Medications Directory

Approved indications: Oral amphetamine sulfate is FDA-approved for narcolepsy, ADHD in children 3–16 years, and short-term (a few weeks) adjunct treatment of exogenous obesity in patients who have not responded to other weight-loss efforts; it is not established as safe and effective for obesity in children under 12 years.¹

Off-label uses: Clinicians may prescribe amphetamine sulfate off-label for ADHD in adults and for narcolepsy or other attention disorders outside the labeled age ranges, drawing on evidence from other immediate-release amphetamine products that show similar efficacy in these groups, although this specific formulation is not FDA-approved for those populations.

Efficacy expectations in ADHD: Benefits often begin within 30–60 minutes of a dose, with improved attention, decreased impulsivity, and reduced hyperactivity the same day; symptom control lasts about 4–6 hours per dose, and many children achieve substantial improvement when appropriately titrated, with effect sizes comparable to other short-acting stimulant medications.

Efficacy in narcolepsy and obesity: In narcolepsy, amphetamine sulfate typically reduces excessive daytime sleepiness and cataplexy frequency, though many patients still require scheduled naps and ongoing non-drug strategies; for obesity, it produces modest short-term weight loss as an adjunct to caloric restriction and lifestyle changes, and its usefulness is limited by tolerance, side effects, and abuse potential, so it is intended only for brief courses.

Comparison to similar drugs: Overall, its effectiveness for ADHD and narcolepsy is similar to other immediate-release amphetamine or methylphenidate products, with response depending more on individual sensitivity, dose titration, and adherence than on brand.

General dosing principles: Regardless of indication, amphetamine sulfate should be started at a low dose and increased gradually to the lowest effective dose, avoiding late-day doses to reduce insomnia; doses are individualized based on response and tolerability, and treatment should be periodically re-evaluated.

ADHD dosing (immediate-release tablets): For children 3–5 years, a typical starting dose is 2.5 mg once daily, increasing by 2.5 mg at weekly intervals as needed. For children 6 years and older, the usual starting dose is 5 mg once or twice daily, with 5 mg weekly increments; only rarely is more than 40 mg per day required. The first dose is given on awakening, with 1–2 additional doses every 4–6 hours, and late-evening doses are avoided to prevent insomnia.

Narcolepsy dosing: Usual total daily doses range from 5 to 60 mg in divided doses, tailored to the individual; children 6–12 years often start at 5 mg daily, and those 12 and older at 10 mg daily, with weekly increases until symptoms are controlled or side effects limit further titration. The first dose is taken on awakening, with additional doses spaced 4–6 hours apart.

Exogenous obesity dosing: For short-term adjunctive treatment of obesity in suitable patients, doses up to 30 mg per day are given in divided 5–10 mg doses, usually 30–60 minutes before meals, and this indication is not recommended for children younger than 12 years.

How to take: Swallow tablets with water, with or without food unless otherwise directed; for weight-loss use they are typically taken before meals. Do not crush or snort tablets, and do not take more often or at higher doses than prescribed, as this increases the risk of serious side effects and addiction.

Special dosing instructions: The prescriber may occasionally recommend “drug holidays” (such as weekends or school breaks) in children with ADHD to reassess the ongoing need for treatment or reduce effects on appetite and growth. People on long-term or high-dose therapy should not stop suddenly without medical guidance because abrupt discontinuation can cause marked fatigue, depression, and sleep changes.

Missed dose: If a dose is missed and it is still early in the day, take it as soon as remembered; if it is close to the next scheduled dose or late in the day, skip the missed dose and resume the regular schedule—do not double up to make up for a missed dose.

Overdose: Overdose can cause severe agitation, tremor, rapid breathing, dangerously high blood pressure, fever, hallucinations, seizures, heart rhythm problems, or coma; in case of suspected overdose, call emergency services or poison control (1-800-222-1222 in the U.S.) immediately.

Common side effects: Decreased appetite and weight loss, insomnia, dry mouth, stomach upset, nausea, headache, nervousness, and increased heart rate or blood pressure are common, especially when starting or after dose increases; these are usually mild to moderate and often improve with dose adjustment or timing changes.

Serious or rare adverse effects: Seek urgent medical attention for chest pain, shortness of breath, fainting, or unexplained rapid heartbeat (possible heart attack, stroke, or serious arrhythmia); signs of severe high blood pressure (severe headache, vision changes); new psychotic or manic symptoms (hallucinations, delusions, extreme agitation); seizures; muscle pain with dark urine (possible rhabdomyolysis); painful or prolonged erections; or signs of allergic reaction such as rash, hives, swelling of the face or throat, or trouble breathing.

Warnings and precautions: Amphetamine sulfate has a high potential for abuse, misuse, and addiction; people with a history of substance use disorder require special caution and close monitoring. It is contraindicated with monoamine oxidase inhibitors (MAOIs) taken within the past 14 days, and in patients with certain serious heart problems, moderate-to-severe high blood pressure, hyperthyroidism, or marked agitation. It can worsen tics and Tourette’s syndrome, and may cause or exacerbate anxiety, irritability, or mood swings.

Pregnancy and breastfeeding: Use during pregnancy only if the potential benefit justifies possible risks, as amphetamines have been associated with low birth weight and premature delivery when used chronically at higher doses; infants exposed in utero should be monitored for withdrawal symptoms after birth. Amphetamine passes into breast milk, and breastfeeding is generally not recommended while taking this medicine because of the potential for serious adverse reactions and unknown long-term neurodevelopmental effects in the infant.

