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{{drugbox |
{{DrugProjectFormSinglePage
| IUPAC_name = (2''S'')-1-phenylpropan-2-amine
|authorTag=<!--Overview-->
| CAS_number = (sulphate),  (hydrochloride)
|aOrAn=a
| CAS_number=51-64-9
|hasBlackBoxWarning=Yes
| CAS_supplemental ={{CAS|51-63-8}} (sulphate), {{CAS|1462-73-3}} (hydrochloride)
|adverseReactions=<!--Black Box Warning-->
| ATC_code = N06BA02
|blackBoxWarningTitle=<span style="color:#FF0000;">ConditionName: </span>
| ATC_prefix = N06
|blackBoxWarningBody=<i><span style="color:#FF0000;">ConditionName: </span></i>
| ATC_suffix = BA02
 
| image=Dextroamphetamine-2D-skeletal.png
* Content
| width=167px
 
| PubChem = 5826
<!--Adult Indications and Dosage-->
| DrugBank =APRD00480
 
| C=9 | H=13 | N=1
<!--FDA-Labeled Indications and Dosage (Adult)-->
| molecular_weight = 135.206 g/mol
|fdaLIADAdult======Condition1=====
| bioavailability = >75%
 
| metabolism = Hepatic
* Dosing Information
| elimination_half-life = 10&ndash;28 hours<br>(Average ~12 hours)
 
| excretion = Renal: ~45%
:* Dosage
| pregnancy_AU = B3
 
| pregnancy_US = C
=====Condition2=====
| pregnancy_category =  
 
| legal_AU = S8
* Dosing Information
| legal_CA = Schedule III
 
| legal_UK = Class B
:* Dosage
| legal_US = Schedule II
 
| legal_status =  
=====Condition3=====
| routes_of_administration = Clinical: Oral, intravenous, sublingual<br>Recreational: Vaporized, insufflated, suppository
 
}}
* Dosing Information
{{CMG}}
 
:* Dosage
 
=====Condition4=====
 
* Dosing Information
 
:* Dosage
 
<!--Off-Label Use and Dosage (Adult)-->
 
<!--Guideline-Supported Use (Adult)-->
|offLabelAdultGuideSupport======Condition1=====
 
* Developed by:
 
* Class of Recommendation:
 
* Strength of Evidence:
 
* Dosing Information
 
:* Dosage
 
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There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in adult patients.
 
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|offLabelAdultNoGuideSupport======Condition1=====
 
* Dosing Information
 
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There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of {{PAGENAME}} in adult patients.
 
<!--Pediatric Indications and Dosage-->
 
<!--FDA-Labeled Indications and Dosage (Pediatric)-->
|fdaLIADPed======Condition1=====
 
* Dosing Information
 
:* Dosage
 
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<!--Guideline-Supported Use (Pediatric)-->
|offLabelPedGuideSupport======Condition1=====
 
* Developed by:
 
* Class of Recommendation:
 
* Strength of Evidence:
 
* Dosing Information
 
:* Dosage
 
=====Condition2=====
 
There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
 
<!--Non–Guideline-Supported Use (Pediatric)-->
|offLabelPedNoGuideSupport======Condition1=====
 
* Dosing Information
 
:* Dosage
 
=====Condition2=====
 
There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
 
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|warnings=* Description
 
====Precautions====
 
* Description
 
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=====Cardiovascular=====
 
 
 
 
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=====Special Senses=====
 
 
 
 
=====Urogenital=====
 
 
 
 
=====Miscellaneous=====
 
 
 
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|postmarketing=There is limited information regarding <i>Postmarketing Experience</i> of {{PAGENAME}} in the drug label.
 
=====Body as a Whole=====
 
 
 
=====Cardiovascular=====
 
 
 
=====Digestive=====
 
 
 
=====Endocrine=====
 
 
 
=====Hematologic and Lymphatic=====
 
 
 
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=====Neurologic=====
 
 
 
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There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
|useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
|useInNursing=There is no FDA guidance on the use of {{PAGENAME}} with respect to nursing mothers.
|useInPed=There is no FDA guidance on the use of {{PAGENAME}} with respect to pediatric patients.
|useInGeri=There is no FDA guidance on the use of {{PAGENAME}} with respect to geriatric patients.
|useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.
 
<!--Administration and Monitoring-->
|administration=* Oral
 
* Intravenous
|monitoring=There is limited information regarding <i>Monitoring</i> of {{PAGENAME}} in the drug label.
 
