Adult: Initially, 10 mg daily in divided doses; may increase in increments of 10 mg at weekly intervals. Max: 60 mg daily. Dose must be individualised according to patient's response and tolerability. Use the lowest effective dose. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines). Elderly: Initially, 5 mg daily; may increase in increments of 5 mg at weekly intervals. Max: 60 mg daily. Dose must be individualised according to patient's response and tolerability. Use the lowest effective dose. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines). Child: 6-11 years Initially, 5 mg daily; may increase in increments of 5 mg at weekly intervals (Max: 60 mg daily); >12 years Same as adult dose. Dose must be individualised according to patient's response and tolerability. Use the lowest effective dose. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines).
Oral Attention deficit hyperactivity disorder
Child: ≥6 years Initially, 5 mg once daily or bid; may increase daily dose in increments of 5 mg at weekly intervals based on patient's tolerability and clinical response. Max daily dose: 20 mg (although, in rare cases, doses of 40 mg may be necessary for optimal titration). Use the lowest effective dose. Dosage and treatment recommendations may vary among countries and between individual products (refer to specific product guidelines).
Adult: Initially, apply 9 mg/9 hours transdermal patch 2 hours before an effect is needed and remove after 9 hours. May increase the dose up to Max of 18 mg/9 hours. Dosing and titration must be individualised based on tolerability and clinical response. Treatment recommendations and/or product availability may vary among countries (refer to specific product guidelines). Child: 6-17 years Initially, apply 4.5 mg/9 hours transdermal patch 2 hours before an effect is needed and remove after 9 hours. May increase the dose in increments of 4.5 mg at weekly intervals up to Max of 18 mg/9 hours; ≥18 years Same as adult dose. Dosing and titration must be individualised based on tolerability and clinical response. Treatment recommendations and/or product availability may vary among countries (refer to specific product guidelines).
Renal Impairment
Transdermal ESRD (GFR <15 mL/min): Max: 9 mg/9 hours. Severe (GFR 15-<30 mL/min): Max: ≤13.5 mg/9 hours. All doses must be applied 2 hours before an effect is needed and removed after 9 hours.
Administration
Dexamfetamine May be taken with or without food.
Contraindications
Advanced arteriosclerosis, symptomatic CV disease, structural cardiac abnormalities, cardiomyopathy, heart failure, arrhythmias (life-threatening), moderate to severe hypertension, cerebrovascular disorders (e.g. cerebral aneurysm, vascular abnormalities including vasculitis or stroke), hyperthyroidism, glaucoma, phaeochromocytoma, history of drug or alcohol abuse. Concomitant use with or within 14 days of discontinuing MAOIs.
Special Precautions
Patient with mild hypertension, seizure or history of seizure disorder, Tourette's syndrome or other tic disorders, pre-existing psychosis, bipolar disorder and/or mania. Not recommended or indicated for obesity treatment. Avoid abrupt withdrawal. Renal and hepatic impairment. Children and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Peripheral vasculopathy (e.g. Raynaud's phenomenon); visual disturbances (e.g. blurred vision, accommodation difficulties); exacerbation of behavioural disturbances and thought disorder (in psychotic patients), precipitation of mixed/manic episode (in patients with bipolar disorder), new-onset psychosis or mania; emergence or worsening of hostility or aggression; weight loss, growth retardation and decreased appetite (particularly in children receiving long-term therapy); onset or exacerbation of tics (motor and verbal), worsening of Tourette's syndrome, pre-existing anxiety, agitation or tension; decreased seizure threshold; increased blood pressure and heart rate; contact dermatitis or sensitisation, local application site reactions such as pain, oedema, pruritus, swelling (transdermal patch). Cardiac disorders: Arrhythmia, palpitations, chest pain. Eye disorders: Vertigo. Gastrointestinal disorders: Nausea, vomiting, abdominal pain and cramps, dry mouth. General disorders and administration site conditions: Hyperpyrexia. Musculoskeletal and connective tissue disorders: Arthralgia. Nervous system disorders: Headache, dizziness, dysgeusia, dyskinesia. Psychiatric disorders: Hyperactivity, insomnia, nervousness, irritability, excitation, depression. Reproductive system and breast disorders: Impotence. Skin and subcutaneous tissue disorders: Alopecia. Potentially Fatal: Serious CV events (including MI and stroke); risk for abuse, misuse, and substance use disorder (that may lead to overdose).
This drug may cause dizziness, drowsiness, and visual disturbances (e.g. accommodation difficulties, diplopia, blurred vision), if affected, do not drive or operate machinery. Transdermal patch: Avoid exposure of the application site to any direct external heat sources (e.g. electric blankets, hair dryers, heating pads).
