What is the mechanism of action of 10mg of extended-release Adderall (amphetamine and dextroamphetamine)?

From the Guidelines

Extended-release Adderall 10mg works by gradually releasing amphetamine salts into your bloodstream over 8-12 hours, providing sustained symptom control for ADHD, with its mechanism of action involving the inhibition of dopamine and norepinephrine transporter, leading to increased levels of these neurotransmitters in the brain, thus improving focus, attention, and impulse control 1.

Key Points to Consider

• The medication contains a combination of immediate-release and delayed-release components, allowing for a steady release of the active ingredients throughout the day 1.
• The 10mg dose is often used as a starting dose for adults new to stimulant medication, and patients typically take it once daily in the morning to avoid sleep disruption.
• Side effects may include decreased appetite, dry mouth, increased heart rate, and potential insomnia, which are generally mild and temporary, but require monitoring of pulse and blood pressure 1.
• The extended-release formulation helps reduce the "rebound" effect that can occur when immediate-release stimulants wear off, providing a more consistent therapeutic effect.

Important Considerations for Treatment

• Medication adherence is crucial for effective treatment, and factors such as patient attitudes, physician-patient relationship, and family support should be evaluated and addressed before initiating treatment 1.
• Regular assessment of medication adherence and potential issues should be performed, and adjustments to the treatment regimen may be necessary to optimize outcomes 1.
• The choice of medication and dosing regimen should be individualized based on the patient's symptom profile, needs, and preferences, taking into account the pharmacokinetic profiles of different formulations 1.

From the FDA Drug Label

CLINICAL PHARMACOLOGY Amphetamines are non-catecholamine, sympathomimetic amines with CNS stimulant activity. Pharmacokinetics ... Following administration of one 15 mg sustained-release capsule, maximal dextroamphetamine plasma concentrations were obtained approximately 8 hours after dosing.

The mechanism of action of 10mg of extended release Adderall is not explicitly stated in the provided text, but it can be inferred that it works as a CNS stimulant.

• The pharmacokinetics of the sustained-release capsule are similar to the immediate-release tablet, with the sustained-release capsule having a slower absorption rate, reaching maximal plasma concentrations approximately 8 hours after dosing for a 15mg dose. Since the provided dose is 10mg, which is less than the 15mg dose described, and there is no direct information on the 10mg dose, no conclusion can be drawn about the specific pharmacokinetics of the 10mg dose 2.

From the Research

Mechanism of Action

• 10mg of extended release Adderall, which contains amphetamine salts, works by increasing the presynaptic release of dopamine and other biogenic amines in the brain 3.
• Amphetamine acts by inhibiting the reuptake of dopamine and norepinephrine, similar to methylphenidate, resulting in increased central dopamine and norepinephrine activity 4.
• The primary pharmacologic effect of amphetamine is to increase dopamine and norepinephrine activity, which impacts executive and attentional function 4.

Effects on the Brain

• Amphetamine's actions include dopamine and norepinephrine transporter inhibition, vesicular monoamine transporter 2 (VMAT-2) inhibition, and monoamine oxidase activity inhibition 4.
• The facilitative effects of stimulants on locomotor activity, reinforcement processes, and rate-dependency are mediated by dopaminergic effects at the nucleus accumbens, whereas effects on delayed responding and working memory are mediated by noradrenergic afferents from the locus coeruleus (LC) to prefrontal cortex (PFC) 5.
• Enhancing effects of the stimulants on attention and stimulus control of behavior are mediated by both dopaminergic and noradrenergic systems 5.

Clinical Implications

• Psychostimulants, including amphetamines, are first-line pharmacotherapies for individuals with attention-deficit/hyperactivity disorder (ADHD) 4.
• The use of psychostimulants, such as methylphenidate, has been studied in patients with dementia, with improvements in apathy consistently noted, but the magnitude and duration of effect remain unclear 6.
• Careful patient selection is critical when using psychostimulants, especially in older adults with severe cardiovascular disease or other underlying cardiac abnormalities 6.