(1)quetiapine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.quinacrineMinor (1)quinacrine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.quinidineMonitor Closely (1)quinidine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.rabeprazoleMonitor Closely (1)rabeprazole, dextroamphetamine. Other (see comment). Use Caution/Monitor. Comment: Reduced gastric acidity caused by proton pump inhibitors decreases time to Tmax for amphetamine and dextroamphetamine. AUC was unaffected. .ranolazineMinor (1)ranolazine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.rasagilineContraindicated (1)rasagiline increases effects of dextroamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Coadministration is contraindicated during or within 14 days following the administration of MAOIs.risperidoneMonitor Closely (1)risperidone increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ritonavirMinor (1)ritonavir will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.rizatriptanMonitor Closely (1)rizatriptan and dextroamphetamine both increase serotonin levels. Use Caution/Monitor.safinamideContraindicated (1)dextroamphetamine, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.sageMinor (1)sage increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.salmeterolMonitor Closely (2)salmeterol and dextroamphetamine both decrease sedation. Use Caution/Monitor. salmeterol and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.SAMeMonitor Closely (1)dextroamphetamine and SAMe both increase serotonin levels. Use Caution/Monitor.scullcapMonitor Closely (1)scullcap increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.secobarbitalMonitor Closely (1)secobarbital increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.selegilineContraindicated (2)selegiline and dextroamphetamine both increase serotonin levels. Contraindicated. Amphetamines should not be administered during or within 14 days following the use of most MAOIs or drugs with MAO-inhibiting activity selegiline increases effects of dextroamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Coadministration is contraindicated during or within 14 days following the administration of MAOIs.selegiline transdermalContraindicated (1)selegiline transdermal increases effects of dextroamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.Monitor Closely (1)selegiline transdermal and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.serdexmethylphenidate/dexmethylphenidateMonitor Closely (2)serdexmethylphenidate/dexmethylphenidate and dextroamphetamine both decrease sedation. Use Caution/Monitor. serdexmethylphenidate/dexmethylphenidate and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.sertralineMonitor Closely (2)sertraline will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. sertraline and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.sevofluraneSerious - Use Alternative (1)sevoflurane increases toxicity of dextroamphetamine by Mechanism: unknown. Avoid or Use Alternate Drug.shepherd's purseMonitor Closely (1)shepherd's purse increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.sodium acid phosphateMonitor Closely (1)sodium acid phosphate decreases levels of dextroamphetamine by increasing renal clearance. Use Caution/Monitor.sodium bicarbonateMonitor Closely (1)sodium bicarbonate will increase the level or effect of dextroamphetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.sodium citrate/citric acidMonitor Closely (1)sodium citrate/citric acid will increase the level or effect of dextroamphetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.sodium lactateMonitor Closely (1)sodium lactate will increase the level or effect of dextroamphetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.sodium zirconium cyclosilicateMonitor Closely (2)sodium zirconium cyclosilicate will increase the level or effect of amphetamine by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate. Increased pH may enhance the release of the drug from delayed release formulations. sodium zirconium cyclosilicate will increase the level or effect of dextroamphetamine by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate. Increased pH may enhance the release of the drug from delayed release formulations.solriamfetolMonitor Closely (1)dextroamphetamine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.St John's WortMonitor Closely (1)dextroamphetamine and St John's Wort both increase serotonin levels. Modify Therapy/Monitor Closely.sufentanilMonitor Closely (1)sufentanil increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)dextroamphetamine increases effects of sufentanil by unspecified interaction mechanism. Minor/Significance Unknown.sufentanil SLMonitor Closely (2)sufentanil SL, amphetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment. sufentanil SL, dextroamphetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.sumatriptanMonitor Closely (1)sumatriptan and dextroamphetamine both increase serotonin levels. Use Caution/Monitor.sumatriptan intranasalMonitor Closely (1)sumatriptan intranasal and dextroamphetamine both increase serotonin levels. Use Caution/Monitor.tapentadolMonitor Closely (1)tapentadol increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)dextroamphetamine increases effects of tapentadol by unspecified interaction mechanism. Minor/Significance Unknown.tazemetostatMonitor Closely (1)tazemetostat will decrease the level or effect of dextroamphetamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.tedizolidSerious - Use Alternative (1)tedizolid, dextroamphetamine. