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Use The four component salts are claimed to be metabolised at different rates. 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 (USP #6,384,020) 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, and cost less than Adderall, though dexamphetamine was less effective in the first few hours.* 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, 30, and 35 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.* Effects While the exact mechanism is unknown, it is believed that Adderall works by blocking the reuptake of dopamine and norepinephrine into the presynaptic neuron and increasing their release from the presynaptic neuron into the extraneuronal space. In other words, Adderall reverses the reuptake mechanism, turning it into a pump instead of a vacuum. Sources note that amphetamine and related compounds (ephedrine, etc.) displace noradrenaline from the presynaptic neuron and do not act as reuptake inhibitors as referenced above. The increased flow of dopamine and norepinephrine into the extraneuronal space causes the patients' brain, as one psychiatrist explains, 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. Though rare, it is possible for Adderall to cause psychotic episodes at recommended doses in patients with a history of psychosis. Some patients feel they are less creative while taking Adderall, while others report that it can aid in creative work. The famous Beat generation writer Jack Kerouac, for instance, is said to have written much of his classic On The Road in a span of three weeks, aided by amphetamine (an active ingredient in Adderall) from Benzedrine inhalers; country music star Johnny Cash had a long period of amphetamine use in the 1960s; and mathematician Paul Erdős was noted for habitual use of prescription amphetamine throughout the final decades of his life; Smile was written by Brian Wilson and Van Dyke Parks with heavy amphetamine use, among others. All of these probably knew the drug by its common name, speed. Double-blind, placebo-controlled studies of dextroamphetamine in normal subjects have shown significant performance increases on cognitive tasks and decreased reaction time. http://www.sciencemag.org/cgi/content/abstract/199/4328/560 Clinical trials establishing the long term effectiveness of Adderall have not been conducted. Controlled studies have not occurred for children on Adderall for a period exceeding three weeks. Also, reviews of effectiveness for adolescents or adults on the medication for longer then four weeks have not been evaluated. Several studies on pregnant rodents have shown that exposure to amphetamines in utero or postnatal can lead to neurological damage and variance in behavior. While more controlled studies on pregnant women taking Adderall are needed, 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. (http://www.fda.gov/cder/foi/label/2004/021303s005lbl.pdf) Side effects Common side effects of Adderall include: Less common side effects Rare side effects Contraindications Using any amphetamine, (including Adderall, Methamphetamine or Ecstasy) within 1-2 weeks of taking a monoamine oxidase inhibitor (MAOI) (an archaic branch of the antidepressant class) can cause a potentially fatal condition known as serotonin syndrome. Performance-enhancing use and abuse 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 however is Adderall's ability to give students the power to focus on and learn what would usually be uninteresting material. 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. To add further insight to Adderall abuse among college students, research done by the National Institute of Drug Abuse (NIDA) shows the more competitive the college, the higher the incidence of stimulant abuse. An article published stated the findings of a nationwide survey of thousands of college students. The findings of this past April 2006 survey shows 5.9% abuse rates among the more competitive campuses, compared to 1.3% abuse rates among less competitive campuses. Breaking down the abuse pattern even further, this same sample done by NIDA reveals whites were more likely to abuse 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 abuse stimulants at a rate of 5.2%, compared to students earning B+ or above who abuse this medication at rates of only 3.3%. This research also specifically identified that students involved in sororities or fraternities abuse stimulants at a much higher rate of 8.6% compared to nonmembers who reported abuse at rates of only 3.3% (Whitten, 6). In addition to the physiological risks posed by using Adderall as a way to enhance performance, the abuse of prescription stimulants has a direct correlation to higher levels of smoking cigarettes, binge drinking, risky behavior