Adderall® is a pharmaceutical stimulant amphetamine used to treat attention-deficit disorder/attention-deficit hyperactivity disorder and narcolepsy. Severe cases of depression may also be treated with Adderall or other stimulants. It was first prescribed in the 1920s as an anorectic (under the brand name Obetrol®), but such usage is now rare. Adderall is a schedule II controlled substance, meaning it has been deemed to have a high potential for abuse.

Contents 1 Use 1.1 Effects 2 Side effects 2.1 Side effects in children 2.2 Side effects in adolescents 2.3 Side effects in adults 2.4 Rare side effects 3 Dependence and addiction caused by abusing Adderall 3.1 Contraindications 4 Performance-enhancing use 5 Government warnings 6 Manufacturers 7 See also 8 External links 9 Notes and references

Use

Adderall was introduced in 1996 as instant-release tablets, which has since become available as the generic formulation "mixed amphetamine salts." The active ingredients of Adderall include a combination of dextroamphetamine and racemic amphetamine salts. Shire later introduced a gradual-release preparation of these ingredients, Adderall XR (extended release), and retains patent rights on Adderall XR that will expire in 2009.^[1]

In particular, Adderall XR is comprised of the following proportions of active ingredients:

• 1/4 Dextroamphetamine Saccharate
• 1/4 Dextroamphetamine Sulfate
• 1/4 dl-amphetamine Aspartate (racemic amphetamine)
• 1/4 dl-amphetamine Sulfate (racemic amphetamine)

The four component salts are claimed to be metabolized at different rates, thereby imparting a more gradual and "smoother" build-up and decline in effect compared to amphetamine preparations comprising only a single salt.

The average elimination half-life for dextroamphetamine is 10 hours in adults, and for levoamphetamine, 13 hours. Its effects are otherwise similar to other central nervous system stimulants (see amphetamine for details.).

The manufacturer claims that the mixture of salts makes Adderall's effects smoother, with softer highs and lows, than those of other treatments for the same disorders.

There is little evidence, however, to support this claim for immediate-release. A recent patent application for Adderall^[2] was a pharmaceutical composition patent listing a rapid immediate release oral dosage form. No claim of increased or smooth drug delivery was made. A recent double-blind, placebo-controlled crossover study, conducted among children, indicated that patients behaved similarly to other immediate release amphetamines. The authors found that sustained-release dexamphetamine (the main isomeric-amphetamine component of Adderall) had a longer duration of action, though dexamphetamine was less effective in the first few hours.^[3]

Adderall is now sold in either an immediate-release tablet or an extended-release capsule, marketed as Adderall XR (for "eXtended Release"). Doses for both immediate-release and extended-release form come in 5, 10, 15, 20, 25 and 30 mg increments.

Adderall XR utilizes the Microtrol® delivery system to achieve the extended-release mechanism. This delivery system incorporates two beads: the first type of bead dissolves immediately and the second type releases four hours later. Maximum plasma concentration is achieved in seven hours, compared to regular Adderall IR (immediate-release) which reaches maximum plasma concentration within three hours. As a result of its high bioavailability, Adderall XR's effectiveness is not altered by food absorption in the gastrointestinal tract. However, tmax (mean plasma concentration) is prolonged by 2.5 hours (using a standard high-fat meal as the control). Acidic beverages should not be ingested with Adderall XR as they alter the pH balance of the stomach.^[4]

Effects

Sources note that amphetamines like Adderall and related compounds (ephedrine, etc.) displace noradrenaline from the presynaptic neuron and do not act as reuptake inhibitors. Template:Shire lable for Adderall

The increased flow of dopamine and norepinephrine into the extraneuronal space causes the patients' brain, as one psychiatrist explains,^{[citation needed]} to experience a more intense level of concentration, causing an increased ability to focus for extended periods of time, and a heightened interest in performing focus based tasks.

Double-blind, placebo-controlled studies of dextroamphetamine in normal subjects have shown significant performance increases on cognitive tasks and decreased reaction time.^[5]

Amphetamines have been shown to pass through into breast milk. Because of this, mothers taking medications containing amphetamines are advised to avoid nursing during their course of treatment.^[6]

Side effects

Aggression, new abnormal thoughts/behaviors, mania, growth suppression, worsening of motion or verbal tics and Tourette’s syndrome have been associated with use of drugs of this type.^[7]

Side effects in children

• decreased appetite^[7]
• difficulty falling asleep^[7]
• stomachache^[7]
• emotional lability^[7]

Side effects in adolescents

• loss of appetite^[7]
• difficulty falling asleep^[7]
• stomachache^[7]
• weight loss^[7]

Side effects in adults

• dry mouth^[7]
• loss of appetite^[7]
• difficulty falling asleep^[7]
• headache^[7]
• weight loss^[7]

Rare side effects

These symptoms require immediate medical assistance:

• symptoms of tourettism^[8]
• aggression^[7]
• symptoms of depression^[7]
• seizures or abnormal EEGs^[7]
• high blood pressure^[7]

Dependence and addiction caused by abusing Adderall

Tolerance, extreme psychological dependence, and severe social disability can occur when Amphetamines are abused. The manufacturer strongly warns against exceeding the prescribed dosage, injecting the drug, or insufflation of the drug.^[9]

Contraindications

Serotonin syndrome is a rare but potentially fatal condition which occurs when an amphetamine such as Adderall is used within 1-2 weeks of taking a monoamine oxidase inhibitor (MAOI).

