Dextroamphetamine

Pronunciation: DEK-stroh am-FET-uh-meen

Chemical Abstracts Service Registry Number: 51-64-9. (Sulphate form 51-63-8)

Formal Names: Adderall, Amsustain, Biphetamine, D-Amphetamine, Dexamphet-amine, Dexedrine, Dexidrine, DextroStat, Sympamin

Informal Names: Beans, Black Beauties, Brownies, Christmas Trees, Dexies, Fastballs, Orange Hearts, Oranges, Purple Hearts

Type: Stimulant (amphetamine class). See page 12

Federal Schedule Listing: Schedule II (DEA no. 1100)

USA Availability: Prescription

Pregnancy Category: C

Dextroamphetamine is often called amphetamine. To reduce potential confusion, remember that in this book "amphetamine" refers to a class of stimulants, and "dextroamphetamine" refers to a specific drug in that class.

Uses. The substance stimulates the central and sympathetic nervous systems and is comparable to methamphetamine. Dextroamphetamine is typically used to treat narcolepsy, to treat attention deficit hyperactivity disorder (ADHD) in adults and children, and to help reduce a person's weight—in rhesus monkey experiments it is one of the most effective appetite suppressants. Some use has been made to help epileptics. The drug can be given in combination with scopolamine as an anti-motion sickness medicine; astronauts have used this combination during missions in outer space and consider it effective.

Dextroamphetamine has been found more effective than standard antide-pressants in alleviating depression among HIV (human immunodeficiency virus) patients and can also increase their energy. The drug has successfully treated depression among non-HIV hospital patients and among other persons as well. The drug has helped restore physical vigor and positive mental outlook to institutionalized elderly persons, so that older individuals who had been unable to take care of themselves were able to go home. Experimenters in the 1970s and 1990s found that the drug could accelerate work rate without multiplying mistakes in performing tasks. Those laboratory results cannot be extrapolated to the workplace in general but nonetheless remind us of the original welcome that employers gave to the first amphetamines. Dextroam-phetamine can help persons maintain satisfactory job performance while being deprived of sleep. In the Persian Gulf War of 1991, U.S. aviators used the drug. Some pilots called the substance crucial for top performance of responsibilities. Outside evaluation concluded that efficiency and safety improved when pilots were under the drug's influence. Athletic performance may be enhanced by the drug, but amphetamine class substances are generally banned by sports regulatory authorities.

Drawbacks. Tests on healthy volunteers found that taking enough dextroamphetamine to produce euphoria was also enough to produce mania. The drug may cause stroke and is normally avoided if patients have heart disease, hardening of the arteries, high blood pressure, glaucoma, hyperthyroidism, restlessness, and former or current drug abuse. Heart trouble has been attributed to several years' abuse of the drug, and brain damage has been noted.

Abuse factors. Lack of dependency has been noted among juveniles receiving medical doses of dextroamphetamine. Another study found that adults with medical authorization to use dextroamphetamine for obesity or depression often found it no more appealing than a placebo. These results are consistent with the fact that any drug's potential for abuse depends on the needs it satisfies in a user; if a medical need is the only one satisfied, then the person will have no interest in continuing the drug once the affliction is cured. Among persons inclined toward abuse, that inclination can be increased by taking dextroamphetamine with morphine. Those two substances can cancel out some of each other's unpleasant physical sensations while retaining the psychological pleasures of both drugs. Abusers may interpret the situation as "gain without pain," but combining stimulants with depressants can give the human body quite a beating. Moreover, researchers find that abusers can acquire tolerance to the psychological effects of dextroamphetamine while effects on blood pressure remain strong. Therefore, boosting the dose to maintain the level of psychic high may pose as much danger to a habituated user as to someone unaccustomed to the drug.

Drug interactions. Although the antimania medicine lithium reduces central nervous system stimulation caused by amphetamine, experiments have not shown lithium reducing either mania or heart rate and blood pressure increases caused by dextroamphetamine. Dextroamphetamine is to be avoided if persons have taken a monoamine oxidase inhibitor (MAOI—in some antidepressants and other medicine) within the past 14 days. Particular hazard arises when combining an MAOI and dextroamphetamine while eating foods containing tyramine. Such foods include beer, some wines, cheese, chocolate, bananas, raisins, avocados, salami, and soy sauce. Although an experimental study found that dextroamphetamine could enhance the beneficial effects of MAOIs, using the two drugs together can be fatal. Tricyclic antidepressants make a dose of dextroamphetamine last longer and can increase amphetamine blood levels produced by dextroamphetamine.