* Description


<!--IV Compatibility-->
|IVCompat=There is limited information regarding <i>IV Compatibility</i> of {{PAGENAME}} in the drug label.


<!--Overdosage-->
|overdose====Acute Overdose===


'''Dextroamphetamine''' is a powerful [[psychostimulant]] which produces increased wakefulness, energy and self-confidence in association with decreased fatigue and appetite. It is perhaps the archetypal psychostimulant, and drugs with similar psychoactive properties are often referred to as "amphetamine analogues", or described as having "amphetamine-like", or even "amphetaminergic" effects. Its stimulant properties are similar to those of [[methylphenidate]] and [[methamphetamine]], though with a slower onset of action and a duration that lies somewhere between the two.{{Fact|date=April 2007}}
====Signs and Symptoms====


Dextroamphetamine is the [[enantiomer|dextrorotary]] stereoisomer of the [[amphetamine]] molecule, which can take two different forms. Other common names for dextroamphetamine include '''d-amphetamine''', '''dexamphetamine''', '''(''S'')-(+)-amphetamine''', and brand names such as '''Dexedrine''' and '''Dextrostat'''. It is combined with levo-amphetamine in [[Adderall]] and other racemic amphetamines.
* Description


==History==
====Management====
Amphetamine was first [[chemical synthesis|synthesized]] under the chemical name "phenylisopropylamine" in [[Berlin]], 1887 by the Romanian chemist [[Lazar Edeleanu]]. It was not widely marketed until 1932, when the pharmaceutical company Smith, Kline, and French (currently known as [[GlaxoSmithKline]]) introduced it in the form of the [[Benzedrine]] Inhaler, for combating cold symptoms. Notably, the chemical form of Benzedrine in the inhaler was the liquid-free base, not a chloride or sulfate salt. In free-base form, amphetamine is a volatile oil, hence the efficacy of the inhalers.


Three years later, in 1935, the medical community became aware of the stimulant properties of amphetamine, specifically dextroamphetamine, and in 1937 Smith, Kline, and French introduced Dexedrine tablets, under the tradename Dexedrine. In the United States, Dexedrine tablets were approved to treat [[narcolepsy]], [[attention deficit disorder|attention disorders]], depression, and obesity. Dextroamphetamine was marketed in various other forms in the following decades, primarily by Smith, Kline, and French, such as several combination medications including a mixture of dextroamphetamine and [[amobarbital]] (a [[barbiturate]]) sold under the tradename [[Dexamyl]] and, in the 1950s, an extended release capsule (the "Spansule").
* Description


It quickly became apparent that Dexedrine and other amphetamines had a high potential for [[substance abuse|abuse]], although they were not heavily [[controlled substances|controlled]] until 1970, when the [[Controlled Substance Act|Comprehensive Drug Abuse Prevention and Control Act]] was passed by the United States Congress. Dexedrine, along with other sympathomimetics, was eventually classified as schedule II, the most restrictive category possible for a drug with recognized medical uses.
===Chronic Overdose===


==Chemistry==
There is limited information regarding <i>Chronic Overdose</i> of {{PAGENAME}} in the drug label.
Dextroamphetamine is a slightly polar, weak base and is [[lipophilic]].


==Formulations==
<!--Pharmacology-->
====Dextroamphetamine sulfate====
[[Image:Dexamphetamine sulfate 5 mg tablets.jpg|250px|thumb|right|5mg dexamphetamine sulfate tablets]]
A tablet preparation of the [[salt]] dextroamphetamine sulfate (pharmaceutical names: '''Dexedrine''' or '''Dextrostat''') is available in two strengths: 5&nbsp;mg and 10&nbsp;mg. A pharmaceutical with a strength of 30mg dextroamphetamine sulfate is 22.0 mg dextroamphetamine.
[[Image:Dexedrine Spansules.jpg|250px|thumb|right|Sustained-Release 15mg Dexedrine Spansules ]]
Dextroamphetamine sulfate is also available in a controlled release version (pharmaceutical name: '''Dexedrine SR''' or '''Dexedrine Spansule'''), capsulated in the strengths: 5&nbsp;mg, 10&nbsp;mg, and 15&nbsp;mg.


