There are several options for printing:

• Click "Print this page" on the left to print the whole section
• Download a handy PILL (Patient Information Leaflet), a two-page summary of the main questions and answers from here for adults with ADHD. This can then be printed.
• Download a handy PILL for parents and carers of people with ADHD
• Download a handy QuILL (Quick Information Leaflet), a shorter, pictorial version of the PILL, designed for younger people. This can then be printed.

There are many other Patient Information Leaflets (PILs) across the world for patients and carers. There are also official information leaflets (often called a Data Sheet, Package Insert, or Summary of Product Characteristics). They are not on our site, so we can't take any responsibility for them but you can click here for links to other sites and leaflets

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Dexamfetamine is a stimulant that can be used to help as part of the treatment for the symptoms of hyperactivity or Attention Deficit (Hyperactivity) Disorder (ADHD). It may be used along with educational, social and psychological help. Dexamfetamine can help the child's abilities to concentrate and to reduce over-activity and impulsive behaviour. It is usually available from specialist centres only, and for children who have not improved with other treatments, e.g. methylphenidate. It can also be used in adults who have not improved from other treatments. Dexamfetamine is also sometimes used sometimes for narcolepsy.

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The usual dose of dexamfetamine for ADHD in children aged 6-18 years of age is 5-10mg a day to start with, then increasing every week to about 20mg a day. Sometimes up to 40mg a day has been used.

In adults, the starting dose is 5mg twice a day (morning and early afternoon), increasing every week up to a top dose of 60mg a day. 

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To help you choose, click on the links for the main options (self-help and help from others), the main medicines, and a handy chart comparing the main medicines for ADHD:

• main options, main medicines and handy chart

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It is not clear exactly how dexamfetamine works but it seems to help to reduce hyperactivity and improve concentration. It may act by stimulating the part of the brain responsible for concentrating. It also helps to improve behavioural problems associated with hyperactivity.

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Dexamfetamine should be taken in the morning, with a second dose at lunchtime and, if needed, a third dose at teatime. Taking the tablets at meal times may make it easier to remember, as dexamfetamine should be taken with or after food. As dexamfetamine is a stimulant, it is best not to take a dose after about 4pm in the afternoon as this might otherwise cause lack of sleep.

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The tablets should be swallowed with at least half a glass of water whilst you are sitting or standing so that they reach the stomach and do not stick in your throat.

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The tablets take about 20-30 minutes to begin to have an effect in ADHD (click the link for more information). The effect from each tablet lasts about 3-4 hours.

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You should talk about this with your doctor as different people respond differently. People will usually need to take dexamfetamine for some time after it has been started for ADHD. If it works, you may need to take dexamfetamine for quite a long time e.g. several years or longer. Sometimes your doctor will ask you not to give or take the medicine at weekends and/or holidays. It may be stopped or reduced once or twice a year to see if you still need it.

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Dexamfetamine is a stimulant drug, as is caffeine (in tea and coffee). In adults, it is possible that the drug can be addictive because it can be taken for its stimulant effect. In children, addiction appears unlikely. Some people do abuse amphetamines. Tolerance can occur (i.e. needing higher doses to get the same effect). There is no evidence that taking dexamfetamine for ADHD will cause someone to take illicit drugs when they are older. In fact the opposite might be true because the person will not try to self-medicate to manage their symptoms.

For a drug to be addictive or produce dependence, then it must have a number of characteristics:

• should produce craving for the drug when the last dose "wears off"

• there should be a "reward" (e.g. a good feeling) from taking the drug

• should produce tolerance ie you need more drug to get the same effect

• should produce withdrawal symptoms specific to that drug.

These characteristics come from the World Health Organisation. Click here to read a bit more about this, where you can find our thoughts on this knotty problem.

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If you remember within two hours of when the next dose is due, then take or give the missed dose (unless it is after 4pm in the afternoon, see "when should I take it?"). Otherwise, start again when you remember. Do not give two doses at the same time to "catch up". This might produce more side effects.