Age limits and medical conditions: Amphetamine sulfate for ADHD is not recommended in children under 3 years, and use for obesity is not established in children under 12; in children and adolescents, height and weight should be monitored regularly because long-term stimulant use can slow growth. People with cardiovascular disease, structural heart defects, significant hypertension, hyperthyroidism, glaucoma, seizure disorders, or severe kidney disease should be evaluated carefully before use, and blood pressure and heart rate should be checked periodically during treatment.

Relative safety vs other stimulants: When prescribed and monitored appropriately, the overall safety profile is similar to other short-acting stimulants, but all amphetamine-containing drugs share black box warnings about abuse, misuse, and addiction, and the potential for serious cardiovascular and psychiatric events at therapeutic or especially at supratherapeutic doses.

Side-effect reporting and safety updates: Patients in the United States can report suspected side effects to the FDA MedWatch program (online or at 1-800-FDA-1088) and can review current safety communications on the FDA’s drug safety webpage or the manufacturer’s site.

Major drug interactions: Amphetamine sulfate must not be used with monoamine oxidase inhibitors (MAOIs) or within 14 days of stopping an MAOI because of the risk of hypertensive crisis. Caution is required when combining with other medicines that increase serotonin (such as SSRIs, SNRIs, triptans, tramadol, lithium, buspirone, some opioids, and St. John’s wort) because of the risk of serotonin syndrome, and with other stimulants (including other ADHD medicines, decongestants, or weight-loss drugs) due to additive cardiovascular and nervous system effects.

Other medicines and substances: Acidifying agents (such as some urinary acidifiers) can lower blood levels of amphetamine and reduce effect, whereas alkalinizing agents (such as certain antacids or urinary alkalinizers) can increase blood levels and side effects. Amphetamine may lessen the effect of some blood pressure medicines and can interact with certain tricyclic antidepressants and antipsychotics, so prescribers often adjust doses and monitor closely. Alcohol can increase heart rate, blood pressure, and mood or behavior changes when combined with amphetamines and is best limited or avoided.

Food, drinks, and lifestyle: Taking doses late in the day or consuming large amounts of caffeine can worsen insomnia and nervousness; modest caffeine intake earlier in the day is usually tolerated but should be monitored. Sudden intense exercise in people with underlying heart disease may be riskier while on stimulants, so anyone with cardiac symptoms should be evaluated before engaging in strenuous activity.

Conditions and co-medications that increase risk: Use is generally avoided or undertaken with great caution in people with serious structural heart disease, symptomatic cardiovascular disease, moderate-to-severe hypertension, hyperthyroidism, glaucoma, active psychosis, uncontrolled bipolar disorder, or a history of stimulant misuse. Stimulants can worsen tics and Tourette’s syndrome, and careful assessment is needed in patients with seizure disorders, peripheral vascular disease, or renal impairment.

Monitoring needs: Before starting treatment, clinicians typically review personal and family cardiac history, check blood pressure and heart rate, and screen for substance use and psychiatric conditions. During therapy, periodic monitoring of blood pressure, pulse, weight, height (in children and adolescents), appetite, sleep, mood, and any signs of misuse or diversion is recommended; some patients with known heart disease may also need ECGs or cardiology consultation.

Q: How quickly will amphetamine sulfate start working for ADHD or narcolepsy?
A: Most people notice effects within about 30–60 minutes of a dose, with improvements in alertness and attention for roughly 4–6 hours, depending on the individual and the dose.

Q: Will my child need to take this medicine every day and for many years?
A: Many children use amphetamine sulfate on school days and may take breaks on weekends or holidays; the need for ongoing treatment is reassessed regularly, and some children can reduce or stop medication as they mature and symptoms become easier to manage.

Q: Is amphetamine sulfate the same as Adderall or other amphetamine ADHD medicines?
A: Amphetamine sulfate contains immediate-release racemic amphetamine, while products like Adderall contain mixed amphetamine salts and others are extended-release formulations; they are related stimulants with broadly similar effects but differ in exact composition, dose strengths, and how long they last.

Q: Can this medicine cause addiction?
A: Yes, amphetamine sulfate is a Schedule II controlled substance with a high potential for abuse, misuse, and addiction, especially if taken at higher doses, more often than prescribed, or by people without a medical need, so it should be used exactly as directed and stored securely.

Q: Is it safe to drink coffee or alcohol while taking amphetamine sulfate?
A: Moderate caffeine may be acceptable for some adults but can increase jitteriness, heart rate, and sleep problems, so intake should be limited and discussed with the prescriber; alcohol can further strain the heart and impair judgment when combined with stimulants and is generally best minimized or avoided.

Q: What happens if I stop taking amphetamine sulfate suddenly?
A: Stopping abruptly, especially after high or prolonged dosing, can cause temporary fatigue, increased sleep, low mood, or irritability, so any plan to reduce or stop the medicine should be done gradually under medical supervision.

Storage: Store amphetamine sulfate tablets at room temperature (68–77°F / 20–25°C) in a tightly closed container, away from moisture, heat, and light, and keep them in a secure place out of sight and reach of children or others who might misuse them.

Disposal: If possible, use a drug take-back program or DEA-authorized collection site; if none is available, mix leftover tablets with an undesirable substance (such as used coffee grounds, dirt, or cat litter), seal in a bag or container, and place in household trash, and always remove or scratch out personal information on prescription labels before discarding.