====Lisdexamfetamine====
<!--Drug box 2-->
{{main|Lisdexamfetamine}}
|drugBox=<!--Mechanism of Action-->
Dextroamphetamine is also the [[metabolite]] of the [[prodrug]] [[lisdexamfetamine]] dimesylate (pharmaceutical name: '''Vyvanse'''). Vyvanse is meant to provide once-a-day dosing because it regulates a slow release of dextroamphetamine into the brain. Vyvanse is available as [[capsules]], in three strengths: 30&nbsp;mg, 50&nbsp;mg, and 70&nbsp;mg. A 30mg-strength Vyvanse capsule is molecularly equivalent to 8.88mg dextroamphetamine. However, this molecular equivalence would only hold true as a [[bioequivalence]] ratio if: the dimesylate salt instantly dissolved resulting in the complete dissociation of lisdexamfetamine ions, and then the covalent amide bond of every lisdexamfetamine molecule immediately underwent hydrolysis. In fact, being a prodrug, lisdexamfetamine has different properties than dextroamphetamine; for instance, lisdexamfetamine is metabolised in the gastrointestinal tract, while dextroamphetamine's metabolism is hepatic.<ref>[http://www.fda.gov/cder/foi/nda/2007/021977s000_PharmToxR.pdf FDA Approval of Vyvanse Pharmacological Reviews Pages 18 and 19 ]</ref>
|mechAction=*


====Mixed amphetamine salts====
<!--Structure-->
[[Image:Adderall 30mg small.jpg|left|250px|thumb|right|Instant Release 30mg Adderall Tablets]]
|structure=*
Another pharmaceutical that contains "active ingredients" in addition to dextroamphetamine is [[Adderall]]. The drug formulation of Adderall (both controlled and instant release forms) is:
::One-quarter racemic (d,l-)amphetamine [[aspartate]] [[monohydrate]]
::One-quarter dextroamphetamine [[saccharate]]
::One-quarter dextroamphetamine [[sulfate]]
::One-quarter racemic (d,l-)amphetamine sulfate
Aspartate, saccharate, and sulfate salts differ [[pharmacokinetics|pharmacokinetically]] in the rate at which they are [[drug metabolism|metabolized]] by the body. For this and other reasons, Adderall's effects are different from pharmaceuticals with dextroamphetamine as an exclusive active ingredient. Contrary to the beliefs that Adderall is three-quarters dextroamphetamine, dextroamphetamine accounts for 72.7% of the amphetamine base in Adderall (the remaining percentage is [[amphetamine|levoamphetamine]]). Adderall’s inclusion of levoamphetamine provides the pharmaceutical with a quicker onset and longer clinical effect compared to pharmaceuticals exclusively formulated of dextroamphetamine<!--
-->.<ref>{{cite journal | author = Glaser, et al | title = Differential Effects of Amphetamine Isomers on Dopamine in the Rat Striatum and Nucleus Accumbens Core | journal = Psychopharmacology | volume = 178 | pages = 250-258 (Pages: 255,256) | year = 2005 }}</ref>  
Although it seems that where the human brain has a preference for dextroamphetamine over levoamphetamine, it has been reported that certain children have a better clinical response to levoamphetamine<!--
-->.<ref name="Arnold">{{cite journal | author = Arnold | title = Methylphenidate vs Amphetamine: Comparative Review | journal = Journal of Attention Disorders | volume = 3 | issue = 4 | pages = 200-211| year = 2000 | doi = 10.1177/108705470000300403}}</ref>


==Uses==
: [[File:{{PAGENAME}}01.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
===Clinical===
*Primarily used to treat [[attention deficit hyperactivity disorder]] (ADHD). In some localities it has replaced [[methylphenidate]] as the first-choice medication for ADHD, a role in which it is considered highly effective.
*Treatment of [[Narcolepsy]], generally where non-pharmacological measures have proved insufficient.
*Occasionally prescribed for weight-loss in cases of extreme obesity.


