Dextroamphetamine Sulfate

  Action Activates noradrenergic neurons causing CNS and respiratory stimulation; stimulates satiety center in brain causing appetite suppression.

  Indications Treatment of narcolepsy, attention-deficit disorder with hyperactivity; adjunct therapy for short-term (ie, few weeks) exogenous obesity when alternative therapy has been ineffective.

  Contraindications Advanced arteriosclerosis; symptomatic cardiovascular disease; moderate to severe hypertension; hyperthyroidism; hypersensitivity or idiosyncratic reactions to sympathomimetic amines; glaucoma; agitated states; history of drug abuse; concurrent use or within 14 days of MAOI use.

  Route/Dosage

Narcolepsy

Adults (older than 12 yr): PO 10 mg/day; may increase weekly by 10 mg to max 60 mg/day in divided doses.

Children (6 to 12 yr): PO 5 mg/day; may increase weekly by 5 mg to max 60 mg/day in divided doses.

Attention Deficit Disorder

Children 6 yr or older: PO 5 mg/day; may increase weekly by 5 mg to max 40 mg/day in divided doses. Usual range is 0.1 to 0.5 mg/kg/dose q morning.

Children 3 to 5 yr: PO 2.5 mg/day; may increase weekly by 2.5 mg. Usual range is 0.1 to 0.5 mg/kg/dose q morning.

Exogenous Obesity

Adults 12 yr or older: PO 5 to 10 mg 30 to 60 min before meals, up to 30 mg/day. Long-acting form: 10 to 15 mg q morning.

  Interactions

Guanethidine Amphetamines may decrease effectiveness. MAOIs, furazolidone: Hypertensive crisis and intracranial hemorrhage may occur. Tricyclic antidepressants: May decrease amphetamine effect. Urinary Acidifiers (eg, Ammonium Chloride, Ascorbic Acid): May decrease amphetamine levels. Urinary Alkalinizers (eg, Acetazolamide, Sodium Bicarbonate): May increase amphetamine levels.

  Lab Test Interferences Plasma and urinary steroid levels may be altered.

  Adverse Reactions

CARDIOVASCULAR: Palpitations; tachycardia; hypertension; arrhythmias. CNS: Nervousness; tremors; dizziness; insomnia, euphoria; headache. DERMATOLOGIC: Urticaria. EENT: Dry mouth; unpleasant taste. GI: Diarrhea; constipation; anorexia. GU: Impotence.

  Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Do not use as anorectic agent in children younger than 12 yr. Not recommended for attention-deficit disorder in children younger than 3 yr. Drug Dependence: Amphetamines have been extensively abused. Tartrazine Sensitivity: Some products contain tartrazine, which may cause allergic reactions in susceptible individuals. Tolerance: May occur; do not exceed recommended dose to overcome this.

  Administration/Storage

• Limit patient's access to medication.
• Give medication 30 to 45 min before meals. Give sustained-release tablets once daily in morning.
• Do not crush or open sustained-release tablets.

  Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Assess baseline nutritional status.
• Document any abnormal behavior.
• Document monthly measurement of physical growth in children.
• Document weight weekly.
• Notify health care provider and withhold medication if BP increases by 20 mm Hg or if heart arrhythmias or increase in heart rate develops.

  Patient/Family Education

• Instruct patient to take medication early in morning and, if possible, to take last dose at bedtime.
• Tell patient to record body weight weekly.
• Instruct patient/family to measure height monthly if patient is child.
• Tell patient to limit intake of coffee, tea, cocoa, chocolate, and caffeinated soft drinks.
• Explain importance of good oral hygiene to prevent or treat dry mouth and changes in breath odor.
• Instruct patient to be aware of increased agitation, palpitations, and dizziness, and to take precautions while performing tasks that require physical coordination or mental alertness.