Attention deficit hyperactivity disorder (ADHD) is a condition which occurs in childhood and adolescence, although it can last into adulthood, and even be initially diagnosed in adulthood. ADHD and attention deficit disorder (ADD) used to be considered separate conditions. Now, the term ADHD includes ADD. The symptoms of ADHD include:
- hyperactivity and impulsive behavior
- difficulty maintaining attention or focus
- easily distracted by external stimuli
- a combination of impulsive behavior and inattention
Psychotherapy, behavior training, and education can be effective for many people with ADHD. However, treating ADHD often includes the use of medications. Before turning to these medications, the FDA has issued a boxed warning indicating that “Misuse of amphetamine may cause sudden death and serious cardiovascular adverse reactions.” Providers who prescribe medications from this drug class may screen you for potential heart problems. In some cases, depending on the provider, a baseline EKG may be obtained by your provider before starting you on a stimulant medication.
The manufacturers of the medications also list contraindications which include:
“Advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, known hypersensitivity or idiosyncrasy to the sympathomimetic amines, glaucoma, and agitated states.”
Dextroamphetamine and amphetamine (brand name: Adderall) and dextroamphetamine (brand name: Dexedrine) are both central nervous system stimulants. They’re approved for the treatment of ADHD and also for narcolepsy (a neurological condition marked by severe daytime drowsiness). These drugs are more stimulating than methylphenidate (brand name: Ritalin), which is often the first drug your doctor might give you. However, variations in individual experiences with each medication have been reported.
Why they’re prescribed
When prescribed and used properly, both medications can help people with ADHD focus more effectively. Because they contain amphetamines, both drugs are sometimes abused. Over time, tolerance may develop, as may dependence, and both substances have been reported to have a high potential for abuse.
While the actual mechanism of action for both drugs is unknown, the drug is believed to work in two ways. It is believed that the drug makes neurotransmitters last longer in the parts of the brain that control attention and alertness, and they are also believed increase the concentration of neurotransmitters. Neurotransmitters are chemicals that send signals from one brain cell to another. By making these areas more active, the drugs can help a person focus their attention. Surprisingly, stimulants can help calm a person with ADHD.
Forms and dosing
Dextroamphetamine and amphetamine (Adderall) and dextroamphetamine (Dexedrine) are usually taken in tablet form once a day. However, they may also be taken twice (or even three times) a day, depending on how a person responds to the medication. Both drugs are FDA approved to treat ADHD in adults and children aged 3 and older.
If your doctor prescribes dextroamphetamine, the starting dose will often be between 2.5 mg and 5 mg per day. The dose may need to be adjusted gradually, as your doctor monitors how well the drug is working. Adult doses range from 5 mg to 60 mg per day. Children may be given doses ranging from 2.5 mg to 40 mg per day. There are several strengths and an extended release form, so the dose can be individualized.
Dextroamphetamine and amphetamine is also started at a low dose, usually 5 mg and may be gradually adjusted by your doctor. The maximum daily dose is 40 mg to 60 mg per day. Children are often started at 2.5 mg a day, and gradually increased to a maximum of 40 mg per day. There are several strengths and also an extended release form, which makes it easier for your doctor to find the right dose for you.
You will need a written prescription from your doctor to obtain either drug.
Both drugs are available in generic forms, which are less expensive than brand name medications. Ask your doctor and talk to your pharmacist about taking the generic form.
The potential side effects of both drugs are similar. They both may raise blood pressure. The increase is usually minor, but if you’ve been diagnosed with a heart condition or hypertension, discuss the risks and benefits of these medications with your doctor.
The two medications may also cause:
- diarrhea or constipation
- urinary symptoms such as burning while urinating
- palpitations or irregular heartbeats
- dry mouth
- loss of appetite
- weight loss
- reduced growth (in children)
- changes in libido and impotence
In rare cases, dextroamphetamine and amphetamine (Adderall) use may result in alopecia, which is hair loss on the scalp and other parts of the body.
People taking either medication should take the lowest dose possible, in order to avoid a possible overdose.
Although rare, both drugs can cause peripheral vasculopathy, which is a problem with blood vessels of the fingers, hands, legs, and feet. If your fingers start to feel numb or cold, or if unusual wounds appear on your fingers or toes, consult a doctor immediately.
If you have a psychiatric illness or a seizure disorder, these drugs may make symptoms worse. Tell your doctor about your medical history before taking a stimulant drug.
Dextroamphetamine and amphetamine (Adderall) may cause motor tics or changes in speech similar to Tourette syndrome. Changing the dosage or changing to a different medication may alleviate some of these problems.
Both medications have a high potential for abuse, and prolonged use of these drugs have been associated with psychological dependence. These drugs may not be appropriate to take if you have a history of substance abuse, and some prescribers will not write prescriptions for the for people who have had a history of addictive disorders. Keep both medications in a secure location in your home.
Pregnancy and breastfeeding
There haven’t been extensive studies conducted on how either drug affects pregnant women and their babies. However, there are concerns that amphetamines, even used at prescribed levels, may pose risks to a developing fetus, such as lower birth weight or premature birth. There is also a risk of behavioral problems in childhood. Nursing mothers should not take these drugs. Amphetamines can pass through breast milk and have toxic effects on infants.
If you take a stimulant drug, you can experience side effects that can include loss of appetite and weight loss. Children can also experience reduced growth. Your doctor may prescribe a “drug holiday,” which is a deliberate break in treatment for a specific amount of time and purpose, such as identifying side effects. For example, your doctor may prescribe a drug holiday for your child during the summer when school is not in session. Everyone who takes stimulant drugs should be periodically re-evaluated to see if the drug is still effective and needed.
Potential drug interactions
Amphetamines in both medications may interact negatively with several other medications.
These drugs can interfere with the action of anti-seizure medications, like ethosuximide, phenobarbital, or phenytoin. The drugs may block the sedative effects of antihistamines in allergy medications. Antihypertensive drugs may be less effective at lowering blood pressure if you take either drug. There is also a risk of complications if you take these ADHD medications and certain antidepressant or antipsychotic drugs.
If you take either of these stimulant drugs with multivitamins, iron, or fluoride, the drug levels may drop and they may not work as well.
If you take antacids, certain antibiotics, MAO inhibitors, or proton pump inhibitors with either drug, the drug level may be increased.
If you’re prescribed either drug, be sure to tell your doctor and pharmacist about all the other drugs and over-the-counter products you currently take. Ask your health providers about warnings and side effects.
The effectiveness and safety profiles of both drugs are relatively similar. However, because each person responds differently to medication, you may find that your attention is better with one medication compared to the other. Your doctor may try you on one medication and then the other, to determine which one is most effective.
You may also have side effects with one drug that you don’t have with the other. You should know within several days of starting a new medication whether it’s effective and how well you tolerate the side effects.
Dextroamphetamine and amphetamine (Adderall) is more widely prescribed than dextroamphetamine (Dexedrine), but that doesn’t mean you wouldn’t do just as well or better on dextroamphetamine. Make sure your doctor has your complete medical history so they can make an informed recommendation. Don’t hesitate to ask for a different drug or a different dose, if you’re not experiencing adequate symptom relief with the first one you try.