====Experimental====
<!--Pharmacodynamics-->
Though such use remains out of the mainstream, dextroamphetamine has been successfully applied in the treatment of certain categories of depression as well as other psychiatric syndromes.<!--
|PD=There is limited information regarding <i>Pharmacodynamics</i> of {{PAGENAME}} in the drug label.
--><ref>{{cite journal | author = Warneke L | title = Psychostimulants in psychiatry. | journal = Can J Psychiatry | volume = 35 | issue = 1 | pages = 3-10 | year = 1990 | id = PMID 2180548}}</ref>
Such alternate uses include reduction of fatigue in cancer patients, antidepressant treatment for [[HIV]] patients with depression and debilitating fatigue,<!--
  --><ref>{{cite journal | author = Wagner G, Rabkin R | title = Effects of dextroamphetamine on depression and fatigue in men with HIV: a double-blind, placebo-controlled trial. | journal = J Clin Psychiatry | volume = 61 | issue = 6 | pages = 436-40 | year = 2000 | id = PMID 10901342}}</ref>
early stage physiotherapy for severe stroke victims,<!--
  --><ref>{{cite journal | author = Martinsson L, Yang X, Beck O, Wahlgren N, Eksborg S | title = Pharmacokinetics of dexamphetamine in acute stroke. | journal = Clin Neuropharmacol | volume = 26 | issue = 5 | pages = 270-6 | year = 2003 | month=Sep-Oct | id = PMID 14520168}}</ref>
If [[physical therapy]] patients take dextroamphetamine while they practice their movements for rehabilitation, they learn to move much faster than without dextroamphetamine, and in practice sessions with shorter lengths<!--
  -->.<ref name = "Butefisch">{{cite journal | author = Butefisch CM ''et al''. | title = Modulation of Use-Dependent Plasticity by D-Amphetamine | journal = Annals of Neurology | volume = 51 | issue = 1 | pages = 59–68 | year = 2002 | pmid = 11782985}}</ref>


===Military===
<!--Pharmacokinetics-->
The U.S. Air Force uses dextroamphetamine as its "go-pill,", given to pilots on long missions to help them remain focused and alert.<ref>http://www.commondreams.org/headlines02/0801-06.htm</ref><ref>Emonson DL, Vanderbeek RD. (1995) ''The use of amphetamines in U.S. Air Force tactical operations during Desert Shield and Storm.'' 66(8):802</ref> Other branches of the U.S. military (as well as the armed forces of other nations) commonly use or have dispensed dextroamphetamine to troops to prevent or treat fatigue in combat situations. Because of the propensity of dextroamphetamine to cause behavioral side effects, this use is viewed as controversial; (Friendly Fire incidents are linked sometimes to the use of this drug and its effects on long term fatigued pilots; e.g. [[Tarnak Farm incident]]) newer stimulant medications with fewer side effects, like [[modafinil]] are being investigated for this reason. [[NASA]] has also used dextroamphetamine to combat fatigue in astronauts near the end of a mission.
|PK=There is limited information regarding <i>Pharmacokinetics</i> of {{PAGENAME}} in the drug label.


===Illicit===
<!--Nonclinical Toxicology-->
Along with Ritalin, illicit use of dextroamphetamine has been reported among students, both as a study aid, social aid, and for purely recreational purposes. According to the [[National Institute on Drug Abuse]], 4% of American college students reported non-prescription stimulant use in 2004.<ref>[http://www.nida.nih.gov/NIDA_notes/NNvol20N4/Studies.html NIDA Notes Volume 20, Number 4 (March 2006)]</ref>
|nonClinToxic=There is limited information regarding <i>Nonclinical Toxicology</i> of {{PAGENAME}} in the drug label.


==Overdose==
<!--Clinical Studies-->
[[Image:Dexedrine doj.jpg|frame|right]]
|clinicalStudies=There is limited information regarding <i>Clinical Studies</i> of {{PAGENAME}} in the drug label.
The ''Physician's 1991 Drug Handbook'' reports: "Symptoms of overdose include restlessness, tremor, [[hyperreflexia]], [[tachypnea]], confusion, aggressiveness, [[hallucinations]], and panic." [[Dilated pupils]] are common with high doses.


The fatal dose in humans is not precisely known, but in various species of rat generally ranges between 50 and 100 mg/kg, or a factor of 100 over what is required to produce noticeable psychological effects.<!--
<!--How Supplied-->
  --><ref>{{cite journal | author = Miczek K | title = A new test for aggression in rats without aversive stimulation: differential effects of d-amphetamine and cocaine. | journal = Psychopharmacology (Berl) | volume = 60 | issue = 3 | pages = 253-9 | year = 1979 | id = PMID 108702 | doi=10.1007/BF00426664 | url=http://www.springerlink.com/content/v11jj22163t30326/ | format=Abstract}}</ref><!--
|howSupplied=*
  --><ref>{{cite journal | author = Grilly D, Loveland A | title = What is a "low dose" of d-amphetamine for inducing behavioral effects in laboratory rats? | journal = Psychopharmacology (Berl) | volume = 153 | issue = 2 | pages = 155-69 | year = 2001 | id = PMID 11205415}}</ref>
This suggests a wide therapeutic range, in contrast to such drugs as [[morphine]] and [[heroin]], where effective doses may be as much as 50% of a fatal dose{{Fact|date=September 2007}}. Although the symptoms seen in a fatal overdose are similar to those of methamphetamine, their mechanisms are not identical, as some substances which inhibit d-amphetamine toxicity do not do so for methamphetamine.<!--
  --><ref>{{cite journal | author = Derlet R, Albertson T, Rice P | title = Antagonism of cocaine, amphetamine, and methamphetamine toxicity. | journal = Pharmacol Biochem Behav | volume = 36 | issue = 4 | pages = 745-9 | year = 1990 | id = PMID 2217500}}</ref><!--
  --><ref>{{cite journal | author = Derlet R, Albertson T, Rice P | title = The effect of SCH 23390 against toxic doses of cocaine, d-amphetamine and methamphetamine. | journal = Life Sci | volume = 47 | issue = 9 | pages = 821-7 | year = 1990 | id = PMID 2215083}}</ref>


