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amphetamine (Mydayis)

Indications: - treatment of attention-deficit hyperactivity disorder (ADHD) Dosage: - Mydayis: - FDA-approved June 2017 - mixed salts of a single-entity amphetamine product - long-acting [6] Adverse effects: - psychosis or mania [5,7,] - risk greater than with methylphenidate; absolute risk is low [7] - 5-fold risk (high dose), 3.5-fold risk (medium dose) [9] - no risk with methylphenidate [9] - delusions - neurosis [5] - reversible cerebral vasoconstriction syndrome - mydriasis - changes in libido [8]; (methylphenidate associated with priapism) - insomnia [8] - tachycardia [8] - hypertension - anxiety [8] - isolated reports of cardiomyopathy associated with chronic amphetamine use [8] - also see sympathomimetic - management of toxicity: a) benzodiazepines for agitation, seizures [3] b) barbiturates or propofol for refractory seizures [4] b) calcium channel blockers for hypertension, tachycardia c) nitroglycerin, nitroprusside, or phentolamine for severe hypertension d) ventricular arrhythmias: lidocaine or amiodarone [4] Drug interactions: - avoid beta-blockers a) unopposed alpha-adrenergic activity b) may result in hypertensive crisis Laboratory: 1) specimen: serum, plasma (EDTA), urine 2) methods: a) serum/plasma: GLC, GC-MS, RIA - amphetamine in serum/plasma - amphetamines in serum/plasma b) urine: EIA, HPLC, FPIA, RIA, GC-MS - amphetamine in urine - amphetamines in urine 3) interferences: a) urine: 1] NaCl causes false negative results 2] EIA: labetolol, ranitidine & certain phenothiazines may cause positive results b) EIA, RIA: ephedrine, phenylpropanolamine, benzphetamine, fenfluramine, mephentermine, phenmetrazine, phentermine may cause positive results 4) amphetamine in specimen - amphetamine in hair - amphetamine in body fluid - amphetamine in blood - amphetamines in meconium - amphetamine in saliva - amphetamine in serum/plasma - amphetamine in serum/plasma/blood - amphetamine in stool - amphetamine in urine 5) amphetamines in specimen - amphetamines in hair - amphetamines in blood - amphetamines in gastric fluid - amphetamines in meconium - amphetamines in saliva - amphetamines in serum/plasma - amphetamines in stool - amphetamines in urine - amphetamines in vitreous fluid Mechanism of action: - enhances release of catecholamines from catecholaminergic neurons

Interactions

drug adverse effects (more general classes)

Related

amphetamine in urine

Specific

dextroamphetamine (Dexedrine) lisdexamfetamine (Vyvanse) methamphetamine p-hydroxyamphetamine

General

adrenergic neuron stimulant amine analeptic (CNS stimulant) aromatic compound

Properties

MISC-INFO: 1/2life 4-8 HOURS therapeutic-range 20-30 NG/ML toxic-range >0.2 UG/ML protein-binding 15-40% pregnancy-category C safety in lactation ?

Database Correlations

PUBCHEM correlations

References

  1. Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed., W.B. Saunders, 1995
  2. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996 pg 220
  3. Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
  4. The Washington Manual of Medical Therapeutics, 33rd edition Foster C et al (eds) Lippincott, Williams & Wilkins, Philadelphia, 2010. pg 985
  5. Beach SR, Kroshinsky D, Kontos N. Case records of the Massachusetts General Hospital. Case 37-2014. A 35-year-old woman with suspected mite infestation. N Engl J Med. 2014 Nov 27;371(22):2115-23 PMID: 25427115 http://www.nejm.org/doi/full/10.1056/NEJMcpc1305989
  6. Brooks M FDA Clears Long-Acting ADHD Drug Mydayis. Medscape. June 21, 2017 http://www.medscape.com/viewarticle/881888
  7. Moran LV, Ongur D, Hsu J et al Psychosis with Methylphenidate or Amphetamine in Patients with ADHD. N Engl J Med 2019; 380:1128-1138 PMID: 30893533 https://www.nejm.org/doi/full/10.1056/NEJMoa1813751 - Cortese S Psychosis during Attention Deficit - Hyperactivity Disorder Treatment with Stimulants. N Engl J Med 2019; 380:1178-1180 PMID: 30893541 https://www.nejm.org/doi/full/10.1056/NEJMe1900502
  8. Windle ML Rapid Rx Quiz: Stimulants Medscape.Oct 23, 2022 https://reference.medscape.com/viewarticle/981392
  9. Moran LV, Skinner JP, Shinn AK et al Risk of Incident Psychosis and Mania With Prescription Amphetamines. Am J Psychiatry. 2024 Sep 12:appiajp20230329. PMID: 39262211

Component-of

Adderall (dextroamphetamine/racemic amphetamine) amphetamine/aspartate/dextroamphetamine amphetamine/dextroamphetamine