What confused me is that my current doctor - we'll call him Dr. I - told me he was prescribing "Adderall XR" when the label on my bottle says something like (sorry, don't have it with me at the moment) "Dext-phetamine SR". I get that "SR" and "XR" both mean extended release, but the generic versions of Adderall I've seen in the past have all been "Amphetamine Salts". Of course, my prescription said "Adderall XR, generics OK" so the obvious conclusion is that Dext-amphetamine SR is simply another name for generic Adderall. Got it.
At this appointment I explained that I was okay with the current medication and dosage, except for the fact that it never seemed to last longer than 6 or 7 hours (and this seemed to depend on how much I ate after taking it). Obviously I don't have a 6 or 7 hour work day, so this was posing a slight problem when 3 PM-ish came around and it suddenly felt as if I'd hit a brick wall. I was honest worried that this was an issue with me personally, but thankfully Dr. I admitted that the extended release seems to have extremely varied results. For some people it lasts 4 hours; for others, 8 or 9 or even more. Some doctors will apparently prescribe two doses of extended release meds a day, but Dr. I said he doesn't like to do that. "Normally my first reaction would be to prescribe a small amount of instant release Adderall," he told me, "but as that's going to be nearly impossible to find until at least January, I think your best bet would be Dexedrine - which is just the instant release version of what you're already prescribed."
This is where I started to get a bit confused. If I was taking what is supposedly the generic form of Adderall XR, and "Dexedrine" is the instant release version of the extended release pills I'm taking...how is it different from instant release Adderall??? Why is there such a problem/shortage of IR Adderall if Dexedrine is the same exact thing?
Since I simply didn't have time to ask Dr. I the million and one questions racing through my brain, I took the first free moments I had and did a little reading online. I found the following descriptions of the "differences" between Adderall and Dexedrine:
From Wikipedia, "In the United States, an instant release tablet preparation of the salt dextroamphetamine sulfate is available under the brand names Dexedrine and Dextrostat, in 5 mg and 10 mg strengths, and as a capsule preparation of controlled release dextroamphetamine sulfate, under the brand names Dexedrine SR and Dexedrine Spansule, in the strengths of 5 mg, 10 mg, and 15 mg."
On the other hand, "Another pharmaceutical that contains dextroamphetamine is Adderall. The drug formulation of Adderall (both controlled and instant release forms) is:
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- One-quarter racemic (d,l-)amphetamine aspartate monohydrate
- One-quarter dextroamphetamine saccharin
- One-quarter dextroamphetamine sulfate
- One-quarter racemic (d,l-)amphetamine sulfate
An experiment with rats suggested Adderall’s inclusion of levoamphetamine provides the pharmaceutical with a quicker onset and longer clinical effect compared to pharmaceuticals exclusively formulated of dextroamphetamine. One study has shown that although the human brain usually has a preference for dextroamphetamine over levoamphetamine, certain children have a better clinical response to levoamphetamine.
Amphetamine exists as two stereoisomers that differ in effects. The l- enantiomer (levoamphetamine) produces more cardiovascular and peripheral effects than the d- enantiomer (dextroamphetamine). At low doses, levoamphetamine produces greater arousal than dextroamphetamine, acting primarily on norepinephrine. At higher doses, dextroamphetamine has stimulant properties that are three to four times as potent as those of levoamphetamine, and acts primarily on dopamine, although few clinical studies of ADHD, have documented differences among d-, l- and racemic amphetamine."
From a Yahoo Answers response by someone who is obviously well-versed in these drugs: "Difference in effect: Adderall is prescribed in approximately twice the dosage of Dexedrine. A 10mg pill of Adderall contains 2.5mg of Dexedrine but has similar effect as 5mg of Dexedrine. Due to the 4 different salts and increased dosage needed, Adderall is more likely to give side effects than Dexedrine. These side effects include increased heart rate, blood pressure, decreased appetite, inability to sleep, muscle tightness, and head ache. Ritalin is a another story and usually falls in between the other two as far as side effects go however, many parents and patients report a withdrawn effect from Ritalin that goes beyond it just being effective. Dexedrine also slightly acts positively on serotonin and can increase mood where as Adderall can make people more moody."
Other information I came across made connotations about Dexedrine having a more negative stigma than Adderall, because it is pure dextroamphetamine. One person made a comment that dosages were actually the same (i.e. 15 mg Dexedrine is the same as 15 mg Adderall) but that doesn't seem to coincide with the fact that Adderall contains less dextroamphetamine...I'm inclined to believe Mr. Yahoo Answers up there regarding Dexedrine being needed in smaller doses. Regardless...at least I'm now a bit more informed about what I'm putting into my body. Previously all of my research had been on Focalin/Ritalin, Vyvanse, Strattera, and Adderall...I had no idea that Dexedrine existed. But it does, and it's decidedly not the same thing as any of the above drugs.
Of course one last problem remains...why would Dr. I be able to prescribe me Adderall XR (despite the shortage, because according to the interwebz all Adderall is hard to find at the mo) and have me receive the generic, which is Dextroamphetamine and therefore must actually be the generic of Dexedrine XR...but then have to prescribe me Dexedrine as an instant release? I don't know. I guess I'm just stupidly confused :-/
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