20 May, 2014
Adderall is a brand-name pharmaceutical psychostimulant composed of mixed amphetamine salts, which is thought to work by increasing the amount of norepinephrine and dopamine in the brain. Adderall is widely reported to increase alertness, concentration and overall cognitive performance while decreasing user fatigue. It is available in two formulations: immediate release and extended release (XR).
Specifically, Adderall XR is composed of the following proportions of active ingredients:
- 1/4 dextroamphetamine saccharate
- 1/4 dextroamphetamine sulfate
- 1/4 (racemic dextro/levo-amphetamine) aspartate monohydrate
- 1/4 (racemic dextro/levo-amphetamine) sulfate
These four salts are metabolized at different rates and possess diverse half lives, therefore resulting in a less dramatic onset and termination of therapeutic action, as compared to single-salt amphetamine preparations.
The average elimination half-life in adults for dextroamphetamine and levoamphetamine is 10 hours and 13 hours respectively. Breakdown rates are affected by many factors including urinary and stomach pH, 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); however, there is little support for this claim.
Urinary and stomach pH levels can have the strongest effect on DL-amphetamine excretion and absorption. Co-administration of acidic substances (e.g. citric acid) causes an accelerated excretion of DL-amphetamine while co-administration of alkaline agents (e.g. antacids) causes a marked increase in both retention and absorption of amphetamines potentially resulting in dangerously high serum amphetamine levels.
Adderall is also reportedly one of the most widely used "study drugs" at many American 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. "In extreme cases, the drug can cause paranoia, hallucinations and heart attacks." William Frankenberger, psychology professor at University of Wisconsin at Eau Claire, led at a study at the university in 2004 that reported 14% of the campus had abused some form of study pills, 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.
Due to side effects including appetite suppression and weight loss, Adderall has also been used as an off-label drug for obesity.
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 Microtrol extended-release delivery system, incorporating two types of beads. The first dissolves immediately, releasing half of the drug, while the second type dissolves much more slowly releasing the remaining drug four hours later. Maximum plasma 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 bioavailability, 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). Drugs that alter urinary pH will cause variations in amount and method of excretion and usage should be monitored when taken concurrently with Adderall.
Adderall Prolonged Use
Tolerance, extreme psychological dependence, and severe social disability can occur when amphetamines are abused. The manufacturer warns against exceeding the prescribed dosage, injecting the drug, or insufflation of the drug. 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 psychosis.
Stop using Adderall if you experience any of these serious side effects:
- fast, pounding, or uneven heartbeats; - feeling light-headed, fainting;
- increased blood pressure (severe headache, blurred vision, trouble concentrating, chest pain, numbness, seizure); or
- tremor, restlessness, hallucinations, unusual behavior, or motor tics (muscle twitches).
Less serious side effects may include:
- headache or dizziness;
- sleep problems (insomnia);
- dry mouth or an unpleasant taste in your mouth;
- diarrhea, constipation;
- loss of appetite, weight loss; or
- loss of interest in sex, impotence, or difficulty having an orgasm.
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.
SSRIs (selective serotonin reuptake inhibitors, e.g., Fluoxetine, Citalopram, Paroxetine, etc.). While rare, the possibility for serotonin syndrome exists with this combination. Use only when it is directed.
NRIs (norepinephrine reuptake inhibitors, e.g., Atomoxetine, Strattera, etc.) NRI medications and amphetamine both enhance noradrenergic activity. Possible ugmentation/potentiation of effects. Use only when directed.
SNRIs (selective serotonin-norepinephrine reuptake inhibitors).
Bupropion (Zyban, Wellbutrin IR) 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.
MAOIs (monoamine oxidase inhibitors, e.g., Phenelzine, Nardil, Selegiline, Emsam, Iproniazid,Iprozid, etc.) Do not administer amphetamines for a minimum of two weeks after last use of MAOI type drugs. Possible hypertensive crises, dangerously elevated amphetamine levels. 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.
CYP2D6 (liver enzyme) inhibitors, e.g., most SSRIs such as escitalopram, fluoxetine, paroxetine, etc. Some anti-psychotics such as thioridazine, haloperidol, and, levomepromazine. The stimulant cocaine. Methadone, a opioid analgesic and anti-addictive. There are additional compounds 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 Adderall (study pills in general) will lead to a elevated level of Adderall in the system and it will also remain longer in the body, this can lead to undesired or possibly serious side effects.