By Anthony McDaniel, M.D.
Adderall is a brand-name psychostimulant medication composed of racemic amphetamine aspartate monohydrate, racemic amphetamine sulfate, dextroamphetamine saccharide, and dextroamphetamine sulfate, which is thought by scientists to work by increasing the amount of dopamine and norepinephrine in the brain. In addition, the drug also acts as a potent dopamine reuptake inhibitor and norepinephrine reuptake inhibitor. Adderall is widely reported to increase alertness, increase libido, increase concentration, and overall cognitive performance, and, in general, improve mood, while decreasing user fatigue. It is available in two formulations: IR (Instant Release) and XR (Extended Release). The immediate release formulation is indicated for use in Attention Deficit Hyperactivity Disorder (ADHD) and narcolepsy, while the XR formulation is approved for use only with ADHD. Like other powerful stimulant drugs, such as methamphetamine and cocaine, Adderall directly affects the mesolimbic reward pathway in the brain. Because of this, Adderall has a relatively high potential for abuse and addiction, especially if the drug is misused.
Adderall is marketed as either an immediate-release tablet Adderall, or an extended-release capsule Adderall XR. Doses of immediate-release Adderall are available in 5, 7.5, 10, 12.5, 15, 20, and 30 mg. Adderall XR is available in 5, 10, 15, 20, 25, and 30 mg doses.Adderall XR utilizes the Microtrol extended-release delivery system, incorporating two types of beads. The first dissolves immediately, releasing half of the medication, while the second type dissolves much more slowly, releasing the remaining medication four hours later. Maximum plasma concentration is achieved in seven hours, compared to instant-release Adderall, which reaches maximum plasma concentration within three hours. As a result of its high bioavailability, Adderall XR's effectiveness is not altered by food absorption in the gastrointestinal tract. However, mean plasma concentration is prolonged by 2.5 hours (using a 900-calorie standard high-fat meal as the control). Medications that alter urinary pH will cause variations in the amount and method of excretion, and usage should be monitored when taken concurrently with Adderall.
Manufacturer's claims of instant release have been disputed. A US patent granted for Adderall was a pharmaceutical composition patent listing a rapid immediate-release oral dosage form. No claim of increased or smooth drug delivery was made. A recent double-blind, placebo-controlled crossover study conducted among 35 children ages 5–12 indicated that patients behaved similarly to those having taken other immediate-release amphetamines. The authors found that sustained-release dexamphetamine (the main isomeric-amphetamine component of Adderall) had a longer duration of action; however D-amphetamine was less effective in the first few hours.
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