Dexamfetamine
ADHD medicines
ADHD medicines
The right-handed (d) form of amphetamine: a stimulant that releases dopamine and noradrenaline, used for ADHD and narcolepsy. High abuse potential.
Also called: Dextroamphetamine, d-amphetamine
Quick facts
- Group
- ADHD medicines
- Target
- Vesicular monoamine transporter 2 (VMAT2) and the dopamine and noradrenaline transporters
- Used for
- Attention-deficit/hyperactivity disorder · Narcolepsy
- Key effects
- Insomnia · Fast heart rate · Irritability
- Monitor
- Blood pressure and heart rate · Signs of misuse · Mood
- ATC
- N06BA02
No doses: the clinician sets them by the current guideline.
Mechanism of action
The figure shows dexamfetamine ((S)-amphetamine) bound to the human vesicular monoamine transporter VMAT2.
Dexamfetamine is taken up into dopamine and noradrenaline nerve endings by their transporters. Inside, it empties the storage vesicles (VMAT2) and makes the membrane transporters run backwards, so catecholamines pour out into the synapse. It is the more centrally potent of the two amphetamine mirror images. In the prefrontal cortex this improves attention; elsewhere it raises heart rate and blood pressure and drives reward and abuse.
- Enters the nerve ending through DAT and NET
- Empties vesicles (VMAT2) into the cytoplasm
- Transporters run in reverse: dopamine and noradrenaline flood out
- Better attention; higher heart rate, blood pressure and abuse risk
Indications
- Attention-deficit/hyperactivity disorder (ADHD), as part of a full treatment programme Attention-deficit/hyperactivity disorder (ADHD) →
- Narcolepsy Narcolepsy →
Adverse effects
Common
- Insomnia, loss of appetite and weight loss
- Fast heart rate and higher blood pressure
- Irritability, nervousness, dry mouth
- Slower growth in children
Contraindications
- MAO inhibitor use now or within the previous 14 days (hypertensive crisis)
- Pheochromocytoma or a history of it
- Hypersensitivity to amphetamines
Key interactions
- MAO inhibitors
- Slower amphetamine breakdown and massive noradrenaline release: hypertensive crisis
- SSRIs, SNRIs, triptans, tramadol, lithium and other serotonergic drugs
- Risk of serotonin syndrome
- Urinary alkalinisers (acetazolamide, some thiazides) or acidifiers (ammonium chloride)
- Alkaline urine raises blood levels and effect; acidic urine lowers them
What is monitored
- Blood pressure and heart rate
- Height and weight in children
- Signs of misuse, diversion or dependence
- Mood, psychotic symptoms and tics
Administration and safety
- A controlled stimulant: stored securely, counted, and never shared
- Immediate- and extended-release products are not interchanged one-for-one
- Late-day doses tend to cause insomnia
Pregnancy and breastfeeding
Infants of mothers dependent on amphetamines have a higher risk of premature birth, low birth weight and withdrawal symptoms; use weighs benefit and risk.
Nursing care
- Records blood pressure, heart rate, height and weight at baseline and during treatment
- Asks about chest pain on exertion, fainting and a family history of sudden death before starting
- Watches for appetite loss, poor sleep, mood changes, psychotic symptoms and new tics
- Teaches the family about safe storage and disposal, and checks fingers and toes for colour change or pain
Pharmacokinetics
- Absorption
- Well absorbed by mouth; immediate- and extended-release forms
- Elimination
- In urine; acidic urine speeds excretion and alkaline urine slows it
- Half-life
- About 12 hours
Test yourself
Think of the answer, then tap the question to see it.
How does dexamfetamine raise synaptic dopamine, compared with methylphenidate?
It releases dopamine from vesicles (VMAT2) and reverses the transporter; methylphenidate only blocks reuptake.
Why is dexamfetamine contraindicated within 14 days of an MAO inhibitor?
Together they can cause a hypertensive crisis.
How does urine pH change dexamfetamine levels?
Acidic urine increases its excretion and lowers levels; alkaline urine does the opposite.
Which growth parameter is followed in children taking it?
Height and weight, because stimulants can slow growth.
Connections
← Back to the class: ADHD medicines
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - DEXTROAMPHETAMINE SULFATE tablet (DailyMed (U.S. National Library of Medicine), 2026); Dextroamphetamine: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.