some of the first antidepressants successfully marketed are in fact Monoamine-Oxidase inhibitors. However, MAO inhibition seen with amphetamine is not substantial enough in duration and quantity to entail the need for a
tyramineTyramine is a naturally-occurring monoamine compound and trace amine derived from the amino acid tyrosine. Tyramine acts as a catecholamine releasing agent...
-limited diet, unlike the more potent and long lived MAO-inhibiting antidepressants.
Amphetamine's ability to cause the inhibition of MAO results in the accumulation of monoamines: amphetamine directly stimulates the release of these neurochemicals, resulting in a potent elevation in monoamine neurotransmission. In sum, the effect of amphetamines is to increase
neurotransmitterNeurotransmitters are endogenous chemicals which relay, amplify, and modulate signals between a neuron and another cell. Neurotransmitters are packaged into synaptic vesicles that cluster beneath the membrane on the presynaptic side of a synapse, and are released into the synaptic cleft, where they...
availability in the synapse, by both releasing more neurotransmitters, as well as prolonging their availability in the synapse by slowing their removal.
Adverse effects
Adderall has a high abuse potential. Due to the fact that Adderall has a powerful effect of increasing
blood pressureBlood pressure is the pressure exerted by circulating blood on the walls of blood vessels, and is one of the principal vital signs. During each heartbeat, BP varies between a maximum and a minimum pressure...
, it carries the same risk of
sudden deathThe term sudden cardiac death refers to natural death from cardiac causes, heralded by abrupt loss of consciousness within one hour of the onset of acute symptoms. Other forms of sudden death may be noncardiac in origin...
,
strokeA stroke is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by thrombosis or embolism or due to a hemorrhage...
, and
heart attackMyocardial infarction or acute myocardial infarction , commonly known as a heart attack, is the interruption of blood supply to part of the heart, causing some heart cells to die...
in patients with pre-existing heart conditions, as does methylphenidate and other stimulants used to treat ADHD, as well as the same risk of seizures in patients with a history of seizures. Studies of long-term use of Adderall and methylphenidate in children have shown a temporary decrease in growth rate that does not affect final adult height. Stimulant medications also decrease appetite in some people, leading to weight loss, and this effect is more common with Adderall than methylphenidate or
atomoxetineAtomoxetine is a non-stimulant drug approved for the treatment of attention-deficit hyperactivity disorder . It is sold in the form of the hydrochloride salt of atomoxetine, a norepinephrine reuptake inhibitor...
. Changes in vision have been reported with both Adderall and methylphenidate. "In extreme cases, the drug can cause paranoia, hallucinations and heart attacks."
Contraindications, interactions, and precautions
The following provides only general guidelines and is not comprehensive. Please refer to a more comprehensive list for further information regarding co-administration of amphetamine with other substances.
- MAOIs (monoamine oxidase inhibitor
Monoamine oxidase inhibitors are a class of powerful antidepressant drugs prescribed for the treatment of depression. They are particularly effective in treating atypical depression, and have also shown efficacy in smoking cessation....
s, e.g., phenelzinePhenelzine is a psychoactive drug of the hydrazine chemical class which is used as an antidepressant and anxiolytic or antipanic agent. It acts as a nonselective and irreversible monoamine oxidase inhibitor...
, selegilineSelegiline is a drug used for the treatment of early-stage Parkinson's disease, depression and senile dementia. In normal clinical doses it is a selective irreversible MAO-B inhibitor, however in larger doses it loses its specificity and also inhibits MAO-A...
, iproniazidIproniazid is a hydrazine drug that was previously used as an antidepressant. It is an irreversible and nonselective monoamine oxidase inhibitor . It has been widely discontinued.-History:Iproniazid was the first antidepressant ever marketed...
, etc.) — Do not administer amphetamine for a minimum of two weeks after last use of MAOI type drug. High risk for hypertensive crisis. Preliminary trials of low dose amphetamine and MAOIs being administered together are in progress. However, this is to only be done under strict supervision of the prescribing parties.
