Dextroamphetamines
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Dextroamphetamine is part of a group of prescription drugs known as central nervous system stimulants. It is FDA-approved for the treatment of attention deficit hyperactivity disorder (ADHD) and narcolepsy. Brand names for DXM include Dexedrine, ProCentra, Biphetamine, Liquadd, and Dextrostat. The drug was first developed in the early 1900s to treat people who struggled with obesity or depression, and was approved by the FDA for the treatment of ADHD in the 1950s. Because of its appetite-suppressing qualities, Dexedrine was a popular drug for weight loss in the 1960s and 1970s.
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Definition
Dextroamphetamine is the dextrorotatory isomer of amphetamine, usually in the form of its sulfate salt (C 9 H 13 N) 2 H 2 SO 4, and is a stimulant of the central nervous system (CNS). Dextroamphetamine is a white, crystalline, water-soluble solid that is available pharmaceutically in the form of 5-mg or 10-mg tablets for oral administration. It is used medicinally as an antidepressive and appetite suppressant primarily for the treatment of narcolepsy and attention-deficient and hyperactivity disorder (ADHD). Dextroamphetamine may also be prescribed to aid treatment for refractory depression by augmenting the effects of antidepressants, or in certain cases of obesity to help curb appetite.
Clinical Information
Dextroamphetamine is available either in immediate-release tablets, known as the brand DextroStat, or sustained-release capsules, known as the brand Dexedrine Spansules. DextroStat is usually issued to adult patients at 10–40 mg daily; or, adults might be prescribed Dexedrine once daily. Dexedrine is preferred for children with ADHD since parents can control the timing of the drug’s release in the child’s system, making it most effective during school hours and avoids interfering with the child’s normal downtime. Dextroamphetamine is effective in the treatment of narcolepsy by helping the brain manage sleep patterns, but should not be confused for also being effective in treating non-narcoleptic excessive tiredness, which it may actually exacerbate. Dextroamphetamine is a common drug of abuse due to its high potential for dependency and illicit psychostimulant effects. Therefore, it is available by non-refillable prescription only, requiring the patient’s physician to write a new prescription each time dextroamphetamine is dispensed. Both DextroStat and Dexedrine Spansules are Schedule II controlled substances in the U.S., the most regulated level for approved medication. Dextroamphetamine should only be taken by the patient to whom it is prescribed, and should be taken exactly as directed at the same time each day. Dextroamphetamine should not be taken before sleep since it may cause alertness and sleep difficulties. Dextroamphetamine cannot be prescribed to anyone with a history of substance abuse.
Medical Use
Like all amphetamines, dextroamphetamine is a non-catecholamine, sympathomimetic amine; this CNS stimulant causes peripheral actions in the bodily system, primarily elevated diastolic and systolic blood pressures, and weakened stimulation of respiratory and bronchodilator action. It has proven to be successful in aiding the management of ADHD and has become integrated into the standard ADHD treatment program that also includes social, educational, and psychological therapy. Dextroamphetamine helps improve the patient’s ability to concentrate, maintain control over actions, decrease impulsivity and hyperactivity, moderate emotional lability, remain still or quiet, and extend attention span. In severe cases of narcolepsy in which other treatment methods have been ineffective, dextroamphetamine has shown to help control daytime somnolence by affecting certain natural substances in the brain related to the sleep-wake control mechanisms.
Side Effects and Symptoms
Dextroamphetamine may cause various side effects, including:
- Restlessness
- Sleeplessness, difficulty falling or staying asleep, insomnia
- Irritability
- Nervousness
- Sweating
- Rapid heart rate
- Palpitations
- Headache
- Loss of appetite
- Dry mouth
- Nausea
- Abdominal pain/cramps
- Diarrhea
- Constipation
- Weight loss
- Increased blood pressure
- Affected sex drive
Extended use or excessive dosages of dextroamphetamine can cause dependence. A physician may not prescribe dextroamphetamine for a long period of time or may allow breaks between patient’s use to avoid dependence. Intermittent breaks also allow child patients to develop since dextroamphetamine can stint linear growth. Other adverse effects may be more serious; the patient’s physician should be contacted immediately if any of the following symptoms occur:
- Excessive tiredness
- Dizziness/faintness
- Affected speech
- Verbal tics
- Shortness of breath
- Increased heart rate
- Chest pains
- Uncontrolled shaking, weakness, or numbness of a body part
- Abnormal movements
- Unusual mood changes
- Abnormal excitability
- Aggression/hostile behavior
- Affected vision
- Hallucinations
- Paranoia
- Seizures
- Hives
Dextroamphetamine should not be used in combination with other medications without consent from a physician as this may result in serious side effects or death. Dextroamphetamine can cause severe cardiovascular adverse events or sudden death in children or teenagers who have preexisting structural cardiac abnormalities, heart defects, or other serious heart problems. Adults with a history of cardiac disorders, heart disease, or other heart problems may be at risk of stroke, heart attack, or sudden death when using dextroamphetamine. A physician may not prescribe dextroamphetamine when the patient is pregnant, may become pregnant, or is breastfeeding to avoid adverse reactions to the fetus/baby that amphetamines are believed to cause. Anyone with a history of high blood pressure, seizures, schizophrenia, or bipolar disorder may not be prescribed dextroamphetamine.
Abuse
Dextroamphetamine can cause dependence and is highly abused by patients or individuals engaged in drug diversion. Individuals with a history of substance abuse are particularly at risk of amphetamine abuse. Dextroamphetamine is sold illicitly on the streets for as much as $5 per tablet and is used for its euphoric effects. It has become one of the most commonly abused prescription drugs in the U.S. in the past decade; as many as 15 million Americans are believed to have abused a prescription drug in their lifetime. The National Institute on Drug Abuse estimates that 4% of college-aged adults abuse prescription medications—which are mostly obtained from peers and are also associated with marijuana use and binge drinking. Dextroamphetamine abuse causes tolerance, euphoria, withdrawal, addiction, and social, psychological, and psychotic dysfunctions including extreme fatigue, depression, and affected sleep EEG. Warning signs of overdose can include any of the following:
- Abnormal tiredness, weakness, and restlessness
- Dizziness
- Fast breathing
- Uncontrollable shaking, tremor
- Hyperreflexia
- Muscle weakness, aching, or cramps
- Irregular heartbeat
- Blurred vision
- Upset stomach, nausea, vomiting, and diarrhea
- Dark red- or brown-colored urine
- Rhabdomyolysis
- Unusual aggressive behavior/assaultiveness
- Hypertension/hypotension
- Hyperpyrexia
- Confusion
- Hallucinations, panic
- Fainting
- Seizures/convulsions
- Coma
Seizures and/or convulsions are usually the preceding indications of amphetamine poisoning. A dextroamphetamine overdose is a medical emergency and requires immediate medical assistance by calling 911 or a certified poison control center.
References
dextroamphetamine. (n.d.). Merriam-Webster's Medical Dictionary. Retrieved April 27, 2010, from Dictionary.com website: http://dictionary.reference.com/browse/dextroamphetamine
http://www.drugs.com/pro/dextroamphetamine.html
http://www.medic8.com/medicines/Dexedrine.html
http://www.justice.gov/dea/pubs/abuse/5-stim.htm
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a605027.html
Chew, Robert H., Robert E. Hales, and Stuart C. Yudofsky. (2009). What your patients need to know about psychiatric medications. 2nd ed. Arlington, VA: American Psychiatric Publishing, Inc.
