What is Adderall (amphetamine and dextroamphetamine) used for?

Adderall Uses and Indications

Adderall (amphetamine and dextroamphetamine) is primarily used for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) and narcolepsy. 1, 2

Primary Indications

ADHD Treatment

• Adderall is a Schedule II controlled substance that effectively treats ADHD symptoms by:
  • Improving attention and focus
  • Reducing hyperactivity and impulsivity
  • Enhancing executive functioning
  • Improving symptom control with an effect size of approximately 1.0 1

Narcolepsy Treatment

• Amphetamine compounds like Adderall are recommended for treating narcolepsy in adults 3
• Benefits for narcolepsy patients include:
  • Reduction in excessive daytime sleepiness
  • Improvement in disease severity
  • Potential reduction in cataplexy symptoms

Mechanism of Action

Adderall works primarily by:

• Acting as a substrate for monoamine transporters, especially the dopamine transporter (DAT) 4
• Stimulating the release of norepinephrine affecting both α- and β-adrenergic receptor sites 2
• Increasing extracellular concentrations of dopamine, norepinephrine, and serotonin 4
• α-Adrenergic stimulation causes vasoconstriction
• β-Adrenergic stimulation increases heart rate, stroke volume, and skeletal muscle blood flow 2

Dosing Considerations

• For ADHD treatment:

  • Starting dose: 5-10 mg daily
  • Maximum daily dose: up to 50 mg daily 1
  • Typically administered in two daily doses 5
  • Average effective dose in adults: approximately 54 mg daily (divided doses) 5

• For narcolepsy:

  • Dosing should be carefully titrated based on clinical response
  • The American Academy of Sleep Medicine provides a conditional recommendation for dextroamphetamine in narcolepsy 3

Efficacy Evidence

• In adults with ADHD:

  • 70% of patients show significant improvement (reduction in ADHD rating scale of ≥30%) compared to 7% with placebo 5
  • 42% decrease in ADHD Rating Scale scores with Adderall treatment 5
  • Low doses (mean 10.77 mg/day) may be effective in some adults 6

• In children with ADHD:

  • Shows robust efficacy versus placebo on behavioral ratings, locomotor activity, and academic measures 7
  • Effects can last up to 12 hours after single doses for some measures 7

Important Warnings and Precautions

• Black box warning: High potential for abuse and dependence 3
• Prolonged administration may lead to dependence 3
• May cause fetal harm based on animal data (human data insufficient to determine risk) 3
• Common adverse effects include:
  • Headache, anxiety, insomnia
  • Decreased appetite, GI upset
  • Increased heart rate and blood pressure
  • Tremors, agitation 6, 2, 4
• Caution in patients with anxiety disorders as it may precipitate anxiety symptoms 6
• Careful monitoring required for cardiovascular effects 2

Monitoring Recommendations

• Regular follow-up every 3-4 weeks during dose titration
• Once stabilized, follow-up every 3-6 months
• Monitor appetite, weight, sleep disturbances, mood changes, and growth parameters 1
• Electronic prescribing systems for Adderall must meet DEA requirements for authentication, security, and record-keeping 1

Adderall is an effective medication for both ADHD and narcolepsy when properly prescribed and monitored, but requires careful consideration of its potential for abuse and side effects.