An extreme symptom of overdose is [[amphetamine psychosis]], characterized by vivid visual, auditory, and sometimes tactile hallucinations. Many of its symptoms are identical to the [[psychosis]]-like state which follows long-term sleep deprivation, so it remains unclear whether these are solely the effect of the drug, or due to the long periods of sleep deprivation which are often undergone by the chronic user or abuser. "In apparently sensitive individuals, psychosis may be produced by 55 to 75 mg of dextroamphetamine. With high enough doses, psychosis can probably be induced in anyone."<!--
<!--Patient Counseling Information-->
  --><ref>{{cite book | author=LS Goodman, A Gilman | title=The Pharmacological Basis of Therapeutics | edition=7th Ed. | publisher=Macmillan Co. | location=New York | date=1970}}</ref>
|fdaPatientInfo=There is limited information regarding <i>Patient Counseling Information</i> of {{PAGENAME}} in the drug label.


==Pharmacology==
<!--Precautions with Alcohol-->
===Subjective effects===
|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
Dextroamphetamine makes people declare that they are in a friendlier than average mood<!--
  -->.<ref name = "Mattay">{{cite journal | author = Mattay VS ''et al''. | title = Dextroamphetamine enhances "neural network-specific" physiological signals: a positron-emission tomography rCBF study | journal = The Journal of Neuroscience | volume = 16 | issue = 15 | pages = 4816–4822 | year = 1996 | pmid = 8764668}} [http://www.jneurosci.org/cgi/content/full/16/15/4816 Free full text]</ref> Dextroamphetamine improves self-control for people who have a hard time naturally controlling themselves<!--
  -->.<ref name = "de Wit">{{cite journal | author = de Wit H, Enggasser JL, Richards JB | title = Acute Administration of D-Amphetamine Decreases Impulsivity in Healthy Volunteers | journal = Neuropsychopharmacology | volume = 27  | pages = 813–825 | year = 2002 | pmid = 12431855}}</ref> Dextroamphetamine aids a person learning and memory of words, and perhaps makes the brain stronger<!--
  -->.<ref name = "Butefisch"/> When a person given dextroamphetamine is tested, their brain is extremely active in the brain parts required for the test and radically less active in other parts<!--
  -->.<ref name = "Mattay"/> Short practice sessions with dextroamphetamine have a greater effect on learning than sessions without dextroamphetamine<!--
  -->.<ref name = "Butefisch"/><ref name = "Mattay"/> Dextroamphetamine raises decision-making scores, improves choices, and changes beliefs about rewards; at the same time, dextroamphetamine barely—if at all—affects guesses of time<!--
  -->.<ref name = "de Wit"/> Those who feel lower amounts of joy from dextroamphetamine have greater impulsivity improvements compared to those who feel extreme happiness<!--
  -->.<ref name = "de Wit"/>
Clinically significant side effects of dextroamphetamine include sleeplessness, reduced appetite, dryness of mouth, and headaches.