- SSRIs (selective serotonin reuptake inhibitor
Selective serotonin reuptake inhibitors or serotonin-specific reuptake inhibitor are a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders, and some personality disorders...
s, e.g., fluvoxamineFluvoxamine is an antidepressant which functions as a selective serotonin reuptake inhibitor and is predominantly used to treat obsessive–compulsive disorder.-History:...
, citalopramCitalopram is an antidepressant drug used to treat major depression associated with mood disorders. It is also used on occasion in the treatment of body dysmorphic disorder and anxiety....
, paroxetineParoxetine is a selective serotonin reuptake inhibitor antidepressant. Marketing of the drug began in 1992 by the pharmaceutical company SmithKline Beecham, now GlaxoSmithKline...
, etc.) — While a common combination, and although rare, the risk for serotonin syndromeSerotonin syndrome is a potentially life-threatening adverse drug reaction that may occur following therapeutic drug use, inadvertent interactions between drugs, overdose of particular drugs, or the recreational use of certain drugs...
exists. Use only when directed.
- NRIs (norepinephrine reuptake inhibitor
A norepinephrine reuptake inhibitor or adrenergic reuptake inhibitor , is a type of drug which acts as a reuptake inhibitor for the neurotransmitters norepinephrine and epinephrine by blocking the action of the norepinephrine transporter...
s, e.g., atomoxetineAtomoxetine is a non-stimulant drug approved for the treatment of attention-deficit hyperactivity disorder . It is sold in the form of the hydrochloride salt of atomoxetine, a norepinephrine reuptake inhibitor...
, etc.) — NRI medications and amphetamineAmphetamine is a psychostimulant drug that is known to produce increased wakefulness and focus in association with decreased fatigue and appetite. Amphetamine is related to drugs such as methamphetamine and dextroamphetamine, which are a group of potent drugs that act by increasing levels of...
both enhance noradrenergic activity. Possible augmentation/potentiation of effects. Use only when directed.
- SNRIs (selective serotonin-norepinephrine reuptake inhibitor
Serotonin-norepinephrine reuptake inhibitors are a class of antidepressant drugs used in the treatment of major depression and other mood disorders...
s) — See SSRIs and NRIs.
- Bupropion
Bupropion is an atypical antidepressant that acts as a norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist...
— Both bupropion and amphetamine have noradrengic and dopaminergic activity. Possible augmentation/potentiation of effects. Bupropion has pro-convulsant properties that may be enhanced or cumulatively potentiated by amphetamine. Use only when directed.
- Tricyclics and related compounds (tricyclic antidepressant
Tricyclic antidepressants are a class of psychoactive drugs used primarily as antidepressants, which were first discovered in the early 1950s, and subsequently introduced later in the decade...
— See SNRIs and SSRIs. Possible potentiation of serotonin, dopamine and norepinephrine related drug effects. The combination of tricyclic and amphetamine compounds / other direct acting sympathomimetics has been associated with increased sympathetic action. Adjustments to dose may be required. Concurrent use not generally recommended due to interaction between direct acting sympathomimetics such as amphetamine and tricyclics. Indirect acting sympathomimetics may have decreased efficacy when combined with tricyclics (tricyclic blockade may inhibit the action of some indirect acting sympathomimetics).
- CYP2D6 (liver enzyme) inhibitors, e.g., most SSRIs such as fluoxetine, citalopram, paroxetine, etc. Some anti-psychotics such as thioridazine
Thioridazine is a piperidine antipsychotic drug belonging to the phenothiazine drug group and was previously widely used in the treatment of schizophrenia and psychosis. It is available from various companies under the names Mellaril, Novoridazine, and Thioril...
, haloperidolHaloperidol is a typical antipsychotic. It is in the butyrophenone class of antipsychotic medications and has pharmacological effects similar to the phenothiazines....
, and, levomepromazineLevomepromazine in Germany and Methotrimeprazine in America is an aliphatic phenothiazine neuroleptic drug...
