Dexedrine Spansules

Generic name:

Dextroamphetamine sulfate

Drug class:

Central nervous system stimulant (amphetamine class)

Dosage form:

Spansule capsules: 5 mg, 10 mg, 15 mg

Root of administration:

Oral

Dose:

• ADHD (children & adults): Initial 5 mg once or twice daily; increase by 5 mg weekly; typical total daily dose 5–40 mg divided in 2–3 doses
• Narcolepsy: 5 mg 1–3 times daily; adjust as needed; max 60 mg/day
• Off-label uses: Varies by indication; consult label.

Mechanism of action:

Dextroamphetamine increases synaptic concentrations of dopamine and norepinephrine by promoting their release and blocking reuptake in the central nervous system, enhancing neurotransmission and producing stimulant effects.

Drug usage cases:

• Attention-deficit/hyperactivity disorder (ADHD) in children and adults (approved)
• Narcolepsy (approved)
• Off-label: treatment-resistant depression
• Off-label: weight management/obesity
• Off-label: fatigue in multiple sclerosis
• Off-label: cognitive enhancement (caution advised)

Drug contra indications:

• Hypersensitivity to amphetamines or any component of the formulation
• Advanced arteriosclerosis
• Symptomatic cardiovascular disease (e.g., coronary artery disease, arrhythmias)
• Moderate to severe hypertension
• Hyperthyroidism
• Glaucoma
• Agitated states
• Pheochromocytoma
• Concurrent treatment with monoamine oxidase inhibitors or within 14 days of MAOI therapy
• Tendency toward drug dependence or abuse

Side effects:

• CNS: insomnia, restlessness, nervousness, tremor, dizziness, headache, irritability, euphoria, dysphoria, psychotic episodes
• Cardiovascular: tachycardia, palpitations, hypertension, chest pain
• Gastrointestinal: dry mouth, anorexia, abdominal pain, nausea, vomiting, diarrhea, weight loss
• Psychiatric: anxiety, agitation, aggression, mood swings, exacerbation of preexisting psychosis, mania
• Neurological: seizures, tics, exacerbation of Tourette syndrome
• Growth suppression in children (weight and height)
• Dependence, tolerance, withdrawal symptoms upon discontinuation

Warnings:

• High potential for abuse and dependence; assess for history of substance abuse
• Serious cardiovascular events including sudden death, myocardial infarction, stroke in patients with structural cardiac abnormalities or other serious heart problems
• Exacerbation of preexisting psychiatric disorders, including psychosis, bipolar illness, and suicidal ideation
• May increase blood pressure and heart rate; monitor vital signs regularly
• Long-term use may cause growth suppression; monitor growth in pediatric patients
• Risk of serotonin syndrome when used with serotonergic drugs
• Potential for withdrawal symptoms upon abrupt cessation; taper gradually
• May impair ability to operate machinery or drive; use caution
• Risk of peripheral vasculopathy, including Raynaud’s phenomenon

Use during pregnancy or breastfeeding:

Pregnancy: Classified as FDA Pregnancy Category C. Animal studies have shown adverse fetal effects at high doses. Use only if the potential benefit justifies the potential risk to the fetus. Monitor for fetal growth restriction and neonatal withdrawal symptoms.

Breastfeeding: Excreted in breast milk; may cause irritability, poor feeding, and sleep disturbances in nursing infants. Mothers should monitor infants for adverse reactions. Consider discontinuation of nursing or the drug based on the importance of therapy.