===Effect on neurochemistry===
<!--Brand Names-->
Dextroamphetamine affects the dynamics [[neurotransmitter]] systems, and its mechanisms of action are continuously being investigated and discovered.
|brandNames=* ®<ref>{{Cite web | title = | url = }}</ref>


====Monoamines====
<!--Look-Alike Drug Names-->
Dextroamphetamine affects dopamine and serotonin levels in the [[Caudate nucleus|caudate]], and norepinephrine in the [[hippocampus]]. Because dextroamphetamine is a substrate analog at monoamine transports, at all doses, dextroamphetamine prevents the reuptake of these neurotransmitters<!--  
|lookAlike=* A® — B®<ref name="www.ismp.org">{{Cite web  | last = | first = | title = http://www.ismp.org | url = http://www.ismp.org | publisher = | date = }}</ref>
-->,<ref name="Kuczenski">{{cite journal | author = Kuczenski R ''et al''. | title = Hippocampus Norepinephrine, Caudate Dopamine and Serotonin, and Behavioral Responses to the Stereoisomers of Amphetamine and Methamphetamine | journal = The Journal of Neuroscience | volume = 15 | issue = 2 | pages = 1308–1317 | year = 1995 | pmid = 7869099}} [http://www.jneurosci.org/cgi/reprint/15/2/1308 Free full text (PDF)]</ref> causing them to remain in the synaptic cleft for a prolonged period (inhibiting monoamine reuptake in rats with a [[norepinephrine]] to [[dopamine]] ratio (NE:DA) of about 1:1 and a norepinephrine to [[Serotonin|5-hydroxytryptamine]] ratio (NE:5HT) of about 1:10<ref>Rothman, et al. "Amphetamine-Type Central Nervous System Stimulants Release Norepinephrine more Potently than they Release Dopamine and Serotonin." (2001): ''Synapse'' '''39''', 32–41 (Table V. on page 37)</ref>). At some point, when doses are high, and the concentration of dextroamphetamine is high enough<!-- 
-->,<ref name="Kuczenski"/> dextroamphetamine will enter nerve cells and cause release of monoamines from the cytoplasmic dopamine pool (as opposed to 'protected' vesicular stores)<!-- 
-->.<ref>{{cite journal | author = Patrick, and Markowitz | title = Pharmacology of Methylphenidate, Amphetamine Enantiomers and Pemoline in Attention-Deificit Hyperacitivty Disorder | journal = Human Psychopharmacology | volume = 12 | pages = 527-546 (Page:530) | year = 1997}}</ref> In such high concentrations, dextroamphetamine will cause the norepinephrine, dopamine and [[serotonin]] (5HT) transporters to reverse their direction of flow. This inversion leads to a release of these transmitters from the vesicles to the cytoplasm and from the cytoplasm to the synapse (releasing monoamines in rats with ratios of about NE:DA = 1:3.5 and NE:5HT = 1:250), causing increased stimulation of post-synaptic receptors.


====Glutamate====
<!--Drug Shortage Status-->
Dextroamphetamine does not alter glutamate levels in the prefrontal cortex. This may be because dextroamphetamine increases dopamine release in the prefrontal cortex; activation of the dopamine-2 receptors inhibits glutamate release in the prefrontal cortex. However activation of the dopamine-1 receptors in the prefrontal cortex, increases glutamate leves in the nucleus accumbens. An increase of the glutamate levels in the nucleus accumbens may be part of the reason that dextroamphetamine has an ability to increase locomotor activity in rats. Serotonin may also play a role in dextroamphetamines affect on glutamate levels.
|drugShortage=
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|fileName={{PAGENAME}}11.png
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{{LabelImage
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<!--Pill Image-->


===Time course and elimination===
On average, about one half of a given dose is eliminated unchanged in the urine, while the other half is broken down into various metabolites (mostly [[benzoic acid]]).<!--
  --><ref>{{cite journal | author = Mofenson H, Greensher J | title = Letter: Physostigmine as an antidote: use with caution. | journal = J Pediatr | volume = 87 | issue = 6 Pt 1 | pages = 1011-2 | year = 1975 | id = PMID 1185381}}</ref>
However, the drug's half-life is highly variable because the rate of excretion is very sensitive to urinary pH. Under alkaline conditions, direct excretion is negligible and 95%+ of the dose is metabolized. The main metabolic pathway is d-amphetamine <math>\rightarrow \;</math> [[phenylacetone]] <math>\rightarrow \;</math> benzoic acid <math>\rightarrow \;</math> [[hippuric acid]]. Another pathway, mediated by enzyme [[CYP2D6]], is d-amphetamine <math>\rightarrow \;</math> p-hydroxyamphetamine <math>\rightarrow \;</math> p-hydroxynorephedrine. Although p-hydroxyamphetamine is a minor metabolite (~5% of the dose), it may may have significant physiological effects as a [[norepinephrine]] analogue.<!--
  --><ref>{{cite journal | author = Rangno R, Kaufmann J, Cavanaugh J, Island D, Watson J, Oates J | title = Effects of a false neurotransmitter, p-hydroxynorephedrine, on the function of adrenergic neurons in hypertensive patients. | journal = J Clin Invest | volume = 52 | issue = 4 | pages = 952-60 | year = 1973 | id = PMID 4348345 | url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=302343 | format=Scanned copy}}</ref>


