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ADDERALL-XR (AMPHETAMINE, DEXTROAMPHETAMINE): DRUG INTERACTIONS
Agents that Increase Blood Levels of Amphetamines
MAOI antidepressants slow amphetamine metabolism. This slowing potentiates amphetamines, increasing their effect on the release of norepinephrine and other monoamines from adrenergic nerve endings; this can cause headaches and other signs of hypertensive crisis. A variety of toxic neurological effects and malignant hyperpyrexia can occur, sometimes with fatal results. Do not administer Amphetamines and Dextroamphetamines (Adderall-XR) during or within 14 days following the administration of monoamine oxidase inhibitors.
Gastrointestinal alkalinizing agents (e.g., sodium bicarbonate) increase absorption of amphetamines. Coadministration of mixed salts of Amphetamine and Dextroamphetamine (Adderall-XR) and gastrointestinal alkalinizing agents, such as antacids, should be avoided. Urinary alkalinizing agents (acetazolamide, some thiazides) increase the concentration of the non-ionized species of the amphetamine molecule, thereby decreasing urinary excretion. Both groups of agents increase blood levels and therefore potentiate the actions of amphetamines.
Agents that Lower Blood Levels of Amphetamines
Gastrointestinal acidifying agents (e.g., guanethidine, reserpine, glutamic acid HCl, ascorbic acid) lower absorption of amphetamines. Urinary acidifying agents (e.g., ammonium chloride, sodium acid phosphate, methenamine salts) increase the concentration of the ionized species of the amphetamine molecule, thereby increasing urinary excretion. Both groups of agents lower blood levels and efficacy of amphetamines.
Agents Whose Effects May be Reduced by Adderall-XR (Amphetamine, Dextroamphetamine) capsules
Amphetamines may reduce the cardiovascular effects of adrenergic blockers.
Adderall-XR may counteract the sedative effect of antihistamines.
Amphetamines may antagonize the hypotensive effects of antihypertensives.
Adderall-XR (Amphetamine, Dextroamphetamine) inhibit the hypotensive effect of veratrum alkaloids.
Amphetamines may delay intestinal absorption of phenobarbital.
Adderall-XR (Amphetamine, Dextroamphetamine mixed salts) may delay intestinal absorption of phenytoin.
Amphetamines may delay intestinal absorption of ethosuximide.
Agents Whose Effects May be Potentiated by Adderall-XR (Amphetamines)
Amphetamines may enhance the activity of tricyclic antidepressants or sympathomimetic agents; damphetamine with desipramine or protriptyline and possibly other tricyclics cause striking and sustained increases in the concentration of D-Amphetamine in the brain; cardiovascular effects can be potentiated.
Adderall-XR (Amphetamines) capsules potentiate the analgesic effect of meperidine.
Amphetamines may enhance the adrenergic effect of norepinephrine.
Agents that May Reduce the Effects of Adderall-XR capsules
Chlorpromazine blocks dopamine and norepinephrine receptors, thus inhibiting the central stimulant effects of amphetamines.
Haloperidol blocks dopamine receptors, thus inhibiting the central stimulant effects of Adderall-XR extended release capsules.
The anorectic and stimulatory effects of amphetamines may be inhibited by lithium carbonate.
Agents that May Potentiate the Effects of Adderall-XR (Amphetamines with Dextroamphetamines)
Norepinephrine may enhance the adrenergic effect of amphetamine.
In cases of propoxyphene overdosage, amphetamine CNS stimulation is potentiated and fatal convulsions can occur.
Proton Pump Inhibitors (PPI)
PPIs act on proton pumps by blocking acid production, thereby reducing gastric acidity. When Adderall-XR (20 mg single-dose) was administered concomitantly with the proton pump inhibitor, omeprazole (40 mg once daily for 14 days), the median Tmax of d-amphetamine was decreased by 1.25 hours (from 4 to 2.75 hours), and the median Tmax of l-amphetamine was decreased by 2.5 hours (from 5.5 to 3 hours), compared to Amphetamine with Dextroamphetamine (Adderall-XR) administered alone. The AUC and Cmax of each moiety were unaffected. Therefore, co-administration of Amphetamines and Dextroamphetamines (Adderall-XR) and proton pump inhibitors should be monitored for changes in clinical effect.
Drug-Laboratory Test Interactions
Amphetamines can cause a significant elevation in plasma corticosteroid levels. This increase is greatest in the evening. Mixed salts of Amphetamine and Dextroamphetamine (Adderall-XR) may interfere with urinary steroid determinations.
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