If you have problems remembering your doses (as very many people do) ask you pharmacist, doctor or nurse about this. There are some special packs, boxes and devices that can be used to help you remember. You can try leaving the pack somewhere you will see it each morning e.g. in the bathroom, kitchen, by your bed etc.

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This will depend on the dose you or your child is taking. At smaller doses, it can be stopped suddenly. At higher doses, it should be stopped gradually over several week as it is possible that 'withdrawal' effects might be seen. These would include extreme tiredness, rebound hyperactivity, increased appetite and depression. If this were to happen by accident, then starting dexamfetamine again would get rid of these effects.

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The table below will show you some of the main side effects you might get from dexamfetamine.

There is no evidence that methylphenidate has any effect on growth or weight when taken for ADHD ^{(Biederman 2010)} and we would expect the same to be true of dexamfetamine. 

Do not be worried by this list of side effects. Some people get no side effects at all and others may get some effects that are not listed in this table. Side effects tend to be worse with higher doses. Starting with a lower dose sometimes helps. If you think you might have a side effect to your medicine, you should discuss this with your doctor, nurse of pharmacist. You should also see the manufacturer's information leaflet.

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This is unlikely as dexamfetamine is generally a stimulant, but it can happen in a very few people if the dose prescribed is too high for them.

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When some people start dexamfetamine, they lose their appetite and then lose weight. After that there may be some weight gain on long-term treatment. In younger people any weight gain seems to be about the same as the normal growth for someone growing up.

Click here for a few tips on how to help you feel less hungry and lose weight.

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Medicines can affect desire (libido), arousal (erection) and orgasmic ability. Dexamfetamine can occasionally cause changes in libido (increased or decreased) and cause impotence.

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There are no known problems with any foods or drinks with dexamfetamine.

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Whether or not it is safe to drink alcohol with any medicine will depend on:

• How much you have to drink e.g. the amount and over how long
• What you then try to do (e.g. sleep or drive)
• If you have any other conditions e.g. asthma or a chest infection (as alcohol can make it harder to breathe), epilepsy
• If you are taking any other medicines

Alcohol reaches all parts of the brain and can affect many things e.g. thinking, reactions and breathing. Alcohol can also boost the effect of GABA (the brain's main calming chemical messenger).

There are no known problems with alcohol and dexamfetamine.  

It is not safe to drive after drinking alcohol, with or without dexamfetamine. Some countries allow driving after a small amount of alcohol but others have a zero tolerance. The UK has the highest limit in Europe, France lower, Scandanavia even lower and zero in some Eastern European countries. It is not possible to say what blood level you might have from a drink so it is safest not to drink if you know you may have to drive. It is taken as a very serious offence in most countries. You should see National Guidelines, laws and regulations in the country in which you are driving.

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Dexamfetamine has a few interactions with other medicines:

• The effect of dexamfetamine can be increased by disulfiram (Antabuse®)
• The effect of dexamfetamine can be decreased by beta-blockers (such as propranolol), lithium and some phenothiazines (e.g. pericyazine). Some cough medicines might also give some stimulating effects
• Dexamfetamine can decrease the effect of some anticonvulsants e.g. ethosuximide, phenytoin (Epanutin®), phenobarbital and primidone.

This does not necessarily mean that some of these drugs can not be used together, just that you may need to follow your doctor's instructions very carefully. There are many other possible drug interactions (e.g. you can try an external on-line drug interactions checker, although this is nothing to do with our site).

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Cigarette smoke contains over 3000 different chemicals. Some of these chemicals can make some of the enzymes in the liver work faster (called "enzyme induction" of e.g. CYP1A2 or P4501A2). This means that any medicine those enzymes break down will be broken down quicker. So, you'll end up with less of that medicine if you smoke. And also you will have more of it in the body if you stop smoking. However, it seems that there are no extra problems if smoking with dexamfetamine.

