Also known as
CCC, Dex, Poor Man’s PCP, Robo, Rojo, Skittles, Triple C, Velvet, Dexedrine, Dexedrine Spansules, Dextrostat, Liquadd, ProCentra, Zenzedi
Classification
CNSthe Central Nervous System, upon which certain drugs act Stimulants
Medical usage
How long do its effects last?
Onset of effects
- Immediate release – 30 – 90 minutes,
- Extended release – 90 – 120 minutes 2.
Duration of effects
- Immediate release dosing – 3 – 7 hours,
- Extended release dosing – 12 hours 2.
Pharmacology
In the CNSthe Central Nervous System, upon which certain drugs act dextroamphetamine induces the release of dopamine within the mesocorticolimbic system, a major component of the brain reward system, resulting in measurable behavioural changes such as euphoriafeelings of joy and happiness. As a CNSthe Central Nervous System, upon which certain drugs act stimulanta drug that acts on the Central Nervous System, increasing some rates of function such as heart-rate, this agent may increase blood pressure and reduce appetite. Similar to other amphetamines, dextroamphetamine has a high potential for abuse, dependence, and addiction if used in large doses over extended periods of time 3, 4.
Pharmacodynamics
Amphetamines such as dextroamphetamine are noncatecholamine, sympathomimetic amines with CNSthe Central Nervous System, upon which certain drugs act stimulanta drug that acts on the Central Nervous System, increasing some rates of function such as heart-rate activity. Peripheral actions include elevations of systolic and diastolic blood pressures and weak bronchodilator and respiratory stimulanta drug that acts on the Central Nervous System, increasing some rates of function such as heart-rate action. There is neither specific evidence that clearly establishes the mechanism whereby amphetamines produce mental and behavioural effects in children, nor conclusive evidence regarding how these effects relate to the condition of the central nervous systembrain and spinal cord 5.
Bioavailability
Oral bioavailability is over 75% 5.
Metabolism
Hepatic 5.
Half-life
10 – 28 hours (average is approximately 12 hours) 5.
Elimination
Renal 45% 2.
Lethal dosage
In rats, the oral LD50the amount of a material, given all at once, which causes the death of 50% (one half) of a group of test animals. The LD50 is one way to measure the short-term poisoning potential (acute toxicity) of a material of dextroamphetamine sulfate is 96.8 mg/kg 5. The acute lethal dose in adults has been reported at 20 – 25 mg/kg, and in children, 5 mg/kg. Death from as little as 1.5 mg/kg in an adult has also been noted 6, 4.
Toxicity
Fatiguea feeling of weariness, tiredness, or lack of energy. More and depression usually follow the central stimulationcan be defined as any changes in a person's energy levels which are interpreted as stimulating and encouraging when it comes to movement and physical activities such as running, walking, cleaning, socializing, dancing, and climbing More 5. Toxiccapable of causing injury or death amphetamine blood concentration: 50 ug/dL; Lethal amphetamine blood concentration: 200 ug/dL 6.
Tolerance
Psychological dependence often occurs when dextroamphetamine is used chronically. Tolerancethis is the process by which the receptors in your brain become habituated to the action of a drug. When tolerance is reached, more of the drug is required to achieve the same effect. With benzodiazepines, and probably with many other classes of drugs as well, tolerance is virtually always associated with some degree of physical dependence. If you find that you are experiencing tolerance, this is a clear warning sign that you may have formed a dependence. More almost invariably develops to the anorexigenic effect of amphetamines, and is often seen also in the need for increasing doses to maintain improvement of mood in psychiatric patients. Tolerancethis is the process by which the receptors in your brain become habituated to the action of a drug. When tolerance is reached, more of the drug is required to achieve the same effect. With benzodiazepines, and probably with many other classes of drugs as well, tolerance is virtually always associated with some degree of physical dependence. If you find that you are experiencing tolerance, this is a clear warning sign that you may have formed a dependence. More is striking in individuals who are dependent on the drug, and a daily intake of 1700 mg without apparent ill effects has been reported. Development of tolerancethis is the process by which the receptors in your brain become habituated to the action of a drug. When tolerance is reached, more of the drug is required to achieve the same effect. With benzodiazepines, and probably with many other classes of drugs as well, tolerance is virtually always associated with some degree of physical dependence. If you find that you are experiencing tolerance, this is a clear warning sign that you may have formed a dependence. More is not invariable, and cases of narcolepsy have been treated for years without requiring an increase in the initially effective dose 7, 4.