Subjective effects are increased by larger doses, however, over the course of a given dose there is a noticeable divergence between such effects and drug concentration in the blood.<ref>{{cite journal |author=Asghar S, Tanay V, Baker G, Greenshaw A, Silverstone P |title=Relationship of plasma amphetamine levels to physiological, subjective, cognitive and biochemical measures in healthy volunteers |journal=Hum Psychopharmacol |volume=18 |issue=4 |pages=291–9 |year=2003 |pmid=12766934}}</ref> In particular, mental effects peak before maximal blood levels are reached, and decline as blood levels remain stable or even continue to increase.<!--
  --><ref>{{cite journal | author = Angrist B, Corwin J, Bartlik B, Cooper T | title = Early pharmacokinetics and clinical effects of oral D-amphetamine in normal subjects. | journal = Biol Psychiatry | volume = 22 | issue = 11 | pages = 1357-68 | year = 1987 | id = PMID 3663788}}</ref><!--
  --><ref>{{cite journal | author = Brown G, Hunt R, Ebert M, Bunney W, Kopin I | title = Plasma levels of d-amphetamine in hyperactive children. Serial behavior and motor responses. | journal = Psychopharmacology (Berl) | volume = 62 | issue = 2 | pages = 133-40 | year = 1979 | id = PMID 111276 | doi=10.1007/BF00427126 | url=http://www.springerlink.com/content/w14m559771164631/ | format=Abstract}}</ref><!--
  --><ref>{{cite journal | author = Brauer L, Ambre J, De Wit H | title = Acute tolerance to subjective but not cardiovascular effects of d-amphetamine in normal, healthy men. | journal = J Clin Psychopharmacol | volume = 16 | issue = 1 | pages = 72-6 | year = 1996 | id = PMID 8834422}}</ref>
This indicates a mechanism for development of acute tolerance, perhaps distinct from that seen in chronic use. Its slower onset of action as compared to methamphetamine and methylphenidate is presumably due to a somewhat lower effectiveness in crossing the [[blood-brain barrier]].<ref>{{cite journal |author=MacKenzie R, Heischober B |title=Methamphetamine |journal=Pediatr Rev |volume=18 |issue=9 |pages=305–9 |year=1997 |pmid=9286149}}</ref>


<!--Label Display Image-->




==References==
* [http://www.inchem.org/documents/pims/pharm/pim178.htm Poison Information Monograph] (PIM 178: Dexamphetamine Sulphate)
* ''Physician's 1991 Drug Handbook''
* ''Dexamphetamine'' {{GPnotebook|1845887055}}
* Package inserts: {{cite web | title=New Zealand | url=http://www.medsafe.govt.nz/Profs/Datasheet/d/Dexamphetaminesulphatetab.htm}} {{cite web | title=Canada| url=http://www.mentalhealth.com/drug/p30-d04.html}}
* {{cite journal | author = Yamada H, Baba T, Hirata Y, Oguri K, Yoshimura H | title = Studies on N-demethylation of methamphetamine by liver microsomes of guinea-pigs and rats: the role of flavin-containing mono-oxygenase and cytochrome P-450 systems. | journal = Xenobiotica | volume = 14 | issue = 11 | pages = 861-6 | year = 1984 | id = PMID 6506758}} <!-- I can't see where this directly links into the text, but it usefully indicates that different species undertake different metabolic approaches. User:Davidruben --->


==Footnotes==
{{reflist|2}}


{{Stimulants}}
{{Psychostimulants, agents used for ADHD and nootropics}}
[[Category:Amphetamines]]


[[gl:Dextroanfetamina]]
<!--Category-->
[[nl:Dextro-amfetamine]]
[[pl:Dekstroamfetamina]]
[[pt:Dextroanfetamina]]
[[fi:Deksamfetamiini]]


{{jb1}}
[[Category:Drug]]
{{WH}}
{{WS}}

Revision as of 16:54, 12 December 2014

Dextroamphetamine
Black Box Warning
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];

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Black Box Warning

ConditionName:
See full prescribing information for complete Boxed Warning.
ConditionName:
  • Content

Overview

Dextroamphetamine is a {{{drugClass}}} that is FDA approved for the {{{indicationType}}} of {{{indication}}}. There is a Black Box Warning for this drug as shown here. Common adverse reactions include .

