Amphetamine sulfate is a medication prescribed to treat attention-deficit/hyperactivity disorder. It can be an effective medication, although it carries a potential for abuse and addiction. As such, it should always be used with caution and exactly as prescribed.
- Amphetamine sulfate is a stimulant medication used to treat narcolepsy and ADHD.
- Brand names include Evekeo, which is available as an orally disintegrating tablet and an immediate-release tablet.
- Amphetamine sulfate can be addictive, and it is important to be aware of side effects, risks, abuse potential, overdose signs, and how or when to seek professional support.
Understanding amphetamine sulfate
Amphetamine sulfate is a central nervous system (CNS) stimulant medication prescribed for various medical purposes. It is a Schedule II controlled substance due to its potential for abuse and addiction. As such, it is only available on prescription and should be used with caution and with regular reviews by the prescribing physician. [1]
Amphetamine, whether as the sole ingredient, in a derivative form, or in combination with another substance, is common in medications for attention-deficit/hyperactivity disorder (ADHD). It is also a commonly abused substance due to its euphoric effect and ability to increase alertness and attention. [2]
Common brand names and formulations
Amphetamine sulfate has been available as a generic medication and as the following brand-name medications:
- Evekeo: An immediate-release tablet in 5 mg and 10 mg strengths.
- Evekeo ODT: Evekeo ODT was previously available as an orally disintegrating tablet but has been discontinued.
How amphetamine sulfate works
Amphetamine sulfate, such as Evekeo, works by increasing the levels of neurotransmitters dopamine and norepinephrine in the brain. It can also increase serotonin levels to a lesser extent. These effects can impact alertness, attention, and impulsivity. [3]
Medical uses of amphetamine sulfate
Amphetamine sulfate is approved by the Food and Drug Administration for various uses, including ADHD, narcolepsy, and obesity. It can also be prescribed off-label for non-approved purposes, including to treat binge-eating disorder. [1][3]
Typical dosage and administration
A typical daily dosage of amphetamine sulfate will vary depending on the condition being treated, age, and other factors.
To treat children with ADHD, Evekeo is prescribed at a starting dose of 2.5 mg daily for 3–5-year-olds, and 5 mg once or twice daily for 6- to 17-year-olds. Doses can be increased by 2.5 mg increments at weekly intervals and should not exceed 40 mg per day. [1]
Adults with narcolepsy are prescribed between 5 and 60 mg per day of Evekeo. The lowest effective dosage should be used. [3]
Common side effects of amphetamine sulfate
It is common to experience some side effects when starting a new medication. These will typically be mild and transient. Common side effects of amphetamine sulfate include: [1][4]
- Decreased appetite
- Weight loss
- Insomnia
- Dry mouth
- Stomach pain
- Increased heart rate and blood pressure
- Irritability
- Overstimulation
- Restlessness
- Dizziness
- Fatigue
- Shaking
- Headache
- Diarrhea
- Constipation
- Nausea
- Sexual dysfunction, including impotence, loss of libido, and prolonged erections
- Jaw clenching or grinding teeth
- Painful urination
If these symptoms worsen or do not improve within a few weeks, consult the prescribing doctor.
Serious risks and long-term effects
In some cases, serious side effects and risks can occur. If any of the following side effects occur, contact your doctor immediately, as you may need to change your dosage or medication, and some symptoms may require additional intervention: [1][4]
- Weakness in the limbs
- Psychotic symptoms, including hallucinations, delusions, or paranoia
- New or worsening mania
- Severe agitation
- Aggression or anger
- Fever, sweating, and other flu symptoms
- Vomiting or diarrhea that lasts more than a few days
- Seizures
- Rash or hives
- Blurry or impaired vision
- Swelling in the face or mouth
- Trouble breathing or chest pain
- Paleness or redness in the fingers or toes
- Severe weight loss
- Emergence of tics
- Significant increase in heart rate or blood pressure
People taking Evekeo should be aware of potential risks and precautions, including the potential for abuse and dependence. The prescribing physician should be reviewing the safety of the medication throughout treatment to monitor for abuse and dependence.
Other precautions include: [1][3]
- Cardiac issues: CNS stimulants, including Evekeo, have been reported to cause sudden death, stroke, and heart attack, especially in those with a history of heart issues.
- Psychiatric reactions: CNS stimulants can worsen or cause psychotic symptoms and mania, particularly in those with a history of psychotic or manic symptoms.
- Seizure risk: People with a history of seizures may experience a lower seizure threshold when taking Evekeo.
- Growth impairment: Children can experience suppressed growth and weight loss when taking CNS stimulants. It may be necessary to terminate treatment if this occurs.