Mechanism of action
The exact mechanism of action is not known. Dextroamphetamine stimulates the release of norepinephrine from central adrenergic receptorsnerve endings that sense changes in the body More. At higher dosages, it causes release of dopamine from the mesocorticolimbic system and the nigrostriatal dopamine systems by reversal of the monoamine transporters. Dextroamphetamine may also act as a direct agonist on central 5-HT receptorsnerve endings that sense changes in the body More and may inhibit monoamine oxidase (MAO). In the periphery, amphetamines are believed to cause the release of noradrenaline by acting on the adrenergic nerve terminals and alpha- and beta-receptors. Modulation of serotonergic pathways may contribute to the calming affect 5.
GHS Classification
Aggregated GHSGlobally Harmonised System of Classification and Labeling of Chemicals, was developed by the United Nations as a way to bring into agreement the chemical regulations and standards of different countries. GHS includes criteria for the classification of health, physical and environmental hazards, as well as specifying what information should be included on labels of hazardous chemicals as well as safety data sheets. More information from 2 notifications provided by 24 companies to the ECHA C&L Inventory. Each notification may be associated with multiple companies 4.
- H226 (100%): Flammable liquid and vapour [Warning Flammable liquids – Category 3],
- H300 (95.83%): Fatal if swallowed [Danger Acute toxicityThis is when too much of something is taken over a short period of time More, oral – Category 1, 2],
- H314 (100%): Causes severe skin burns and eye damage [Danger Skin corrosion/irritation – Category 1A, B, C] 4.
Information may vary between notifications depending on impurities, additives, and other factors. The percentage value in parenthesis indicates the notified classification ratio from all companies. Only Hazard Codes with percentage values above 10% are shown 4.
Signs of usage
- rapid heartbeat,
- reduced appetite or weight loss,
- tremors,
- sleep difficulty,
- dry mouth,
- mood swings,
- verbal tics,
- hostility,
- paranoiasuspicion, distrust or fear of other people,
- hallucinationswhere someone sees, hears, smells, tastes or feels things that don't exist outside of their mind,
- erratic behaviour,
- tolerancethis is the process by which the receptors in your brain become habituated to the action of a drug. When tolerance is reached, more of the drug is required to achieve the same effect. With benzodiazepines, and probably with many other classes of drugs as well, tolerance is virtually always associated with some degree of physical dependence. If you find that you are experiencing tolerance, this is a clear warning sign that you may have formed a dependence. More,
- withdrawal symptoms when attempting to cut down use 8.
The user may have a persistent runny nose or nosebleeds if the pills are crushed and snorted. A user may have needle or “track” marks if he or she injects the pills 8.
Effects
Minor
Incidence not known –
- bad, unusual, or unpleasant (after) taste,
- change in taste,
- constipationmeans that you're not passing stools regularly or you're unable to completely empty your bowels. More,
- decreased interest in sexual intercourse,
- dry mouth,
- hivesThis is an allergic skin reaction causing localised redness, swelling, and itching. or welts, itching, or skin rash,
- inability to have or keep an erection,
- indigestion,
- loss in sexual ability, desire, drive, or performance,
- passing wind,
- redness of the skin,
- weight loss 1.
Major
Rare
- agitation,
- delusions,
- hallucinationswhere someone sees, hears, smells, tastes or feels things that don't exist outside of their mind 1.
Incidence not known
- blurred vision,
- chest discomfort or pain,
- difficulty breathing,
- dizziness,
- faintness,
- false or unusual sense of well-being,
- fast, pounding, or irregular heartbeat or pulse,
- headache,
- pounding in the ears,
- shakiness in the legs, arms, hands, or feet,
- oedemathe medical term for fluid retention in the body. Oedema often causes swelling in the feet and ankles. More,
- trembling or shaking of the hands or feet,
- troubled breathing,
- twitching, twisting, or uncontrolled repetitive movements of tongue, lips, face, arms, or legs,
- insomniadifficulty in going to sleep or in getting enough sleep,
- uncontrolled vocal outbursts and/or tics (uncontrolled repeated body movements),
- unusual tiredness or weakness 1.
Serious
- difficulty thinking clearly,
- impaired memory,
- unhealthy weight loss,
- malnutrition,
- hypertensionhigh blood pressure,
- tachycardiarapid pulse rate,
- impaired eyesight,
- psychoticthis is a mental state when you see or hear things which aren't there and have delusions More symptoms,
- tremors,
- seizuresthe outward effect can vary from uncontrolled jerking movement (tonic-clonic seizure) to as subtle as a momentary loss of awareness More (highest risk in patients with seizure history),
- heart attack,
- stroke,
- death 8.
