dextroamphetamine

AKA

Dexedrine®, Dexedrine Spansule®, Adderall®, Adderall XR®, Adzenys XR-ODT®, Dyanavel XR®, Evekeo®, Zenzedi®, ProCentra®, ACT Amphetamine XR®,ACT Dextroamphetamine SR®, Apo-Amphetamine XR®, Sandoz-Amphetamine XR®, mixed amphetamine salts, mixed salts amphetamine, MSA, MAS, Mydayis® and others.

Purpose [+] Anti-ADHD

HIDE ALL

SHOW ALL

Alcohol

Booze, ethyl or ethanol, adult beverage, brew, brewski, liquor, drink, shot, sauce, rot gut, hooch, giggle juice, moonshine, jello shots, wobbly pop

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Interaction
Dextroamphetamine and ethanol produce their stimulant-like subjective effects by a shared mechanism: increased rating of stimulant-like subjective effects such as increased heart rate and blood pressure, and improved vigilance performance after dextroamphetamine, and increased rating of sedative-like subjective effects, increased heart rate and blood pressure and impaired vigilance after alcohol.

Mechanism
Ethanol is a sedative drug but also has stimulant-like effects. The stimulant-like effects of ethanol are mediated by catecholamines, such as dopamine. Dextroamphetamine is a dopamine and norepinephrine agonist and reuptake inhibitor. Since stimulant-like effects of both ethanol and dextroamphetamine are mediated through catecholamine systems, stimulant-like subjective, cognitive, and performance responses of the two drugs should be positively correlated.

Significance
Patients who experience pronounced stimulant-like effects from alcohol also report greater stimulant effects from dextroamphetamine. This correlation does not apply with performance measures, such as the DSST (digit symbol substitution test), or vigilance task performance or heart rate, suggesting that these other effects are mediated by a different mechanism.

Serious Risk for Harm

Dextroamphetamine makes some people feel more awake and alert. If you have been drinking alcohol, dextroamphetamine might fool you into feeling alert enough to drive, or do other activities requiring alertness. This would be false. You may still be impaired and it would be unsafe to drive.

Think First

If you are depressed, blue, or moody, alcohol is a 'downer' and will make you feel worse.

Tobacco

smokes, butts, cigs, cigars, darts, stogies, cancer sticks, chew, dip

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Interaction
a) 33 smokers with and without ADHD were given moderate doses of the related drug methylphenidate (10-40 mg). Methylphenidate did not seem to have an effect on smoking-reinforced responding.

b) In an open-label study of 154 participants, use of related drug methylphenidate extended-release was associated with low rates of smoking in those with ADHD.

c) In a prospective observational study, individuals with ADHD who received related drug methylphenidate increased their tobacco consumption compared to when they were not taking methylphenidate.

Mechanism
a-c) Evidence suggests that individuals with ADHD smoke more than their non-ADHD counterparts, possibly because the effects of nicotine on cognition are similar to the effects of stimulants such as methylphenidate. Therefore, individuals who take stimulants may be less likely to smoke cigarettes, as this may "replace" the desire for the effects of smoking.

Significance
a-c) Overall, the effects of stimulant use of tobacco consumption are conflicting. More studies are needed to draw a conclusion regarding the effects of stimulant use on smoking.

Think First

If you take dextroamphetamine you may find you want to smoke cigarettes less often. More information is needed to figure out if the combination of tobacco and dextroamphetamine is safe.

Caffeine

coffee, java, joe, soda, pop, tea, energy drinks (Red Bull®, Monster®, Rock Star®, Amp®, NOS®, Full Throttle®, 5-hour Energy Drink®, Beaver Buzz®), chocolate, cocoa

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Interaction
As a sympathomimetic, dextroamphetamine has the potential to enhance the adverse or toxic effects of other sympathomimetics, such as caffeine.

Mechanism
Additive sympathomimetic effects.

Significance
Patients should be monitored for increased sympathomimetic effects such as increased blood pressure or heart rate if these drugs are used concomitantly. Patients should also be counselled to avoid excessive caffeine intake.

Think First

Consuming lots of caffeine could make the side effects of dextroamphetamine worse. This includes jittery or irritable feelings, trembling hands, or trouble sleeping.

Cannabis/ Hash

Marijuana, mary jane, BC bud, blunt, chronic, J, jay, joint, hemp, pot, grass, herb, 420, dope, THC, weed, reefer, ganja, gangster, skunk, hydro, hash oil, weed oil, hash brownies, grease, boom, honey oil, K2, spice, poppers, shatter, budder

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Interaction

Use of cannabis has the potential to increase the tachycardic effects of dextroamphetamine.

Mechanism

Additive sympathomimetic effects.