including driving while under the influence of drugs and the abuse of marijuana, ecstasy and cocaine. For example, the NIDA survey respondents revealed the likelihood that a stimulant abuser used cocaine in the past year was twenty times that of a non-abuser. Similarly, they reported being five times as likely to drive drunk (Whitten, 6). Another major concern about the abuse of Adderall among college students is the psychological dependence that causes 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). On the street, Adderall is sold illegally for $2 to $8 a pill (pills ranging from 5 to 35 mg) (Purdie) or about $4-$10 for 20 mg (Peter). Slang terms for Adderall are: "slack", "zing", "fatty addy", "Blue Spanish Fly", "a.d.", "study buddies", "ralls", "headlight through fog," "smart pills", "beenies", "amps", "a-bombs", "addies", "poopy," "blue buddies", "Blue Betties", "orange tic-tacs", "the blue dutchman", "candy", "A candy", "blue boy," "nig nigs", "jollies", "smurphs", "rinky dink," "diet coke", "Thrash" by some skateboarders, "Davies"(for their founder, Dave Herrington), "team blue", "derallo," "the A train", "A+" in reference to its stimulant effect (Ambien is often referred to as "A-", the reverse effect of Adderall), and in some regions of the U.S., "railguns" and "that'da boy(s)" (from noted increase in productivity). On some college campuses taking Adderall is known as "taking the A train" or "getting some vitamin A", most likely inspired by the song "Take The A Train" by Duke Ellington. The 5 and 10 mg doses are also known in the northwest as "BBs", which is short for "Blueberries", named for their blue color. Heavier users tend to use the term "GBs", which is short for "goof balls". Some Adderall abusers crush and inhale the 5 and 10 mg pills to experience a stronger "rush" and a more rapid onset of the drug's effects. This has led to the term "smurf snot," used to describe how the pills color one's mucus blue. Aside from being used by college students as a study aide, 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. (http://www.msnbc.msn.com/id/15385195/) History/How it works Adderall, formulated in the early 1990’s, is the newest and most popular drug on the market for the treatment of ADHD. Due to the composure of Adderall, the four salts listed beforehand, it is superior to any other ADHD drug that has been created and used in the past. With Adderall, as opposed to drugs like Ritalin and Dexedrine, there are hardly any issues with withdraw that were clearly apparent with ADHD drugs in the past. Not only is Adderall considered a smoother ADHD drug than any other, but because of its potency there is no need for doses to be taken throughout the day as was the case with previous drugs for treatment. Results yield that Adderall is just as effective, if not better, in treating the symptoms of ADHD in children as well as adults (about 60-70% improvement). ADHD is a diagnosis of what is believed to be a part of the brain that insufficiently regulates brain chemicals. This irregularity causes decrease in efficiency which leads to the symptoms that define ADHD. The way Adderall works is by stimulating these areas of the brain that are considered to be working and regulating improperly. The proper dose of Adderall boosts this part of the brain to perform and function at the normal level, reverting one to normal behavior. Normal behavior is attached to a person who can maintain focus, promote calmness, and control their impulsivity. http://www.add-adhd-infoplus.com/adderall.html 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. 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. *, * In August, 2005, Health Canada followed the committee report of three independent physicians and lifted the ban on Adderall XR. *, * Given that persons with AD/HD are a high risk group, it has been suggested that stimulant medications for persons with AD/HD will actually result in lower incidence of premature death. * Currently the FDA and Health Canada advise the use of Adderall in those persons with pre-existing cardiac or mental illnesses. They also suggest against its use in persons who have a history of drug abuse. * 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. * A Black Box Warning regarding amphetamine abuse potential is in place, however. Manufacturers Adderall is manufactured by Catalytica Pharmaceuticals Inc. of Greenville, North Carolina and is distributed by Shire Pharmaceuticals. Generic equivalents (known to pharmacists as "amphetamine salts," "mixed amphetamines," or simply "amphetamines," ) are also distributed in the United States by Barr Pharmaceuticals, Mallinckrodt Pharmaceuticals, Eon Labs and Ranbaxy Laboratories. See also | ||||||||||
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