Medications Directory

Approved indications: In the United States, oral extended-release amphetamine products are approved as central nervous system stimulants for the treatment of attention-deficit/hyperactivity disorder (ADHD) in pediatric patients generally 6 years of age and older (some products 13+ years) and in adults; extended-release forms are not FDA-approved for narcolepsy, which is typically treated with immediate-release amphetamine or other wake-promoting agents.

Off-label uses: Some clinicians may occasionally prescribe extended-release amphetamine off-label for conditions such as narcolepsy, treatment-resistant depression, or fatigue in selected medical or neurologic disorders, but these uses rely on limited data or extrapolation from other stimulant studies and are generally reserved for specialist care after standard treatments have been tried.

Efficacy expectations: For ADHD, many patients notice improved focus and reduced hyperactivity or impulsivity within the first few doses (often within 1–2 hours of a morning dose), with benefits lasting about 8–16 hours depending on the specific formulation; overall response rates to stimulant therapy are high (roughly two-thirds of patients achieve clear symptom improvement), and extended-release amphetamine has similar effectiveness to methylphenidate-based stimulants but with once-daily convenience and smoother symptom control across the school or work day, while typically providing faster and larger symptom reductions than non-stimulant ADHD medications.

Typical dosing (ADHD): For most extended-release amphetamine products, children 6–12 years often start at a low once-daily morning dose (for example, the equivalent of 5–10 mg of mixed amphetamine salts), which can be increased in small weekly steps up to about 20–30 mg/day depending on response and product-specific limits; adolescents and adults usually start at about 10–20 mg-equivalent once each morning and may be titrated up (often to 20–40 mg/day) while staying within the maximum daily dose specified in the product’s prescribing information.

How to take: Take the dose once daily in the morning, with or without food, swallowing capsules or tablets whole unless your specific product instructions allow opening the capsule and sprinkling its contents on a small amount of soft food (which should then be eaten immediately without chewing); do not crush, chew, or split extended-release beads or tablets, and avoid taking the medicine in the afternoon or evening to reduce sleep problems.

Special dosing instructions: Dosing is individualized and should not be switched milligram-for-milligram between different amphetamine products because strengths and release profiles differ; patients with severe kidney disease may need lower doses or should avoid some extended-release products, and prescribers generally reassess periodically whether the medication and dose are still needed, sometimes considering brief “drug holidays” in children to check growth and symptom control.

Missed dose: If you miss your usual morning dose but remember later in the morning, you may take it then; if it is already later in the day, skip the missed dose and take your next dose at the normal time the following day, and do not double doses to make up for one that was missed.

Overdose: Signs of overdose can include extreme restlessness, shaking, rapid breathing, very fast or irregular heartbeat, high blood pressure, fever, confusion, hallucinations, severe nausea or vomiting, muscle pain, or collapse; in case of suspected overdose, call emergency services (911 in the U.S.) or the poison control center (1-800-222-1222 in the U.S.) right away.

Common side effects: Very common effects include decreased appetite, weight loss, trouble falling or staying asleep, dry mouth, stomach upset, increased heart rate, mild increases in blood pressure, headache, anxiety, or irritability; these usually begin in the first days to weeks of treatment, are often mild to moderate, and can sometimes be improved by dose adjustments, timing the dose earlier in the day, or dietary strategies.

Serious or rare adverse effects: Seek urgent medical attention for chest pain, shortness of breath, fainting, irregular heartbeat, signs of stroke (sudden weakness, trouble speaking, vision changes), severe high blood pressure, seizures, uncontrollable movements or tics, new or worsening aggression, paranoia, hallucinations, manic symptoms, signs of allergic reaction (rash, swelling of face or throat, trouble breathing), or prolonged and painful erections in males.

Warnings and precautions: Amphetamine extended-release carries boxed warnings for abuse, misuse, and addiction, and should not be used in people with certain serious heart problems, uncontrolled high blood pressure, hyperthyroidism, glaucoma, or recent monoamine oxidase inhibitor (MAOI) use; caution is needed in patients with anxiety disorders, bipolar disorder, psychosis, tics or Tourette syndrome, seizure disorders, or a history of substance use disorder, and growth (height and weight) should be monitored in children because long-term use can modestly slow growth in some patients.

Pregnancy, breastfeeding, and age considerations: Use in pregnancy is generally avoided unless the benefits clearly outweigh risks, as stimulants may be associated with low birth weight or preterm birth; amphetamine passes into breast milk and may affect a nursing infant (poor sleep, irritability, poor weight gain), so breastfeeding while taking it is usually avoided or requires individualized risk–benefit discussion and close monitoring; extended-release formulations are not recommended in children younger than 6 years, and older adults may be at higher risk for cardiovascular and other side effects.