. The stimulantStimulants, also sometimes called psychostimulants, are psychoactive drugs which induce temporary improvements in either mental or physical function or both. Examples of these kinds of effects may include enhanced alertness, wakefulness, and locomotion, among others...
cocaineCocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system and an appetite suppressant...
. The opioid agonist methadoneMethadone is a synthetic opioid, used medically as an analgesic, antitussive and a maintenance anti-addictive for use in patients on opioids. It was developed in Germany in 1937...
. There are additional drugs that inhibit CYP2D6, it is important to find out if any medication or drug that is being taken is a CYP2D6 inhibitor. Taking a CYP2D6 inhibiting drug along with amphetamine will lead to an elevated level of amphetamine in the system and the drug will also remain longer in the body, this can lead to undesired or possibly serious side effects.
Prolonged use
Prolonged high doses of amphetamines followed by an abrupt cessation can result in extreme fatigue and mental depression. Chronic abuse of amphetamines can result in the manifestation of
amphetamine psychosisStimulant psychosis is a form of psychosis which can result from the use of stimulants, such as amphetamine or methamphetamine. Typically it appears after large doses or chronic use, although in rare cases some people may become psychotic after relatively small doses...
.
Performance-enhancing use
Due to side effects including appetite suppression and weight loss, Adderall has also been used as an
off-labelOff-label use is the practice of prescribing pharmaceuticals for an unapproved indication.. In the United States, the Food and Drug Administration Center for Drug Evaluation and Research reviews a company's New Drug Application for data from clinical trials to see if the results support the drug...
drug for obesity.
Adderall is also reportedly widely used as a
"study drug"Nootropics, also referred to as smart drugs, memory enhancers, and cognitive enhancers, are drugs, supplements, nutraceuticals, and functional foods that are purported to improve mental functions such as cognition, memory, intelligence, motivation, attention, and concentration. The word nootropic...
at many universities. Adderall is reported to help focus energy and concentration to a much higher level than normal. It enables the user to focus and stay awake. Stories of students writing papers continuously for an unusually long time, or "cramming" all night for an exam with no loss of energy or concentration are common. However, the user reportedly can suffer from drastic side effects the following day if Adderall was used to avoid a normal sleep pattern. William Frankenberger, psychology professor at University of Wisconsin at Eau Claire, led a study at the university in 2004 that reported 14% of the campus had abused some form of ADHD drug, including Adderall. College campuses known to be highly competitive or have a high rate of binge drinking had up to 25% of students who misused an ADHD medication within one year, a survey of students at 119 colleges across the country concluded. Other forms of ADHD medication used as a performance enhancing drug include
methylphenidateMethylphenidate is the most commonly prescribed psychostimulant and is indicated in the treatment of attention-deficit hyperactivity disorder, Postural Orthostatic Tachycardia Syndrome and narcolepsy, although off-label uses include treating lethargy, depression, neural insult, and obesity.In...
preparations, such as Ritalin and Concerta.
The Nevada State Athletic Commission has banned athletes in the state from using Adderall.
Tim CredeurTimothy Wallace Credeur II is an American professional mixed martial arts fighter. He was defeated off of SpikeTV's The Ultimate Fighter 7 by fellow cast member Jesse Taylor in the semi-finals. He was then brought back into the competition following the disqualification of Taylor. He fought C.B...
was removed from a UFC fight on the finale of The Ultimate Fighter 7 because of a positive drug test due to his use of it.