Performance-enhancing use

Because Adderall uses amphetamine stimulants to help the user concentrate for extended periods of time, many students today request Adderall from doctors in order to use it as a study aid. Thus, it is increasingly popular on college campuses. The largest benefit to students is Adderall's ability to give students the power to learn and study what would usually be uninteresting material. Thus it is used extensively by students wishing to pull all-nighters to study for tests. Because of the appetite-suppressing properties of amphetamines, it is also sought after by those wishing to lose weight. Another less common use for students is to take Adderall before or during a night of heavy drinking in order to remain alert and active despite being intoxicated.

Research done by the National Institute of Drug Abuse (NIDA) shows the more competitive the college, the higher the incidence of stimulant use. An article published stated the findings of a nationwide survey of thousands of college students.^[10] The findings of this past April 2006 survey shows 5.9% use rates among the more competitive campuses, compared to 1.3% use rates among less competitive campuses. Breaking down the use pattern even further, this same sample done by NIDA reveals whites were more likely to use stimulants compared to African Americans and Asians, at rates of 4.9%, 1.6%, and 1.3% respectively. Further, students with lower grade point averages of B’s or below use stimulants at a rate of 5.2%, compared to students earning B+ or above who use this medication at rates of only 3.3%. This research also specifically identified that students involved in sororities or fraternities use stimulants at a much higher rate of 8.6% compared to nonmembers who reported use at rates of only 3.3%.^[11]

Another major concern about the use of Adderall among college students is the psychological dependence that may cause students to lose faith in their own ability to perform well and the dependence on the advantageous effects of stimulant medication. Jackie Kurta, an Alcohol and Drug Specialist at UC Santa Barbara’s Student Heath Services states, “Students start out taking study drugs one time to study. The drugs work so well that the students begin to lose confidence in their own abilities to study without them,” (Hirschey).

Aside from being used by college students as a study aid, Adderall has been used as an off label drug for weight loss. Adderall’s side effect of weight loss and appetite suppression is a desired result for those trying to lose weight. It is administered as part of a “cocktail” of other off label prescription drugs that have side effects used to treat obesity. There have not been any scientific studies performed to evaluate the effectiveness of this form of treatment and is viewed a very risky and potentially dangerous way to shed pounds.^[12]

Government warnings

On February 9, 2005, Health Canada suspended all sales of Adderall XR after data collected by manufacturer Shire Pharmaceuticals linked the drug to 12 sudden deaths in American children between the years 1999 to 2003.^[13] Further research, however, found little data suggesting use of Adderall resulted in an increased risk of cardiac defect. Of the twelve sudden deaths positively linked to pediatric Adderall users during the four year period, five had known pre-existing cardiac conditions, one died after strenuous exercise in 110 degree heat and two had levels suggestive of an overdose. Given the more than 37,000,000 prescriptions for Adderall filled during the four years, the US Food and Drug Administration could find no increased risk of sudden death among Adderall users beyond the normal rate of the general population.^[14][15] In August, 2005, Health Canada followed the committee report of three independent physicians and lifted the ban on Adderall XR.^[16][17] Given that persons with ADHD are more likely to engage in risky or dangerous behavior, it has been suggested that stimulant medications for persons with ADHD may actually result in lower incidence of premature death.^[18] The use of Adderall is generally not advised in those persons with pre-existing cardiac or mental illnesses. It is also not advised in persons who have a history of drug abuse.^[19] Although FDA safety advisors voted 8 to 7 to issue a Black Box Warning, the FDA's pediatric advisory committee refused to give the drug its most severe black box warning in March, 2006.^[20] A Black Box Warning regarding amphetamine abuse potential is in place, however.

Manufacturers

Adderall is manufactured by Shire Pharmaceuticals and is distributed by Catalytica Pharmaceuticals Inc. of Greenville, North Carolina. Generic equivalents (known to pharmacists as "amphetamine salts," "mixed amphetamines," or simply "amphetamines," among other things) are also distributed in the United States by Barr Pharmaceuticals, Mallinckrodt Pharmaceuticals, Eon Labs and Ranbaxy Laboratories.

See also

• amphetamine
• methamphetamine
• methylphenidate
• dextroamphetamine
• HT-0712

External links

• Hanna, Mohab "Making the Connection: A Parent's Guide to Medication in AD/HD" Ladner-Drysdale 2006
• General Amphetamine Information

• Report of study indicating Adderall more effective than Ritalin for ADHD treatment
• Article by a medical doctor outlining the benefits of Adderall as an ADHD medication
• Adderall Abuse
• Adderall a crutch for students pressed for study time
• Adderall XR® barred in Canada

• The Adderall Me - My romance with ADHD meds by Joshua Foer in Slate
• Effects of Adderall

Notes and references