adderall phentermine
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Adderall is a brand-name pharmaceutical psychostimulant composed of mixed amphetamine salts, the actions of which are sympathomimetic. The drug is used primarily to treat attention-deficit hyperactivity disorder and narcolepsy, which are its only two approved indications for use in the United States. It is available in two formulations: immediate release and extended release (XR). The XR formulation, however, is not approved to treat narcolepsy.
Other Uses
Adderall has also been used successfully to manage severe cases of treatment-resistant depression. Individuals who show little or no response to typical antidepressants, including SSRIs and tricyclic antidepressants, are more likely to respond to psychostimulant therapy. These patients, however, are the exception, rather than the norm among those with depression and this is not an approved indication. Other recognized uses include:
- Idiopathic Central Nervous System Hypersomnia established by recognized diagnostic criteria
- Drug-induced brain dysfunction
- Epilepsy
- Depression shown to be refractory to other therapeutic modalities
- Senile apathetic behavior.
These above uses are not necessarily licensed in any particular country; for example they are not FDA approved in the USA.
History
Shire Pharmaceuticals introduced the Adderall brand in 1996 in the form of a multi-dose, instant-release tablet derived from an original formula of the weight management drug Obetrol. In 2006, Shire agreed to sell rights to the Adderall name for this instant-release medication to Duramed Pharmaceuticals and this instant-release medication has since become available in a generic formulation of "mixed amphetamine salts". The active ingredients of Adderall XR include a combination of dextroamphetamine and racemic DL -amphetamine salts. In 2001, Shire Pharmaceuticals introduced an extended-release preparation of these ingredients in a variety of dosages under the brand name "Adderall XR", on which Shire retains exclusive patent rights until the patent expires, expected in 2009.
Chemistry
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. Alkaline increases bioavailability and acidic foods cause the drug to be excreted sooner. Manufacturers claim that the mixture of salts makes the effects of Adderall XR smoother (i.e., with 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's effects are similar to other CNS stimulants of the same class and preparation (see amphetamine for details).
Dosing and administration
Adderall is marketed as either an immediate-release tablet, Adderall, or an extended-release capsule, Adderall XR. Doses for both Adderall XR and Adderall are 5, 10, 15, 20, and 30 mg strengths; instant-release Adderall also has 7.5 and 12.5 mg doses, and Adderall XR has a 25 mg dose.
Adderall XR utilizes the Microtrol extended-release delivery system, incorporating two types of beads. The first dissolves immediately, releasing half of the medication, while the second type dissolves much more slowly releasing the remaining medication 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). Medications that alter urinary pH will cause variations in amount and method of excretion and usage should be monitored when taken concurrently with Adderall.
Manufacturer's claims of instant release have been disputed. A US patent granted for Adderall was a pharmaceutical composition patent listing a rapid immediate release oral dosage form. No claim of increased or smooth drug delivery was made. A recent double-blind, placebo-controlled crossover study, conducted among children, indicated that patients behaved similarly to other immediate release amphetamines. The authors found that sustained-release dexamphetamine (the main isomeric-amphetamine component of Adderall) had a longer duration of action, though D -amphetamine was less effective in the first few hours.
Use as treatment for attention-deficit/hyperactivity disorder (ADHD)
Adderall has been commonly prescribed for many years as a treatment for children and adults with attention deficit/hyperactive disorder (ADHD), a disorder that comes in three types, Inattentive, Hyperactive, and Combined (containing traits from both Inattentive and Hyperactive ADHD). The disorder can prevent children and adults from being able to focus on tasks for extended periods of time while affecting their working memories and processing speeds, a particularly detrimental condition for school performance. After administration of Adderall students have been shown to give higher teacher ratings and perform better in mathematics within 1.5 hours of initial dose. Depending on dosage, these beneficial effects can also last several hours allowing improved performance throughout the day.
Other studies comparing Adderall with other similar medications have shown that Adderall is also more potent than Ritalin (methylphenidate) and has a longer period of efficaciousness. For many this means it is likely preferable as a medication for ADHD, and certainly a substitute for children who have adverse side effects to Ritalin, or for whom Ritalin has become ineffective.
There are also other reasons for taking Adderall aside from just alleviating the symptoms of ADHD. Untreated ADHD has been linked to an increased risk of psychoactive substance abuse later in life.Fortunately, the likelihood of a drug abuse disorder can be approximately halved by proper treatment during childhood. For many, these stimulant medications used to treat ADHD actually provide protection against developing other drug dependencies in this increased risk population. This contradicts the commonly held misconception that use of drugs like Adderall or Ritalin can cause increased drug dependency later in life.
However, specialists also stress the need for ADHD treatments not to rely solely on drugs like Adderall. They advise a comprehensive treatment plan that includes ADHD education, coaching and support groups; regular visits to your doctor; therapy or counseling regarding ADHD; involvement in recovery programs, and family and relationship counseling when appropriate.
Generic equivalents/alternatives
Until recently, the closest generic equivalent to Adderall (which uses racemic mixed amphetamine salts) was dextroamphetamine sulfate also known as Dexedrine and available in a sustained release form called Dexedrine ER. As of 2008, mixed amphetamine salts are available as a generic formulation. It should be noted that Dexedrine is a single salt form of D-amphetamine, therefore Dexedrine and Dexedrine ER are not strict generic equivalents for Adderall and Adderall XR, though they may, in terms of physiological and psychological effects, be a de facto generic alternative. The savings between Adderall XR and generic Dexedrine ER are significant: 90 dextroamphetamine extended-release capsules cost $20 at a retail pharmacy in the United States, while the equivalent 90 Adderall XR capsules cost approximately $420. The difference is because Adderall XR has been protected under patent in the United States. Until this patent expires, generic versions of Adderall XR will not become available. The generic formulation of Adderall, however, marketed as "mixed amphetamine salts" or "d-amphetamine salt combo," carry a significant savings over that of branded Adderall. On average, Adderall runs about $330 per 100 doses (or $3.30 per dose), whereas the generic mixed amphetamine salts are about one third as expensive - running about $120 per 100 doses (or a little more than $1 per dose).
Vyvanse is another alternative which is actually a prodrug (precurs