From the Guidelines
Long-term use of dextroamphetamine XR at 60 mg daily in adult males is strongly associated with increased risks of cardiovascular issues, neurological effects, psychiatric consequences, and metabolic changes, and thus, it is recommended to discontinue or decrease the dose, considering alternative treatments for ADHD, as suggested by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline 1.
Key Considerations
- The dose of 60 mg daily exceeds the typical maximum recommended dose of 40 mg daily, which may lead to increased risks of adverse effects.
- Cardiovascular issues, including increased blood pressure, heart rate abnormalities, and potential heart muscle damage, are potential long-term effects of high-dose dextroamphetamine use 1.
- Neurological effects, such as tolerance, dependence, and potential cognitive changes, may also occur with long-term use 1.
- Psychiatric consequences, including mood disturbances, anxiety, paranoia, and psychosis, have been reported with prolonged high-dose use of dextroamphetamine 1.
- Metabolic and physical effects, including appetite suppression, weight loss, sleep disturbances, and potential impacts on sexual function, are common with long-term use of dextroamphetamine 1.
Monitoring and Management
- Regular monitoring is essential for patients on long-term treatment with dextroamphetamine, including cardiovascular assessments, psychiatric evaluations, and metabolic monitoring 1.
- Patients should never abruptly discontinue this medication due to withdrawal risks and should work with their healthcare provider if dose adjustments are needed.
- Alternative treatments for ADHD, such as behavioral therapies, should be considered for patients taking high-dose dextroamphetamine long-term 1.
From the FDA Drug Label
DRUG ABUSE AND DEPENDENCE Dextroamphetamine sulfate tablets are a Schedule II controlled substance. Amphetamines have been extensively abused. Tolerance, extreme psychological dependence and severe social disability have occurred. There are reports of patients who have increased the dosage to many times that recommended. Abrupt cessation following prolonged high dosage administration results in extreme fatigue and mental depression; changes are also noted on the sleep EEG. Manifestations of chronic intoxication with amphetamines include severe dermatoses, marked insomnia, irritability, hyperactivity and personality changes. The most severe manifestation of chronic intoxication is psychosis, often clinically indistinguishable from schizophrenia. This is rare with oral amphetamines. ADVERSE REACTIONS Cardiovascular: Palpitations, tachycardia, elevation of blood pressure. There have been isolated reports of cardiomyopathy associated with chronic amphetamine use. Central Nervous System: Psychotic episodes at recommended doses (rare), overstimulation, restlessness, dizziness, insomnia, euphoria, dyskinesia. dysphoria, tremor, headache, exacerbation of motor and phonic tics and Tourette's syndrome. Gastrointestinal: Dryness of the mouth, unpleasant taste, diarrhea, constipation, other gastrointestinal disturbances. Anorexia and weight loss may occur as undesirable effects. Allergic: Urticaria. Endocrine: Impotence, changes in libido.
The long-term effects of taking dextroamphetamine XR 60 mg/daily in adult males after several years of treatment may include:
- Tolerance and psychological dependence
- Cardiovascular problems, such as cardiomyopathy
- Psychotic episodes (rare)
- Severe dermatoses, insomnia, irritability, hyperactivity, and personality changes
- Endocrine problems, such as impotence and changes in libido According to 2 and 2, these effects are associated with chronic amphetamine use.
From the Research
Long-term Effects of Dextroamphetamine XR 60 mg/Daily
The long-term effects of taking dextroamphetamine XR 60 mg/daily in adult males are not directly addressed in the provided studies. However, some studies provide information on the effects of dextroamphetamine and other stimulants that may be relevant.
- Cardiovascular Effects: A study published in 2024 3 found no difference in the incidence of major cardiovascular events between elderly veterans taking amphetamine/dextroamphetamine and those taking methylphenidate.
- Cognitive Impact and Adverse Effects: A review published in 2012 4 discussed the misuse of prescription stimulants, including dextroamphetamine, and the associated risks, such as psychosis, myocardial infarction, cardiomyopathy, and sudden death.
- Treatment of Stimulant Use Disorder: A study published in 2021 5 explored the effectiveness of dextroamphetamine for the treatment of stimulant use disorder and found that patients reported a range of benefits, including achieving a substitution effect and reaching a preferred dose.
- Clinical Effects Beyond Cocaine Use: A secondary analysis of a double-blind, placebo-controlled randomized trial published in 2020 6 found that sustained-release dexamphetamine treatment improved the health status of patients with cocaine dependence and comorbid opioid dependence.
Key Findings
- Dextroamphetamine may have cardiovascular effects, but the incidence of major cardiovascular events was not found to be different from methylphenidate in elderly veterans 3.
- Misuse of prescription stimulants, including dextroamphetamine, is associated with serious risks, such as psychosis and sudden death 4.
- Dextroamphetamine may be effective in treating stimulant use disorder, with patients reporting benefits such as achieving a substitution effect and reaching a preferred dose 5.
- Sustained-release dexamphetamine treatment may improve the health status of patients with cocaine dependence and comorbid opioid dependence 6.