Significance

The clinical significance of this interaction is unclear.

Think First

Using cannabis while taking dextroamphetamine could make your heart beat too fast.

Cocaine/ Crack

coke, snow, flake, nose candy, blow, lady white, stardust, rock, crystal, bazooka, moon rock, tar

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Interaction

a) Dextroamphetamine taken together with cocaine is expected to have additive side effects, including cardiovascular effects. A 16 year old male who intranasally inhaled amphetamine and cocaine in combination experienced an ischemic event.

b) 73 cocaine dependent individuals in a multi-centre randomized, double-blind, placebo-controlled trial receiving opioid agonist treatment (OAT) received sustained-release (SR) dextroamphetamine or placebo for cocaine use disorder. The dextroamphetamine group had a significantly higher number of cocaine abstinent days.

c) A large meta-analysis has shown efficacy of high doses and extended-release formulations of prescription psychostimulants in cocaine use disorder.

Mechanism

a) Amphetamines cause the release of epinephrine and norepinephrine, and cocaine prevents the reuptake of these neurotransmitters. Combined, these effects may be additive, and may lead to vasospasm.

b, c) The mechanism is unclear. Amphetamines/stimulants can mimic the stimulating effects of cocaine, acting as agonists with slower kinetics and a long elimination half-life, which provides stability and less euphoric and discontinuation effects.

Significance

a) Combined use of stimulants and cocaine should be avoided.

b, c) Dextroamphetamine SR and other mixed amphetamine salts may be beneficial in reducing cocaine use use. Further larger studies are required to confirm this use.

Serious Risk for Harm

Cocaine and dextroamphetamine have some things in common, like the way they can affect your heart and blood pressure if you have too much. Taken together, we think the risk is greater. You could get a dangerously fast heart beat, or too high blood pressure. There is a risk of you having heart damage, seizures, or even a stroke.

Think First

Some doctors may prescribe medical amphetamines or stimulants to reduce the desire (often called "cravings") to use cocaine. This is done very carefully.

Opioids

codeine, Tylenol #3®, cody, meperidine, Demerol®, DXM, dextromethorphan, robo, skittles, morphine, morph, monkey, methadone, bupe, sub, or dollies, oxycodone, Oxycontin®, hillbilly heroin, OxyNeo®, OC, oxy, roxy, percs, fentanyl, Sublimaze®, Duragesic®, china white, hydrocodone, Hycodan®, Vicodin®, suboxone®, buprenorphine, vike, heroin, H, horse, junk, smack, brown sugar, black tar, down, china white, purple drank, W18, carfentanil, elephant tranquilizer, loperamide, lope, lean

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Interaction
In a double-blind study, dextroamphetamine 10 mg augmented the analgesia of morphine by 200%, while 5 mg of dextroamphetamine augmented the analgesia of morphine by 150%. Morphine side effects such as sedation were offset by the addition of dextroamphetamine. Another study showed that dextroamphetamine completely antagonized the respiratory depression from moderate-dose morphine (0.15 mg/kg), but only partially antagonized by respiratory depression from high-dose morphine (0.3 mg/kg)

Mechanism
The mechanism for this is likely due to increased noradrenergic activity via dextroamphetamine.

Significance
Amphetamines may potentiate the analgesic effects and diminish the sedating adverse effects of opioids. Lower doses of opioids may be able to be used.

Think First

Amphetamines may affect the way your body responds to opioids. Sometimes doctors prescribe dextroamphetamine for patients taking opioids, but this is done carefully, with close monitoring.

Amphetamines/ Stimulants

uppers, ecstasy, E, X, Molly, mesc, XTC, love drug, MDA, MDE, Eve, MDMA, adam, disco biscuit, bennies, black beauties, Dexedrine®, Adderall®, dexies, Ritalin®, speed, crystal, meth, ice, glass, crank, tweak, cat, qat, kat, khat, bath salts, Ivory Wave, Vanilla Sky, Cloud 9

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Interaction
If taken together with other stimulants, amphetamines would be expected to have additive side effects.

Mechanism
Additive stimulant effects.

Significance
Stimulant use should be avoided in patients taking amphetamine derivatives, methylphenidate or pseudoephedrine.

Serious Risk for Harm

Amphetamines, dextroamphetamine, methylphenidate and other stimulants have some things in common, kind of like cousins in the 'chemical family'. Taking one of these stimulants and street amphetamines together could put you at risk of severe side effects. It could cause dangerous heart problems, high blood pressure, or even seizures. It would be like taking too much amphetamine.