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

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  • Dosing Information
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Condition2
  • Dosing Information
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Condition3
  • Dosing Information
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Condition4
  • Dosing Information
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Off-Label Use and Dosage (Adult)

Guideline-Supported Use

Condition1
  • Developed by:
  • Class of Recommendation:
  • Strength of Evidence:
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Guideline-Supported Use of Dextroamphetamine in adult patients.

Non–Guideline-Supported Use

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Non–Guideline-Supported Use of Dextroamphetamine in adult patients.

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding FDA-Labeled Use of Dextroamphetamine in pediatric patients.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

Condition1
  • Developed by:
  • Class of Recommendation:
  • Strength of Evidence:
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Guideline-Supported Use of Dextroamphetamine in pediatric patients.

Non–Guideline-Supported Use

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Non–Guideline-Supported Use of Dextroamphetamine in pediatric patients.

Contraindications

  • Condition1

Warnings

ConditionName:
See full prescribing information for complete Boxed Warning.
ConditionName:
  • Content
  • Description

Precautions

  • Description

Adverse Reactions

Clinical Trials Experience

There is limited information regarding Clinical Trial Experience of Dextroamphetamine in the drug label.

Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous

Postmarketing Experience

There is limited information regarding Postmarketing Experience of Dextroamphetamine in the drug label.

Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous

Drug Interactions

  • Drug
  • Description

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA):

  • Pregnancy Category


Pregnancy Category (AUS):

  • Australian Drug Evaluation Committee (ADEC) Pregnancy Category

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Dextroamphetamine in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Dextroamphetamine during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Dextroamphetamine with respect to nursing mothers.

Pediatric Use

There is no FDA guidance on the use of Dextroamphetamine with respect to pediatric patients.

Geriatic Use

There is no FDA guidance on the use of Dextroamphetamine with respect to geriatric patients.

Gender

There is no FDA guidance on the use of Dextroamphetamine with respect to specific gender populations.

Race

There is no FDA guidance on the use of Dextroamphetamine with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Dextroamphetamine in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Dextroamphetamine in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Dextroamphetamine in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Dextroamphetamine in patients who are immunocompromised.

Administration and Monitoring

Administration

  • Oral
  • Intravenous

Monitoring

There is limited information regarding Monitoring of Dextroamphetamine in the drug label.

  • Description

IV Compatibility

There is limited information regarding IV Compatibility of Dextroamphetamine in the drug label.

Overdosage

Acute Overdose

Signs and Symptoms

  • Description

Management

  • Description

Chronic Overdose

There is limited information regarding Chronic Overdose of Dextroamphetamine in the drug label.

Pharmacology

There is limited information regarding Dextroamphetamine Pharmacology in the drug label.

Mechanism of Action

Structure

File:Dextroamphetamine01.png
This image is provided by the National Library of Medicine.

Pharmacodynamics

There is limited information regarding Pharmacodynamics of Dextroamphetamine in the drug label.

Pharmacokinetics

There is limited information regarding Pharmacokinetics of Dextroamphetamine in the drug label.

Nonclinical Toxicology

There is limited information regarding Nonclinical Toxicology of Dextroamphetamine in the drug label.

Clinical Studies

There is limited information regarding Clinical Studies of Dextroamphetamine in the drug label.

How Supplied

Storage

There is limited information regarding Dextroamphetamine Storage in the drug label.

Images

Drug Images

{{#ask: Page Name::Dextroamphetamine |?Pill Name |?Drug Name |?Pill Ingred |?Pill Imprint |?Pill Dosage |?Pill Color |?Pill Shape |?Pill Size (mm) |?Pill Scoring |?NDC |?Drug Author |format=template |template=DrugPageImages |mainlabel=- |sort=Pill Name }}

Package and Label Display Panel

{{#ask: Label Page::Dextroamphetamine |?Label Name |format=template |template=DrugLabelImages |mainlabel=- |sort=Label Page }}

Patient Counseling Information

There is limited information regarding Patient Counseling Information of Dextroamphetamine in the drug label.

Precautions with Alcohol

  • Alcohol-Dextroamphetamine interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

Look-Alike Drug Names

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

  1. ↑ Empty citation (help)
  2. ↑ "http://www.ismp.org". External link in |title= (help)

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