- Serotonin syndrome: If Evekeo is used alongside other serotonergic medications or substances, the risk of serotonin syndrome, a serious and sometimes fatal condition, is increased.
Is amphetamine sulfate addictive?
Amphetamine sulfate can be addictive for some individuals, although others are able to use the medication as prescribed without becoming dependent. People who are using amphetamine sulfate should be aware of the signs of dependence and addiction and should be regularly reviewed by the prescribing physician. [1]
Amphetamines, such as Evekeo, can be effective medications but should always be used with caution and never shared with others or used in higher or more frequent doses than prescribed. As a controlled substance, it has a potential for abuse, dependence, and addiction, especially when misused.
Amphetamines can cause powerful effects, including euphoria and increased alertness, which contribute to their abuse potential. Their impact on dopamine levels can further increase this potential and contribute to addiction risks, particularly with repeated and chronic use. [3]
Signs of amphetamine sulfate misuse
Signs of amphetamine sulfate misuse can include:
- Running out of prescribed medications too early.
- “Doctor shopping”, attempting to obtain multiple prescriptions from different doctors.
- Physical and psychological health issues that continue to worsen, including sudden weight loss, psychotic and manic symptoms, cognitive impairments, severe agitation, and heart issues.
- Improvements in professional and academic functioning.
- Social withdrawal and isolation.
Amphetamine sulfate withdrawal
Withdrawal symptoms can occur when a person has been taking a substance regularly and for a prolonged period and then suddenly reduces or stops taking it. If the body has developed a dependence on the substance, psychological and physical reactions can occur when it is stopped.
Amphetamine sulfate withdrawal can cause symptoms such as: [1][5]
- Severe fatigue
- Sleep disturbances
- Vivid or frightening dreams
- Rapid mood swings, including depressed mood, agitation, anxiety, and irritability
- Pain and stiffness in the body
- Headaches
- Increase in appetite
- Poor concentration
These symptoms can emerge within 24 hours of the last dose and can be severe within the first few days or weeks. Initially, people will experience a “crash”, during which they experience severe fatigue and a significantly increased need to sleep, although sleep is disturbed and of poor quality. [5]
Withdrawal can continue for three or more weeks, during which time severe depression and suicidal ideation can be common. People may require clinical intervention during withdrawal. [5]
Amphetamine sulfate overdose
Amphetamine sulfate overdose can be severe and sometimes fatal. Signs of an overdose can include: [1][4]
- Confusion
- Severe fatigue and weakness
- Vomiting and diarrhea
- Changes in mood
- Increased or irregular heartbeat
- Stomach pain
- Shaking
- Agitation or aggression
- Seizures
- Loss of consciousness
If an amphetamine overdose is suspected, call 911 immediately.
Amphetamine sulfate vs. Other prescription stimulants
| Brand name | Containing | Duration | Prescribed for/benefits |
|---|---|---|---|
| Evekeo | Amphetamine sulfate | 4-6 hours | Short-acting management of symptoms for acute or as-needed treatment |
| Adderall | Dextroamphetamine and amphetamine | 4-6 hours (IR) and 10-12 hours (XR) | Often the first choice for adult ADHD |
| Vyvanse | Lisdexamfetamine | 10-12 hours | Long duration of release and effect for all-day symptom management with lower potential for abuse |
| Ritalin | Methylphenidate | 3-4 hours (IR) and 8-10 hours (ER) | ADHD in children |
| Desoxyn | Methamphetamine | 8-12 hours | Severe ADHD that has not improved with other medications (highest risk of abuse and addiction) |
Treatment for amphetamine addiction
People who experience stimulant addiction, whether to prescribed or illicit substances, can benefit from professional intervention. This might include: [5][6]
- Supported withdrawal: Amphetamine withdrawal can be severe, and it may be necessary to utilize professional intervention. Medications can be used to provide symptom relief for a short-term period of around two weeks.
- Inpatient or outpatient rehabilitation programs: People can use residential or inpatient services if they experience severe addiction, while outpatient programs provide ongoing support while the individual remains living at home. This can include therapies, medications to manage physical or psychological impacts, and psychosocial support. There are currently no approved medications to treat amphetamine use disorder.
- Therapies: Psychotherapy and behavioral therapy can be beneficial to people with amphetamine addiction, to help identify and manage root causes of addictive behaviors and develop positive coping strategies. Cognitive behavioral therapy (CBT) is a common treatment for amphetamine addiction.
- Ongoing support: People may require long-term support when overcoming amphetamine addiction and may experience relapses during their recovery.