New Orleans SaintsThe New Orleans Saints are a professional American football team based in New Orleans, Louisiana. The Saints play in the South Division of the National Football Conference in the National Football League ....
kicker
Garrett HartleyGarrett Hartley is an American football placekicker for the New Orleans Saints of the National Football League. He was signed by the Denver Broncos as an undrafted free agent in 2008. He played college football at Oklahoma....
plans to serve a four-game suspension when the 2009 regular season begins because he tested positive for the banned stimulant. The
Arizona CardinalsThe Arizona Cardinals are a professional American Football team based in Glendale, Arizona. The Cardinals are members of the Western Division of the National Football Conference in the National Football League . The Cardinals were founded in 1898, and are the oldest continuously run professional...
tight end
Ben PatrickBen Patrick tight end for the Arizona Cardinals of the National Football League. He was originally drafted by the Cardinals in the seventh round of the 2007 NFL Draft. He played college football at Duke and Delaware.-Early years:Patrick attended Herschel V...
received a four-game suspension as a result of using Adderall.
Government warnings
On February 9, 2005,
Health CanadaHealth Canada is the department of the government of Canada with responsibility for national public health.The current Minister of Health is Leona Aglukkaq, a Conservative Member of Parliament appointed to the position by Prime Minister Stephen Harper.-Branches, regions and agencies:Health Canada...
suspended all sales of Adderall XR after data collected by manufacturer Shire Pharmaceuticals linked the drug to 12 sudden deaths in American children. Further research found data suggesting use of Adderall resulted in an increased risk of cardiac defect. Given the more than 37,000,000 prescriptions for Adderall filled during the four years, the U.S.
Food and Drug AdministrationThe Food and Drug Administration is a Government agency of the United States Department of Health and Human Services and is responsible for regulating and supervising the safety of foods, tobacco products, dietary supplements, Medication drugs, vaccines, Biopharmaceutical, blood transfusion,...
could find no increased risk of sudden death among Adderall users beyond the normal rate of the general population.
In August 2005, Health Canada followed the committee report of three independent physicians and lifted the ban on Adderall XR. Given that persons with ADHD are more likely to engage in risky or dangerous behavior, it has been suggested that stimulant medications for persons with ADHD may actually result in lower incidence of premature death. The use of Adderall is generally not advised in those persons with pre-existing cardiac or mental illnesses. It is also not advised in persons who have a history of drug abuse. Although FDA safety advisors voted 8 to 7 to issue a
black box warningIn the United States, a black box warning is a type of warning that appears on the package insert for prescription drugs that may cause serious adverse effects...
, the FDA's pediatric advisory committee refused to give the drug its most severe black box warning in March 2006. A Black Box Warning regarding amphetamine abuse potential is in place, however. In September 2008, Britain's National Institute for Health and Clinical Excellence urged physicians not to prescribe Adderall or similar drugs to children under 5, and to exhaustively consider other approaches to behavioral modification before prescribing such drugs to children 5 and up.
International Availability/Legal Status
- South Korea
South Korea, officially the Republic of Korea and often simply referred to as Korea, is a country in East Asia, located on the southern half of the Korean Peninsula. It is neighbored by China to the west, Japan to the east, and North Korea to the north. Its capital is Seoul, the second largest...
: Adderall, and all other amphetamine-based medications (such as Vyvanse and Dexedrine), are considered "banned narcotics" in South Korea. They cannot be obtained at a South Korean pharmacy, and are illegal to import. Concerta and other methylphenidateMethylphenidate is the most commonly prescribed psychostimulant and is indicated in the treatment of attention-deficit hyperactivity disorder, Postural Orthostatic Tachycardia Syndrome and narcolepsy, although off-label uses include treating lethargy, depression, neural insult, and obesity.In...
-based medications, however, are available.
- Taiwan
Taiwan , also known as Formosa , is the largest island of the Republic of China in East Asia. Taiwan is located east of the Taiwan Strait, off the southeastern coast of mainland China...
: Adderall and Dexedrine are classified as schedule II controlled drugs, and are not available, in Taiwan. MethylphenidateMethylphenidate is the most commonly prescribed psychostimulant and is indicated in the treatment of attention-deficit hyperactivity disorder, Postural Orthostatic Tachycardia Syndrome and narcolepsy, although off-label uses include treating lethargy, depression, neural insult, and obesity.In...
-based medications are available. Vyvanse is not currently classified, and is not available in Taiwan.