Although extrapolation of animal studies to human conditions must always be cautious, it is known that dextroamphetamine's effects become stronger in rats if they take caffeine at the same time. Rat and human experiments also indicate that dextroamphetamine will improve pain relief provided by morphine. Animal experiments indicate that dextroamphetamine interferes with alcohol absorption, suggesting that achieving alcohol intoxication might re quire a dextroamphetamine user to drink more than normal. Upon taking dextroamphetamine, tobacco cigarette smokers use more cigarettes and report greater pleasure from smoking.

Combining marijuana smoking with dextroamphetamine does not seem to affect physical coordination (walking and the like) more than just using marijuana alone. Each of those two drugs raises heart rate and blood pressure but do not seem to have a multiplier effect when used together—the increase in cardiac effects is simply the amount caused by dextroamphetamine plus the amount caused by marijuana; one does not make cardiac effects of the other more potent.

Cancer. Potential for causing cancer is unknown.

Pregnancy. As with many drugs, effect on fetal development is unknown. One instance of serious birth defects is reported from a woman who used dextroamphetamine in the first trimester, but the meaning of that one instance is uncertain because she also used lovastatin (a drug for reducing cholesterol in persons at serious risk of heart attack), and lovastatin by itself is considered highly dangerous to fetal development. A statistical association has been reported between maternal dextroamphetamine use and infant heart defects. Dextroamphetamine has been prescribed for use in pregnancy without apparent ill effect on infants but is considered potentially hazardous. Possible consequences merit full discussion between doctor and pregnant patient.

Combination products. Adderall contains several active ingredients: dextro-amphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate USP, and amphetamine sulfate USP (the latter substance formerly marketed as Benzedrine).

Biphetamine, like other dextroamphetamines, is medically used to treat obesity, narcolepsy, and ADHD. Biphetamine is used recreationally to boost mental quickness and physical activity and to create euphoria. The compound can facilitate hallucinations, raise blood pressure, and prevent sleep.

Dexedrine's oral capsule is designed to deliver some of the drug immediately, followed by gradual delivery of the remaining drug. Capsule and tablet products both contain "inactive" ingredients. In this context "inactive" means an ingredient that does not promote a drug's medical purpose, not that the ingredient has no pharmaceutical effect. Inactive ingredients in the tablet include FD&C Yellow No. 5 (tartrazine), a substance to which some persons are allergic, particularly if they are abnormally sensitive to aspirin. Their reactions can include bronchial asthma. When used against ADHD in children Dexe-drine can curtail growth, but that effect is believed to be temporary. Dexedrine can raise body temperature. Experimenters found that the product can allow satisfactory performance by airplane pilots on continuous simulator flight duty for 64 hours straight without sleep.

DextroStat tablets include FD&C Yellow No. 5 (tartrazine).

Additional scientific information may be found in:

Brauer, L.H., J. Ambre, and H. De Wit. "Acute Tolerance to Subjective But Not Cardiovascular Effects of D-Amphetamine in Normal, Healthy Men." Journal of Clinical Psychopharmacology 16 (1996): 72-76. Caldwell, J.A., et al. "Efficacy of Dexedrine for Maintaining Aviator Performance dur ing 64 Hours of Sustained Wakefulness: A Simulator Study." Aviation, Space, and Environmental Medicine 71 (2000): 7-18.

Domino, E.F., et al. "Effects of D-Amphetamine on Quantitative Measures of Motor Performance." Clinical Pharmacology and Therapeutics 13 (1972): 251-57.

Emonson, D.L., and R.D. Vanderbeek. "The Use of Amphetamines in U.S. Air Force Tactical Operations during Desert Shield and Storm." Aviation, Space, and Environmental Medicine 66 (1995): 260-63.

Graybiel, A. "Space Motion Sickness: Skylab Revisited." Aviation, Space, and Environmental Medicine 51 (1980): 814-22.

Griffith, J.D., et al. "Dextroamphetamine." Archives of General Psychiatry 26 (1972): 97100.

Jacobs, D., and T. Silverstone. "Dextroamphetamine-Induced Arousal in Human Subjects as a Model for Mania." Psychological Medicine 16 (1986): 323-29.

Jasinski, D.R., and K.L. Preston. "Evaluation of Mixtures of Morphine and D-Amphetamine for Subjective and Physiological Effects." Drug and Alcohol Dependence 17 (1986): 1-13.

Ward, A.S., et al. "Effects of D-Amphetamine on Task Performance and Social Behavior of Humans in a Residential Laboratory." Experimental and Clinical Psychophar-macology 5 (1997): 130-36.

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