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By including this section, we're not saying it's right to take illicit or illegal drugs, because it isn't. We're just trying to answer the questions as best we can under the circumstances. With illicit drugs, the full answer is usually that we don't really know. So, we can only go on a few studies, a few reports and what we know about the drugs themselves.

Cannabis (illegal in most countries):

Smoking cannabis increases the amount of dopamine in the pleasure centres of the brain, which is where the reward or buzz comes from. However, psychosis also comes from having too much dopamine in another area of the brain. You have to remember that cannabis can increase dopamine in all areas of the brain and so can make psychosis worse. Please be careful, everything in moderation and if dope makes you worse, keep off the grass. It really won't help you in the long-term. Don't forget that if you're a toker, you're also a smoker, so see the question above. However, it seems that there are no extra problems if smoking cannabis with dexamfetamine.

Cocaine (illegal in most countries)

Cocaine is of course highly addictive and has many adverse or side effects on the body and brain. It can make most mental health symptoms worse in the long-term. However, it seems that there are no extra problems with cocaine and dexamfetamine, although this doesn't mean it's safe, and both are stimulants.

Ecstasy (illegal in most countries)

Ecstasy has many effects on the brain, the main ones producing the high seem to be by boosting serotonin, noradrenaline and dopamine in the brain. While it can cause a high, the effect wears off fairly quickly. It seems that the toxic effects on the brain are cumulative i.e. the more tablets you have over your lifetime, the more chance you have of having damage to the brain e.g. long-term depression and poor memory. However, there are no reports of extra problems with dexamfetamine and ecstasy, but again this doesn't mean it's safe.

Opiates

The opiates include many chemicals, some of which are used in medical care (e.g. codeine for diarrhoea and stopping coughs, diamorphine and morphine for pain). However, there are no extra problems reported from taking opiates (e.g. heroin, methadone, codeine) with dexamfetamine, but again this doesn't mean it's safe.

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You should have no problems with "The Pill" and dexamfetamine.

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In the UK, Levonelle one step® is available and is usually known as 'the morning after pill'. It is taken to reduce the chances of becoming pregnant after unprotected sex or failure of a contraceptive method. In fact "Emergency Contraception" is the better term because it can be taken up to 72 hours (3 days) afterwards. It can be bought over-the-counter without a prescription from pharmacies. EllaOne® tablets (which may work up to 5 days afterwards) and a coil (Intra-uterine device) can also be used but must be prescribed by a Doctor.

If you are taking dexamfetamine, the usual dose should work if you follow the instructions carefully.

N.B. We accept that for religious, cultural or ethical reasons some people do not approve of, or agree with, the use of the "Morning After" pill. However, we have answered the question because it is one of the most often asked of NHS Direct in UK, and they suggested we include it.

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Several female functions such as menstrual cycle (e.g. your periods) are controlled by a hormone called prolactin. Prolactin in the body rises during and after pregnancy and this triggers the body to make breast milk. The amount of prolactin in the body is kept in control by one part of the brain uses dopamine as its chemical messenger. Some medicines (especially antipsychotics) block the effect of dopamine in the brain.

Luckily dexamfetamine doesn't seem to have any effect on dopamine in this part of the brain and so should not have any effect on your periods. If your periods are irregular or late, or you start leaking milk, then you should see your doctor about this to find the cause.

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It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur 'spontaneously' in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed 'teratogenicity' i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a 'teratogen'. Since a baby has completed its main development between days 17 and 60 of the pregnancy (the so-called 'first trimester') these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs.

If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine.

Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press.

It may be helpful to know that in the USA, the FDA (Food and Drug Administration) classifies medicines in pregnancy in five groups:
A = Studies show no risk, so harm to the unborn child appears only a remote possibility
B = Animal and human studies indicate a lack of risk but are not fully conclusive
C = Animal studies indicate a risk but there is no safety data in humans
D = a definite risk exists but the benefit may outweigh the risk in some people
X = the risk outweighs any possible benefit

Dexamfetamine is classified as "C" and is not recommended in pregnancy but there is no evidence of problems.

