AdultPediatricDosage Forms & Strengths transdermal system: Schedule II 4.5mg/9hr 9mg/9hr 13.5mg/9hr 18mg/9hr Attention Deficit Hyperactivity Disorder Indicated for attention deficit hyperactivity disorder (ADHD) Apply to application site 2 hr before an effect is needed and remove within 9 hr after application 9 mg/9 hr patch initially; may adjust dose up to 18 mg/9 hr Titrate dose according to individual clinical response and tolerability Pharmacological treatment of ADHD may be needed for an extended period Periodically reevaluate long-term use and adjust dosage as needed Dosage Modifications Coadministration with agents that alter urinary pH Alkalinizing agents: Avoid; coadministration may increase amphetamine blood levels Acidifying agents (eg, ascorbic acid): Consider increasing dextroamphetamine dose based on clinical response; coadministration may lower amphetamine blood levels Coadministration with CYP2D6 inhibitors and/or serotonergic drugs Initiate with lower dose Renal impairment Severe (GFR 15 to <30 mL/min/1.73 m2): Do not exceed 13.5 mg/9 hr End-stage renal disease (GFR <15 mL/min/1.73 m2): Do not exceed 9 mg/9 hr Dextroamphetamine is not dialyzable Dosing Considerations Switching from another medication or any other amphetamine product Discontinue previous treatment, and titrate dextroamphetamine transdermal system using titration schedule Do not substitute for other amphetamine products on a mg-per-mg basis owing to different amphetamine base compositions and differing pharmacokinetic profiles Before initiating Assess for presence of cardiac disease (eg, perform a careful history, family history of sudden death or ventricular arrhythmia, physical exam) Assess risk of abuse before prescribing, and monitor for signs of abuse and dependence while on therapy Maintain careful prescription records, educate patients about abuse, monitor for signs of abuse and overdose, and periodically re-evaluate the need for use Dosage Forms & Strengths transdermal system: Schedule II 4.5mg/9hr 9mg/9hr 13.5mg/9hr 18mg/9hr Attention Deficit Hyperactivity Disorder Indicated for attention deficit hyperactivity disorder (ADHD) in adults and pediatric patients aged ≥6 years <6 years: Safety and efficacy not established 6-17 years Apply to application site 2 hr before an effect is needed and remove within 9 hr after application Apply 4.5 mg/9 hr patch initially May increase by increments of 4.5 mg/week; not to exceed 18 mg/9 hr Titrate dose according to patient’s clinical response and tolerability Pharmacological treatment of ADHD may be needed for an extended period Periodically reevaluate long-term use and adjust dosage as needed Dosage Modifications Coadministration with agents that alter urinary pH Alkalinizing agents: Avoid; coadministration may increase amphetamine blood levels Acidifying agents (eg, ascorbic acid): Consider increasing dextroamphetamine dose based on clinical response; coadministration may lower amphetamine blood levels Renal impairment Severe (GFR 15 to <30 mL/min/1.73 m2): Do not exceed 13.5 mg/9 hr End-stage renal disease (GFR <15 mL/min/1.73 m2): Do not exceed 9 mg/9 hr Dextroamphetamine is not dialyzable Dosing Considerations Limitation of use: Patients with ADHD aged <6 years experienced more long-term weight loss than patients aged ≥6 years Switching from another medication or any other amphetamine product Discontinue previous treatment, and titrate dextroamphetamine transdermal system using titration schedule Do not substitute for other amphetamine products on a mg-per-mg basis owing to different amphetamine base compositions and differing pharmacokinetic profiles Before initiating Assess for presence of cardiac disease (eg, perform a careful history, family history of sudden death or ventricular arrhythmia, physical exam) Assess risk of abuse before prescribing, and monitor for signs of abuse and dependence while on therapy Maintain careful prescription records, educate patients about abuse, monitor for signs of abuse and overdose, and periodically re-evaluate the need for use Document height and weight; monitor growth during treatment Interaction CheckerEnter a drug name and dextroamphetamine transdermalNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (5)isocarboxazidisocarboxazid increases effects of dextroamphetamine transdermal by decreasing metabolism. Contraindicated. MAOIs slows amphetamine metabolism, increasing amphetamine?s effect on norepinephrine release and other monoamines from adrenergic nerve endings causing signs of hypertensive crisis. Do not administer dextroamphetamine during or within 14 days following MAOI administration.linezolidlinezolid increases effects of dextroamphetamine transdermal by decreasing metabolism. Contraindicated. MAOIs slows amphetamine metabolism, increasing amphetamine?s effect on norepinephrine release and other monoamines from adrenergic nerve endings causing signs of hypertensive crisis. Do not administer dextroamphetamine during or within 14 days following MAOI administration.phenelzinephenelzine increases effects of dextroamphetamine transdermal by decreasing metabolism. Contraindicated. MAOIs slows amphetamine metabolism, increasing amphetamine?s effect on norepinephrine release and other monoamines from adrenergic nerve endings causing signs of hypertensive crisis. Do not administer dextroamphetamine during or within 14 days following MAOI administration.procarbazineprocarbazine increases effects of dextroamphetamine transdermal by decreasing metabolism. Contraindicated. MAOIs slows amphetamine metabolism, increasing amphetamine?s effect on norepinephrine release and other monoamines from adrenergic nerve endings causing signs of hypertensive crisis. Do not administer dextroamphetamine during or within 14 days following MAOI administration.tranylcyprominetranylcypromine increases effects of dextroamphetamine transdermal by decreasing metabolism. Contraindicated. MAOIs slows amphetamine metabolism, increasing amphetamine?s effect on norepinephrine release and other monoamines from adrenergic nerve endings causing signs of hypertensive crisis. Do not administer dextroamphetamine during or within 14 days following MAOI administration.Serious - Use Alternative (2)potassium citratepotassium citrate will increase the level or effect of dextroamphetamine transdermal by Other (see