Relative safety compared with other options: Within the stimulant class, extended-release amphetamine has a broadly similar safety profile to other amphetamine products and to methylphenidate, though some individuals tolerate one class better than the other; non-stimulant ADHD medications may be preferred when there is high concern about abuse, cardiovascular risk, or intolerable stimulant side effects, but they often have a slower onset and somewhat lower average effectiveness.

Reporting and safety updates: Side effects can be reported to the U.S. Food and Drug Administration (FDA) through the MedWatch program (online or by phone), and up-to-date safety communications, including any new warnings or recalls, are available on the FDA’s drug safety webpages.

Major drug interactions: Amphetamine extended-release must not be used with monoamine oxidase inhibitors (MAOIs) or within 14 days of stopping an MAOI because of the risk of dangerously high blood pressure and other toxic reactions; it can also interact with other stimulants (including some weight-loss pills and ADHD medications), decongestants such as pseudoephedrine, certain antidepressants (SSRIs, SNRIs, tricyclics, bupropion), some antipsychotics, and medicines that inhibit CYP2D6, which together may increase blood pressure and heart rate, raise amphetamine levels, or increase the risk of serotonin syndrome.

Foods, alcohol, and supplements: Large amounts of caffeine or other stimulatory supplements can add to side effects such as nervousness, palpitations, or insomnia; acidic foods or vitamin C supplements taken at the same time may modestly reduce amphetamine absorption, while alkalinizing agents (such as some antacids or sodium bicarbonate) can increase levels; alcohol can worsen judgment, increase heart-related side effects, and may alter the release profile of some extended-release products, so concurrent use is generally discouraged.

Conditions requiring caution or avoidance: Use is usually avoided or needs specialist oversight in people with known structural heart disease, cardiomyopathy, serious heart rhythm disorders, coronary artery disease, moderate-to-severe hypertension, hyperthyroidism, glaucoma, severe anxiety or agitation, active psychosis or uncontrolled bipolar disorder, significant tics or Tourette syndrome, severe kidney disease, or a history of substance misuse that is not in stable remission.

Monitoring needs: Before and during treatment, clinicians typically review personal and family cardiac history, measure blood pressure and heart rate, check weight and height in children, screen for mood, anxiety, psychosis, and substance use, and may order an ECG or additional tests if cardiac risk factors or other medical issues are present; ongoing follow-up visits are used to adjust the dose, watch for diversion or misuse, and decide whether continued treatment is appropriate.

Q: How long does amphetamine extended-release last during the day?
A: Most extended-release amphetamine products start working within about 1–2 hours of a morning dose and can control ADHD symptoms for roughly 8–16 hours, depending on the exact formulation and individual response.

Q: Is amphetamine extended-release addictive?
A: This medicine has a high potential for abuse and dependence, especially if taken in higher doses than prescribed or by people without ADHD, so it is classified as a Schedule II controlled substance and should be used only as directed, with regular monitoring by the prescriber.

Q: Can I drink coffee or alcohol while taking this medication?
A: Moderate caffeine may be acceptable for some people but can worsen jitteriness, anxiety, or sleep problems, while alcohol can increase heart-related side effects and impair judgment and is generally discouraged, so you should discuss your typical caffeine and alcohol use with your clinician.

Q: Will this medicine stunt my child’s growth?
A: Stimulant treatment can slow growth slightly in some children, especially early in therapy, but the effect is usually small, and clinicians monitor height and weight regularly and may adjust the dose, timing, or schedule if growth seems to be affected.

Q: Do I need to take "drug holidays" from amphetamine extended-release?
A: Some families and clinicians choose to pause medication on weekends or school breaks to reassess symptoms and growth, but this is not required for everyone and should only be done under the guidance of the prescribing clinician based on how much benefit the medicine provides in daily life.

Q: How is amphetamine extended-release different from immediate-release amphetamine?
A: Extended-release forms are designed to be taken once daily and release medicine gradually for all-day coverage, while immediate-release tablets act more quickly but wear off sooner and may require multiple doses per day.

Storage: Store amphetamine extended-release at room temperature in a tightly closed original container, away from moisture, heat, and light, and keep it locked or in a secure place out of reach of children, teens, and anyone who could misuse it.

Disposal: Do not save unused capsules or tablets "just in case"; use a pharmacy or community drug take-back program when available, or follow local guidance by mixing leftover medicine with something unappealing (such as used coffee grounds or cat litter), sealing it in a container, and placing it in the household trash after removing personal information from the label, and never share this medication with others.