Medical Uses

• FDA-approved for:
  • ADHD in children (6+ years), adolescents, and adults.
  • Moderate to severe binge eating disorder (BED) in adults.
• Off-label uses (sometimes prescribed): Narcolepsy or treatment-resistant depression (evidence varies).

Mechanism of Action

• Prodrug: Inactive until metabolized in red blood cells to dextroamphetamine (active form).
• Longer-lasting than immediate-release amphetamines (up to 14 hours), reducing abuse potential via oral route (snorting/IV less effective).
• Boosts neurotransmitters: Dopamine and norepinephrine in the prefrontal cortex for better attention and executive function.

Dosage & Administration

• Take with/without food; avoid late-day dosing to prevent insomnia.
• Capsules: Swallow whole, open and mix in water/yogurt (don’t chew).

Side Effects

Contraindications & Warnings

• Do not use if: Heart disease, advanced arteriosclerosis, hyperthyroidism, glaucoma, history of drug abuse, MAOI use (within 14 days).
• Pregnancy: Category C; potential fetal harm.
• Interactions: Avoid with SSRIs/SNRIs (serotonin syndrome risk), alcohol, caffeine, or other stimulants.
• Overdose: Symptoms include agitation, hallucinations, seizures, coma. Call emergency services.

Abuse & Dependence

• High potential for misuse (e.g., for studying/partying). Extended-release design lowers street value for injection.
• Withdrawal: Fatigue, depression, increased appetite.

Cost & Availability

• Brand: ~400/month (US, without insurance). Generics available since 2023 (~200).
• Covered by most insurance with prior authorization.

Evidence & Studies

• ADHD efficacy: Meta-analyses (e.g., Cochrane Review) show 70–80% response rate, superior to placebo.
• BED: STAR trial (2015) demonstrated reduced binge days by 3–4/week vs. placebo.
• Long-term: Safe for 2+ years in kids with monitoring; growth monitored via height/weight charts.