Phencyclidine/ Ketamine

PCP, angel dust, PeaCe Pill, rocket fuel, love boat, embalming fluid, elephant tranquilizer, hog, illy, wet, wet stick, dipper, toe tag, cadillac, snorts, or surfer, Special K, vitamin K, CVR, cat tranquilizer, cat valium, jet, kit kat, Ketalar®

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Interaction
No information currently available.

Unknown Dangers

Unknown dangers

LSD/ Hallucinogens

acid, blotter, cartoon acid, hit, purple haze, trip, white lightning, raggedy ann, sunshine, window-pane, microdot, boomers, buttons, mesc, peyote, salvia, morning glory seeds, flying saucers, licorice drops, pearly gates, magic mushrooms, shrooms

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Interaction
No information currently available.

Unknown Dangers

Unknown dangers

Benzodiazepines

benzos, downers, tranquilizers, tranks, Ativan®, Halcion®, Klonopin®, Rivotril®, Restoril®, Serax®, Valium®, Xanax®, Rohypnol® (roofies, rope, the forget or date rape pill)

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Interaction
The sedative effects of benzodiazepines may counteract the stimulating effects of amphetamines.

Mechanism
Opposing CNS effects.

Significance
Benzodiazepines should be avoided when the stimulatory effects of amphetamines are required.

Serious Risk for Harm

Dextroamphetamine makes some people feel more awake and alert. If you have been using benzodiazepines, taking dextroamphetamine might fool you into feeling alert enough to drive, or do other activities requiring alertness. This would be false. You may still be impaired, and it would be unsafe to drive.

Think First

Benzodiazepines may reduce the stimulant effects of amphetamines such as dextroamphetamine.

Think First

Doctors sometimes prescribe benzodiazepines to patients taking dextroamphetamine to help treat some illnesses, but this is done very carefully.

Benzodiazepines are 'downers'. If you are depressed, blue, or moody, benzodiazepines can make this worse.

References

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Blanken P, Nuijten M, van den Brink W, et al. Clinical effects beyond cocaine use of sustained-release dexamphetamine for the treatment of cocaine dependent patients with comorbid opioid dependence: secondary analysis of a double-blind, placebo-controlled randomized trial. Addiction 2020; 115: 917-23.

Bourke DL, Allen PD, Rosenberg M et al. Dextroamphetamine with morphine: respiratory effects. J Clin Pharmacol 1983; 23: 65-70.

Bron TI, Bijlenga D, Kasander MV et al. Long-term relationship between methylphenidate and tobacco consumption and nicotine craving in adults with ADHD in a prospective cohort study. Eur Neuropsychopharmacol 2013; 23: 542-54.

Forrest WH Jr, Brown BW Jr, Brown CR et al. Dextroamphetamine with morphine for the treatment of postoperative pain. N Engl J Med 1977; 296: 712-5.

Hammerness P, Joshi G, Doyle R et al. Do stimulants reduce the risk for cigarette smoking in youth with attention-deficit hyperactivity disorder? A prospective, long-term, open-label study of extended-release methylphenidate. J Pediatr 2013; 162: 22-7.

Holdstock L, de Wit H. Individual differences in responses to ethanol and D-amphetamine: A within-subject study. Alcohol Clin Exp Res 2001; 25: 540-8.

Izenwasser S, Kornetsy C. Potentiation of morphine analgesia by D-amphetamine is mediated by norepinephrine and not dopamine. Pain 1988; 33: 363-8.

Kollins SH, Schoenfelder E, English JS et al. Methylphenidate Does Not Influence Smoking-Reinforced Responding or Attentional Performance in Adult Smokers With and Without Attention Deficit Hyperactivity Disorder (ADHD). Exp Clin Psychopharmacol 2013; 21: 365-84.

Lexi-Comp ONLINE, Lexi-Comp ONLINE Interaction Analysis, Hudson, Ohio: Lexi-Comp, Inc.; 2021; August 8, 2021.

Nurnberger JI Jr., Simmons-Alling S, Kessler L et al. Separate mechanisms for behavioural, cardiovascular, and hormonal responses to dextroamphetamine in man. Psychopharmacology 1984; 84: 200-4.

Preston CL (Ed), Stockley’s Interactions Checker. [online] London: Pharmaceutical Press. (accessed on August 8, 2021).

Strupp M, Hamann GF, Brandt T. Combined amphetamine and cocaine used caused mesencephalic ischemia in a 16 year old boy – due to vasospasm? Eur Neurol 2000; 43: 181-2.

Tardelli VS, Bisaga A, Arcadepani FB, et al. Prescription psychostimulants for the treatment of stimulant use disorder: a systematic review and meta-analysis. Psychopharmacology (Berl) 2020; 237: 2233-55.

Wills S. Drugs of Abuse, 2nd edition. Great Britain: Pharmaceutical Press 2005.

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dextroamphetamine

References

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