Monitoring Parameters
Perform cardiac evaluation at baseline and in patients who develop symptoms of cardiac disease (e.g. exertional chest pain, unexplained syncope) during therapy. Evaluate risk for abuse or misuse, risk for bipolar disorder, and Tourette's syndrome (including family history) prior to treatment initiation. Monitor blood pressure, heart rate growth rate (height, weight), and appetite. Assess for signs of peripheral vasculopathy (e.g. digital changes), behavioural or sleep changes; worsening of psychiatric disorder; new signs or worsening of tics or Tourette's syndrome; signs of misuse, abuse, or addiction.
Overdosage
Symptoms: Headache, vomiting, sweating, mydriasis, flushing, mucous membrane dryness, hyperpyrexia, tremors, hyperreflexia, muscle twitching, convulsions, confusion, agitation, aggression, delirium, euphoria, hallucinations, chest pain, tachycardia, palpitations, cardiac arrhythmias, hypertension, respiratory depression, coma, and circulatory collapse. Treatment: Symptomatic and supportive treatment. Protect the patient from self-injury and external stimuli that could exacerbate overstimulation. If the patient is conscious, may induce vomiting to empty gastric contents if ingestion was <1 hour prior. Administration of activated charcoal and a cathartic may also be considered. Benzodiazepines may be given to treat excessive stimulation or seizures. Ensure adequate circulation and respiratory exchange; external cooling methods may be needed for hyperpyrexia.
Drug Interactions
Reduced absorption with gastrointestinal acidifying agents (e.g. guanethidine, reserpine, glutamic acid hydrochloride, ascorbic acid). Decreased efficacy and blood levels with urinary acidifying agents (e.g. Na acid phosphate, ammonium chloride). Enhanced absorption with gastrointestinal alkalinising agents (e.g. Na bicarbonate). Increased efficacy and blood levels with urinary alkalinising agents (e.g. acetazolamide). May inhibit the antihypertensive effect of clonidine and guanethidine. May cause severe hypertonia with β-blockers. May reduce depressant effects of opiates. May increase the risk of CV adverse effects with TCAs. May increase the adrenergic effect of norepinephrine. May potentiate the analgesic effect of pethidine and morphine. Chlorpromazine, haloperidol and lithium may inhibit the stimulant effects of dexamfetamine. Potential inhibition of metabolism and excretion with disulfiram. May delay absorption of anticonvulsants (e.g. phenobarbital, phenytoin, primidone, ethosuximide). Potentially Fatal: Increased risk of serotonin syndrome and hypertensive crisis with MAOIs. Concomitant use with other serotonergic agents (e.g. SSRIs, SNRIs, triptans, TCAs, fentanyl, lithium, tramadol, buspirone, tryptophan) may increase risk of serotonin syndrome.
Food Interaction
May exacerbate CNS adverse effects with alcohol. May increase risk for serotonin syndrome with St. John's wort. Decreased oral absorption and plasma levels with acidic food or juices.
Lab Interference
May interfere with the determination of urinary steroids. May significantly increase plasma corticosteroid levels.
Action
Description: Mechanism of Action: Dexamfetamine, the dextrorotatory isomer of amfetamine, is an indirect-acting sympathomimetic amine with α- and β-adrenergic agonist activity. Its action in the periphery is thought to occur by releasing norepinephrine from adrenergic nerve terminals and by directly stimulating the α- and β-receptors. In addition, it increases blood systolic and diastolic blood pressure and has weak respiratory stimulant and bronchodilator actions. Synonym(s): Dextroamphetamine. Duration: Oral: 4-6 hours (conventional form), 8 hours (extended-release form). Transdermal: 9 hours. Pharmacokinetics: Absorption: Readily absorbed from the gastrointestinal tract. Time to peak plasma concentration: Oral: Approx 3 hours (conventional form), approx 8 hours (extended-release form); Transdermal: 6-9 hours (initial application), 6 hours (repeat application). Distribution: Distributed into most body tissues with high concentrations in the brain and CSF. Enters breast milk. Metabolism: Partially metabolised in the liver by CYP2D6. Excretion: Via urine as unchanged drug (pH-dependent). Elimination half-life: Approx 12 hours (oral); 6.4-11.5 hours (transdermal).
Chemical Structure
Dexamfetamine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 5826, Dextroamphetamine. https://pubchem.ncbi.nlm.nih.gov/compound/Dextroamphetamine. Accessed Mar. 27, 2025.
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