From the Guidelines
Dextroamphetamine ER and CR are essentially interchangeable in clinical practice, with both providing a sustained release of the medication over an extended period. When considering the use of dextroamphetamine ER vs CR, it's essential to understand that both formulations are designed to provide a gradual release of the medication, allowing for once-daily dosing 1. The key benefits of these formulations include:
- Convenience and improved adherence due to once-daily dosing
- Reduced "peaks and valleys" associated with immediate-release versions
- Decreased need for multiple daily doses
- Steady blood levels throughout the day The standard dosing range for adults is typically 5-40 mg once daily, while children may start at lower doses based on weight and clinical response. It's worth noting that the strategy of combining short-acting stimulants with long-acting formulations, as described in the practice parameter for the use of stimulant medications 1, can be used to increase efficacy and duration of effect, but this approach may not be necessary when using ER or CR formulations. In terms of side effects, both ER and CR versions may include decreased appetite, insomnia, increased heart rate, and potential for misuse, but these are generally similar between the two formulations. When switching between immediate-release and extended-release formulations, the total daily dose often remains the same, but the timing changes to a single morning dose, as outlined in the practice parameter 1.
From the Research
Dextroamphetamine ER vs CR
- There are no direct comparisons between dextroamphetamine ER (extended release) and CR (controlled release) in the provided studies.
- However, the studies provide information on the effects of amphetamines, including dextroamphetamine, on attention deficit hyperactivity disorder (ADHD) symptoms and side effects 2, 3.
- Dextroamphetamine is a stimulant medication that acts by increasing presynaptic release of dopamine and other biogenic amines in the brain, similar to methylphenidate 2.
- The effects of amphetamines on blood pressure and heart rate have been studied, with results showing that daily oral amphetamines increase blood pressure, heart rate, and withdrawals due to adverse effects 3.
- Other studies have compared the efficacy of methylphenidate and atomoxetine in improving ADHD symptoms and emotional/behavioral problems in youths and adults with ADHD 4, 5, 6.
- While these studies do not directly compare dextroamphetamine ER and CR, they provide information on the pharmacology and effects of stimulant medications, including amphetamines, which may be relevant to understanding the differences between ER and CR formulations.