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Dextroamphetamine (Dexadrine) 

Initial Therapy

Initial therapy in children diagnosed with uncomplicated ADD always consists of one the psychostimulants: methylphenidate, dextroamphetamine, or a combination of dextroamphetamine and levoamphetamine (Adderall). These medications are extremely safe and require no serologic or hematologic monitoring. Patients may respond better to one or the other of these psychostimulants, and patients who do not respond to the initial choice can be treated with either remaining alternative. Interestingly, parent-rating scales favored dextroamphetamine over methylphenidate, probably secondary to the longer half-life of dextroamphetamine dextroamphetamine, Dexadrine, Dexedrine Barkley reviewed 15 studies using dextroamphetamine and 14 using methylphenidate and observed a mean improvement of 75% for both drugs. Large clinical trials directly comparing the two classes of

Children 5 to 14 Years of Age

Although selecting with which medication to initiate therapy may be somewhat arbitrary, in children 5 to 14 years old, either Dextroamphetamine Spansules or Adderall (mixture of amphetamine salts) may be preferred because of the longer, smoother duration of effects, reduced likelihood of midday school dosing with its subsequent stigmatization and teasing by classmates, ease of titration, and relatively lower costs. According to Pelham, Dextroamphetamine Spansules may be the preferred medication

Compared with methylphenidate, sustained-release Dextroamphetamine Spansules (and possibly Adderall) is a significantly more reliable and effective long-acting form of amphetamines. Furthermore, sustained-release preparations are preferred by the children themselves and are less likely to be a factor in nonadherence. As shown in, the spansules and Adderall allow for easier titration in 2.5-mg (half-dose) increments. Adderall tablets may be cut in half. Pediatricians should consider demonstrating to the parents that the dextroamphetamine Spansules can be twisted into two halves, and, by using the small "top" half as a measuring device, the beads from the capsule can be carefully poured up to the brim of the smaller half to make a "half-dose" of the spansule, that is, half of a

Stimulant therapy is often avoided in children aged 3 to 4 years because of lower efficacy; the increased rate of problematic AEs, especially moodiness, irritability, and appetite suppression; and because of the lack of availability of a liquid formulation. Only highly aggressive and pervasively, behaviorally disruptive or defiant children in this group warrant therapy. Because of its reduced rate of

Prescribing psychostimulants for the adolescent population creates a significant dilemma for pediatricians, who must now choose between the standard stimulants, which demonstrate no evidence of lethality when used appropriately and singly but that are associated with the potential for being abused in this population versus pemoline, which has been associated with an exceptionally rare