Abuse
Overdose
- change in consciousness,
- dark-coloured urine,
- diarrhoeaWhere you frequently pass watery or loose faeces,
- discouragement,
- feeling sad or empty,
- fever,
- irritability,
- lack of appetite,
- loss of consciousness,
- loss of interest or pleasure,
- mood or mental changes,
- muscle cramps or spasms,
- muscle pain or stiffness,
- nausea,
- panic state,
- physical attempt to injure,
- rapid breathing,
- seizuresthe outward effect can vary from uncontrolled jerking movement (tonic-clonic seizure) to as subtle as a momentary loss of awareness More,
- stomach cramps,
- sweating,
- trouble concentrating,
- violent actions,
- vomiting 9.
History
Racemic amphetamine was first synthesised under the chemical name “phenylisopropylamine” in Berlin, 1887 by the Romanian chemist Lazar Edeleanu. It was not widely marketed until 1932, when the pharmaceutical company Smith, Kline & French (now known as GlaxoSmithKline) introduced it in the form of the Benzedrine inhaler for use as a bronchodilator. Notably, the amphetamine contained in the Benzedrine inhaler was the liquid free-base, not a chloride or sulfate salt.
Three years later, in 1935, the medical community became aware of the stimulanta drug that acts on the Central Nervous System, increasing some rates of function such as heart-rate properties of amphetamine, specifically dextroamphetamine, and in 1937 Smith, Kline, and French introduced tablets under the tradename Dexedrine. In the United States, Dexedrine was approved to treat narcolepsy, attention disorders, and obesity. In Canada indications once included epilepsy and parkinsonism 10. Dextroamphetamine was marketed in various other forms in the following decades, primarily by Smith, Kline, and French, such as several combination medications including a mixture of dextroamphetamine and amobarbital (a barbiturate) sold under the tradename Dexamyl and, in the 1950’s, an extended release capsule (the “Spansule”). Preparations containing dextroamphetamine were also used in World War II as a treatment against fatiguea feeling of weariness, tiredness, or lack of energy. More 11.
It quickly became apparent that dextroamphetamine and other amphetamines had a high potential for misuse, although they were not heavily controlled until 1970, when the Comprehensive Drug Abuse Prevention and Control Act was passed by the United States Congress. Dextroamphetamine, along with other sympathomimetics, was eventually classified as Schedule II, the most restrictive category possible for a drug with a government-sanctioned, recognized medical use. Internationally, it has been available under the names AmfeDyn (Italy), Curban (US), Obetrol (Switzerland), Simpamina (Italy), Dexedrine/GSK (US & Canada), Dexedrine/UCB (United Kingdom), Dextropa (Portugal), and Stild (Spain) 12.
In October 2010, GlaxoSmithKline sold the rights for Dexedrine Spansule to Amedra Pharmaceuticals (a subsidiary of CorePharma) 2.
Footnotes:
Dextroamphetamine, 2017, https://www.drugs.com/cdi/dextroamphetamine.html
Dextroamphetamine, 2017, https://en.wikipedia.org/wiki/Dextroamphetamine
Dextroamphetamine (Code C28981), 2017, https://ncit.nci.nih.gov/ncitbrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&ns=NCI_Thesaurus&code=C28981
Dextroamphetamine, 2017, https://pubchem.ncbi.nlm.nih.gov/compound/dextroamphetamine
Dextroamphetamine, 2017, https://www.drugbank.ca/drugs/DB01576
Gossel, T. A. and Bricker, J. D., Principles of Clinical Toxicology, 1994, 3rd edition, Raven Press, Ltd., New York, NY, 348
Gilman, A. G. and Goodman, L. S. and A. Gilman, A., Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 1985, 7th edition, Macmillan Publishing Co., Inc., New York, 168
Miller, L., Dextroamphetamine Abuse, 2017, http://drugabuse.com/library/dextroamphetamine-adhd-drug/
Dextroamphetamine (Oral Route), 2017, http://www.mayoclinic.org/drugs-supplements/dextroamphetamine-oral-route/description/drg-20071795
Dextroamphetamine, 2005, https://web.archive.org/web/20060427084347/http://www.mentalhealth.com/drug/p30-d04.html
Heal, D. J. and Smith, S. L. and Gosden, J. and Nutt, D. J., Amphetamine, past and present – a pharmacological and clinical perspective, Journal of Psychopharmacology, 2013, 27, 6, 479-496, https://dx.doi.org/10.11772F0269881113482532, https://www.ncbi.nlm.nih.gov/pubmed/23539642
Sittig, M., Pharmaceutical Manufacturing Encyclopedia, 1988, 2nd edition, William Andrew Publishing/Noyes, ISBN 978-0-8155-1144-1, http://www.knovel.com/web/portal/browse/display?_EXT_KNOVEL_DISPLAY_bookid=598