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Almost every medicine passes into breast-milk. The main questions are how much and if this is likely to have an effect on your baby. But also remember that being ill (e.g. depressed, manic, psychotic) may have more harmful and lasting effects on you and your child (such as bonding and behaviour e.g. Field, 2010) than a small amount of an effective medicine. If you have been taking a medicine while you are pregnant, you should usually be able to carry on as the amount in breast-milk is much less than the baby would have got while you were pregnant. It is usually thought to be fairly safe if the baby gets less than 10% of the mum's dose. But there may be times when although a medicine gets into breast milk the benefit may be worth the risk, so you should seek personal advice on this.

If you stop any medicine suddenly, some people can get discontinuation or withdrawal symptoms (see question above). If you have been taking a medicine during pregnancy, the same can sometimes happen to the baby when born. If the drug gets into breast milk, this can reduce the effect of suddenly not having the medicine (as well as coping with being in the big wide world too).

If you want to breast-feed there are some things you can do to reduce any risk:

• Nearly all medicines can be taken once a day. So, taking your daily dose just before the baby's longest sleep (often this will be at night) will reduce the amount the baby gets from the milk.
• Any side effects in the baby will be higher if the mum is taking a higher dose. So, try to take the lowest dose possible to still get an effect.
• Try not to take any medicines you don't really need. This includes any medicines you might buy over-the-counter
• Make sure your nurse, health visitor or doctor checks your baby for any side effects e.g. being extra sleepy, having colic, feeding problems, being floppy or poor weight gain. If there are any problems you might need to switch medicines or drop your dose a bit
• Hind milk (the second half of the feed) is likely to contain slightly more of any medicine than the first half
• Avoid new medicines if possible as there is less information about them and breast-feeding.

You must be extra careful of any medicines if your baby was pre-mature, or has kidney, liver, heart or brain problems.

We know that dexamfetamine gets into breast milk. However, it seems that the amount that would reach the baby through the milk is likely to be very low, and well less than a tenth of the mum's dose. This is thought to be fairly safe. You should make sure the baby is looked after and checked up on by your doctor, nurse or health visitor if you decide to breast-feed with dexamfetamine.

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It is not thought that dexamfetamine has any adverse effect on driving. In fact, dexamfetamine might actually help with driving in adults as loss of concentration can happen with ADHD. Adults with ADHD have more accidents and incidents (especially on longer straighter bits of road, where concentration wanders).

If you are taking any medicines, the rules about driving will depend on the country you’re driving in. Click on the links below for advice:

• Medicines and driving in the UK (England, Scotland, Northern Ireland and Wales)

• Medicines and driving in the Republic of Ireland

General advice on driving safely

If you want to drive, you should take sensible steps to reduce any risk. These could include:

• Avoid driving when you are tired or ill
• Do not drive after having any alcohol as this can make any drowsiness worse (a third of all fatal road traffic incidents involve alcohol-dependent drivers)
• Avoid driving at night, dusk or in bad weather
• Avoid motorways, dual carriageways and the rush hour
• Give yourself plenty of time. Don’t rush
• Be extra careful if you have not slept well the previous night

As some medicines can affect your driving, be extra careful:

• If starting a new medicine
• After a change in dose (especially an increase)
• If you are on a high dose or seem very sensitive to side effects
• If you are taking any medicines for other symptoms e.g. antihistamines for hay fever or allergies
• If your medicine causes you blurred vision, drowsiness, poor co-ordination, poor attention

If you are driving less than 2000 miles a year, once you consider insurance, tax, MoT, repairs, maintenance, parking and petrol, you may actually find it is cheaper to get taxis and busses, and walk the short journeys.

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You should not normally need blood tests if you are taking dexamfetamine.

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