Orally Disintegrating Adderall ER vs. Adderall XR: Comparative Efficacy
Orally disintegrating Adderall ER (AMP XR-ODT) is not stronger than Adderall XR; they have equivalent bioavailability and similar pharmacokinetic profiles when administered at equivalent doses. 1
Pharmacokinetic Comparison
- A randomized crossover study in healthy adults demonstrated that AMP XR-ODT (18.8 mg) and Adderall XR (30 mg) have equivalent bioavailability, with geometric mean ratios for Cmax, AUC5-last, AUClast, and AUCinf falling within the 80%-125% bioequivalence range for both d- and l-amphetamine 1
- The only slight difference was in the AUC0-5 (early absorption phase), which was slightly below the 80%-125% range, suggesting minimal variations in initial absorption 1
- Both formulations utilize extended-release technology to provide once-daily dosing with approximately 12 hours of symptom control 2
Clinical Implications
- The orally disintegrating formulation provides the same clinical efficacy as the capsule formulation but offers an alternative for patients who have difficulty swallowing pills 3
- When AMP XR-ODT was taken with food, there was a slight decrease in peak concentration and approximately a 2-hour delay in reaching maximum concentration, but this food effect is not considered clinically significant 1
- Both formulations contain the same active ingredients (mixed amphetamine salts) and are designed to deliver medication in a two-phase release pattern 2
Dosing Considerations
- The American Academy of Child and Adolescent Psychiatry recommends similar dosing approaches for both formulations, with a starting dose of 10 mg once daily in the morning, which can be titrated by increasing 5 mg weekly based on clinical response 4
- The maximum recommended daily dose for both formulations is 50 mg according to clinical guidelines 4
- For adults, doses may be calculated up to approximately 1.0 mg/kg per day for either formulation 4
Administration Differences
- The primary difference between the formulations is the route of administration - the orally disintegrating tablet dissolves in the mouth without requiring water, while the XR capsule must be swallowed whole 3
- The orally disintegrating formulation should not be crushed or chewed, as this would disrupt the extended-release properties 4
- Morning administration is recommended for both formulations to minimize sleep disturbances 5
Monitoring and Follow-up
- For both formulations, clinicians should assess both therapeutic effects and side effects before each dose increase 5
- Monitor vital signs, including blood pressure and pulse, at baseline and with each dose increase 5
- For adults on either formulation, blood pressure and pulse should be checked quarterly 5
Special Considerations
- If a patient reports inadequate symptom control on either formulation, dose adjustments should follow the same protocol - increasing by 5-10 mg increments weekly until optimal symptom control is achieved 6
- If maximum doses are ineffective, consider switching to an alternative stimulant or non-stimulant medication rather than exceeding recommended maximums 4