comment). Avoid or Use Alternate Drug. Urinary alkalinizing agents can increase blood levels and potentiate the action of amphetamine.potassium citrate/citric acidpotassium citrate/citric acid will increase the level or effect of dextroamphetamine transdermal by Other (see comment). Avoid or Use Alternate Drug. Urinary alkalinizing agents can increase blood levels and potentiate the action of amphetamine.Monitor Closely (62)abirateroneabiraterone will increase the level or effect of dextroamphetamine transdermal by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor patients for signs and symptoms of serotonin syndrome, particularly during dextroamphetamine initiation and after a dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and CYP2D6 inhibitor.almotriptanalmotriptan, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).amitriptylineamitriptyline will increase the level or effect of dextroamphetamine transdermal by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May enhance the activity of tricyclic or sympathomimetic agents causing striking and sustained increases in dextroamphetamine levels in brain; May be potentiate cardiovascular effects. Monitor frequently and adjust or use an alternant based on clinical response.amoxapineamoxapine will increase the level or effect of dextroamphetamine transdermal by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May enhance the activity of tricyclic or sympathomimetic agents causing striking and sustained increases in dextroamphetamine levels in brain; May be potentiate cardiovascular effects. Monitor frequently and adjust or use an alternant based on clinical response.ascorbic acidascorbic acid will decrease the level or effect of dextroamphetamine transdermal by Other (see comment). Modify Therapy/Monitor Closely. Urinary acidifying agents can lower blood levels and efficacy of amphetamines. Increase dose of dextroamphetamine transdermal based on clinical response.bupropionbupropion will increase the level or effect of dextroamphetamine transdermal by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor patients for signs and symptoms of serotonin syndrome, particularly during dextroamphetamine initiation and after a dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and CYP2D6 inhibitor.buspironebuspirone, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).cinacalcetcinacalcet will increase the level or effect of dextroamphetamine transdermal by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor patients for signs and symptoms of serotonin syndrome, particularly during dextroamphetamine initiation and after a dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and CYP2D6 inhibitor.citalopramcitalopram, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).citric acid/glucono-delta-lactone/magnesium carbonatecitric acid/glucono-delta-lactone/magnesium carbonate will decrease the level or effect of dextroamphetamine transdermal by Other (see comment). Modify Therapy/Monitor Closely. Urinary acidifying agents can lower blood levels and efficacy of amphetamines. Increase dose of dextroamphetamine transdermal based on clinical response.clomipramineclomipramine will increase the level or effect of dextroamphetamine transdermal by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May enhance the activity of tricyclic or sympathomimetic agents causing striking and sustained increases in dextroamphetamine levels in brain; May be potentiate cardiovascular effects. Monitor frequently and adjust or use an alternant based on clinical response.cocaine topicalcocaine topical will increase the level or effect of dextroamphetamine transdermal by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor patients for signs and symptoms of serotonin syndrome, particularly during dextroamphetamine initiation and after a dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and CYP2D6 inhibitor.cyclobenzaprinecyclobenzaprine, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).dacomitinibdacomitinib will increase the level or effect of dextroamphetamine transdermal by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor patients for signs and symptoms of serotonin syndrome, particularly during dextroamphetamine initiation and after a dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and CYP2D6 inhibitor.darunavirdarunavir will increase the level or effect of dextroamphetamine transdermal by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor patients for signs and symptoms of serotonin syndrome, particularly during dextroamphetamine initiation and after a dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and CYP2D6 inhibitor.desipraminedesipramine will increase the level or effect of dextroamphetamine transdermal by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May enhance the activity of tricyclic or sympathomimetic agents causing striking and sustained increases in dextroamphetamine levels in brain; May be potentiate cardiovascular effects. Monitor frequently and adjust or use an alternant based on clinical response.desvenlafaxinedesvenlafaxine, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).dextromethorphandextromethorphan, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).dextroamphetamine transdermal, dextromethorphan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when amphemtamines are coadministered with dextromethorphan. .doxepindoxepin will increase the level or effect of dextroamphetamine transdermal by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May enhance the activity of tricyclic or sympathomimetic agents causing striking and sustained increases in dextroamphetamine levels in brain; May be potentiate cardiovascular effects. Monitor frequently and adjust or use an alternant based on clinical response.duloxetineduloxetine, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).eletriptaneletriptan, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).escitalopramescitalopram, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).fluoxetinefluoxetine, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).fluoxetine will increase the level or effect of dextroamphetamine transdermal by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor patients for signs and symptoms of serotonin syndrome, particularly during dextroamphetamine initiation and