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dextroamphetamine sulfate

(dex troe am fet' a meen)


Dexedrine, Dexedrine Spansule, DextroStat

Pregnancy Category C
Controlled Substance C-II

Drug classes
Amphetamine
CNS stimulant

Therapeutic actions
Acts in the CNS to release norepinephrine from nerve terminals; in higher doses also
releases dopamine; suppresses appetite; increases alertness, elevates mood; often
improves physical performance, especially when fatigue and sleep-deprivation have
caused impairment; efficacy in hyperkinetic syndrome, attention-deficit disorders in
children appears paradoxical and is not understood.

Indications
• Narcolepsy
• Adjunct therapy for abnormal behavioral syndrome in children (attention-deficit
disorder, hyperkinetic syndrome) that includes psychological, social, educational
measures

Contraindications and cautions


• Hypersensitivity to sympathomimetic amines, tartrazine (Dexedrine); advanced
arteriosclerosis, symptomatic CV disease, moderate to severe hypertension,
hyperthyroidism, glaucoma, agitated states, history of drug abuse; pregnancy;
lactation.

Available forms
Tablets—5, 10, 15 mg; SR capsules—5, 10, 15 mg; CR capsules—10, 15 mg

Dosages
ADULTS
• Narcolepsy: Start with 10 mg/day PO in divided doses; increase in increments of
10 mg/day at weekly intervals. If insomnia, anorexia occur, reduce dose. Usual
dosage is 5–60 mg/day PO in divided doses. Give first dose on awakening,
additional doses (one or two) q 4–6 hr; long-acting forms can be given once a day.
PEDIATRIC PATIENTS
• Narcolepsy:
6–12 yr: Condition is rare in children < 12 yr; when it does occur, initial dose is
5 mg/day PO. Increase in increments of 5 mg at weekly intervals until optimal
response is obtained.
>12 yr: Use adult dosage.
• Attention-deficit disorder:
< 3 yr: Not recommended.
3–5 yr: 2.5 mg/day PO. Increase in increments of 2.5 mg/day at weekly intervals
until optimal response is obtained.
> 6 yr: 5 mg PO daily–bid. Increase in increments of 5 mg/day at weekly
intervals until optimal response is obtained. Dosage will rarely exceed 40 mg/day.
Give first dose on awakening, additional doses (one or two) q 4–6 hr. Long-acting
forms may be used once a day.

Pharmacokinetics
Route Onset Peak Duration
Oral Rapid 1–5 hr 8–10 hr

Metabolism: Hepatic; T1/2: 10–30 hr


Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• CNS: Overstimulation, restlessness, dizziness, insomnia, dyskinesia, euphoria,
dysphoria, tremor, headache, psychotic episodes
• CV: Palpitations, tachycardia, hypertension
• Dermatologic: Urticaria
• Endocrine: Reversible elevations in serum thyroxine with heavy use
• GI: Dry mouth, unpleasant taste, diarrhea, constipation, anorexia and weight loss
• GU: Impotence, changes in libido
• Other: Tolerance, psychological dependence, social disability with abuse

Interactions
Drug-drug
• Hypertensive crisis and increased CNS effects if given within 14 days of MAOIs;
do not give dextroamphetamine to patients who are taking or who have recently
taken MAOIs
• Increased duration of effects if taken with urinary alkalinizers (acetazolamide,
sodium bicarbonate), furazolidone
• Decreased effects if taken with urinary acidifiers
• Decreased efficacy of antihypertensive drugs (guanethidine) given with
amphetamines

Nursing considerations
Assessment
• History: Hypersensitivity to sympathomimetic amines, tartrazine; advanced
arteriosclerosis, symptomatic CV disease, moderate to severe hypertension,
hyperthyroidism, glaucoma, agitated states, history of drug abuse; lactation,
pregnancy
• Physical: Weight; T; skin color, lesions; orientation, affect, ophthalmic exam
(tonometry); P, BP, auscultation; R, adventitious sounds; bowel sounds, normal
output; thyroid function tests, blood and urine glucose, baseline ECG

Interventions
• Ensure proper diagnosis before administering to children for behavioral
syndromes. Drug should not be used until other causes (learning disability, EEG
abnormalities, neurologic deficits) are ruled out.
• Interrupt drug dosage periodically in children being treated for behavioral
disorders to determine if symptomatic response still validates drug therapy.
• Monitor growth of children on long-term amphetamine therapy.
• Dispense the lowest feasible dose to minimize risk of overdosage; should be in a
light-resistant container.
• Ensure that patient swallows SR tablets whole; do not cut, crush, or chew.
• Give drug early in the day to prevent insomnia.
• Monitor BP frequently early in therapy.

Teaching points
• Take this drug exactly as prescribed. Do not increase the dosage without
consulting your physician. If the drug appears ineffective, consult your health care
provider.
• Do not crush or chew sustained-release or long-acting tablets.
• Take drug early in the day (especially sustained-release preparations) to avoid
insomnia.
• Avoid pregnancy while taking this drug. This drug can cause harm to the fetus.
• These side effects may occur: Nervousness, restlessness, dizziness, insomnia,
impaired thinking (may diminish in a few days; avoid driving or engaging in
activities that require alertness); headache, loss of appetite, dry mouth.
• Report nervousness, insomnia, dizziness, palpitations, anorexia, GI disturbances.

Adverse effects in Italic are most common; those in Bold are life-threatening.

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