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.temazepamMonitor Closely (1)temazepam increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.terbutalineMonitor Closely (2)terbutaline and dextroamphetamine both decrease sedation. Use Caution/Monitor. terbutaline and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.thioridazineMonitor Closely (2)thioridazine, dextroamphetamine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. thioridazine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)thioridazine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.thiothixeneMonitor Closely (1)thiothixene increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.tipranavirMinor (1)tipranavir will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.topiramateMonitor Closely (1)topiramate increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.tramadolMonitor Closely (2)tramadol increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. dextroamphetamine and tramadol both increase serotonin levels. Use Caution/Monitor.Minor (1)dextroamphetamine increases effects of tramadol by unspecified interaction mechanism. Minor/Significance Unknown.tranylcypromineContraindicated (1)tranylcypromine increases effects of dextroamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.Serious - Use Alternative (1)tranylcypromine and dextroamphetamine both increase serotonin levels. Avoid or Use Alternate Drug.trazodoneMonitor Closely (3)trazodone increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor. trazodone and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely. trazodone increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trazodone, dextroamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.triazolamMonitor Closely (1)triazolam increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.triclofosMonitor Closely (1)triclofos increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.trifluoperazineMonitor Closely (2)trifluoperazine, dextroamphetamine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. trifluoperazine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.trimipramineMonitor Closely (3)trimipramine increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor. trimipramine and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely. trimipramine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, dextroamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.triprolidineMonitor Closely (1)triprolidine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.venlafaxineMonitor Closely (2)venlafaxine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. venlafaxine and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.vilazodoneSerious - Use Alternative (1)dextroamphetamine, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .xylometazolineMonitor Closely (2)dextroamphetamine and xylometazoline both decrease sedation. Use Caution/Monitor. dextroamphetamine and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.yerba mateMinor (1)yerba mate increases effects of dextroamphetamine by pharmacodynamic synergism. Minor/Significance Unknown.yohimbeSerious - Use Alternative (1)yohimbe, dextroamphetamine. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.yohimbineMonitor Closely (2)dextroamphetamine and yohimbine both decrease sedation. Use Caution/Monitor. dextroamphetamine and yohimbine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.ziconotideMonitor Closely (1)ziconotide increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ziprasidoneMonitor Closely (1)ziprasidone increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.zolmitriptanMonitor Closely (1)zolmitriptan and dextroamphetamine both increase serotonin levels. Use Caution/Monitor. >10% (Extended Release) Loss of appetite (22-36%) Headache (<26%) Insomnia (12-27%) Abdominal pain (11-14%) Weight loss (4-11%) 1-10% (Extended Release) Anxiety (8%) Vomiting (7%) Nervousness (6%) Tachycardia (6%) Fever (5%) Nausea (5-8%) Infection (4%) Emotional lability (2-9%) Dizziness (2-7%) Diarrhea (2-6%) Fatigue (2-4%) Dry mouth (2-4%) Dyspepsia (2-4%) Postmarketing Reports Cardiovascular: Palpitations; isolated reports of cardiomyopathy associated with chronic amphetamine use CNS: Psychotic episodes at recommended doses, overstimulation, restlessness, irritability, euphoria, dyskinesia, dysphoria, depression, tremor, tics, aggression, anger, logorrhea, dermatillomania, paresthesia (including formication), bruxism Eye disorders: Blurred vision, mydriasis Gastrointestinal: Unpleasant taste, constipation, intestinal ischemia, dryness of the mouth, diarrhea, anorexia, weight loss, and other gastrointestinal disturbances Allergic: Urticaria, rash, hypersensitivity reactions (including angioedema and anaphylaxis); serious skin rashes (including Stevens-Johnson syndrome and toxic epidermal necrolysis) Endocrine: Impotence, changes in libido, frequent/prolonged erections Skin: Alopecia Vascular disorders: Raynaud phenomenon Musculoskeletal: Rhabdomyolysis Black Box Warnings Amphetamines have a high potential for abuse and dependence Administration for prolonged periods may lead to dependence and must be avoided Assess the possibility of persons obtaining amphetamines for nontherapeutic use or distribution to others Prescribed or dispensed sparingly Misuse of amphetamines may cause sudden death and serious cardiovascular adverse eventsContraindications Hypersensitivity Hyperthryroidism Glaucoma Hypertension, advanced arteriosclerosis, symptomatic CVD Symptomatic cardiovascular disease Moderate-to-severe hypertension Agitated states, history of drug abuse MAO inhibitors given within 14 days (risk of severe hypertensive reaction) Cautions Preexisting cardiac structural abnormalities associated with risk of sudden death (if abused) Time to maximum concentration decreased when coadministered with acid-suppressing drugs (eg, proton pump inhibitors) Associated with peripheral vasculopathy, including Raynaud phenomenon Difficulties with accommodation and blurring of vision have been reported with stimulant treatment May impair ability to engage in potentially hazardouse activities due to CNS effects Potential exists for drug dependency Use caution in hypertension, history of psychosis, seizure disorders, elderly, or Tourette's syndrome (may unmask tics) Abrupt discontinuation may result in symptoms for withdrawal Sudden deaths, stroke, and myocardial infarction reported in adults taking stimulants at usual doses Patients who develop symptoms such as exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease during stimulant treatment should undergo a prompt cardiac evaluation Particular care should be taken in using stimulants to treat ADHD patients with comorbid bipolar disorder because of concern for possible induction of mixed/manic episode in such patients Aggressive behavior or hostility is often observed in children and adolescents with ADHD; monitor for the appearance of or worsening of aggressive behavior or hostility Monitor growth of children ages 7 to 10 years during treatment with stimulants; may need to interrupt therapy in patients not growing or gaining weight as expected Stimulants may lower convulsive threshold in patients with prior history of seizure, patients with prior EEG abnormalities in absence of seizures, and very rarely, patients without a history of seizures and no prior EEG