Amphetamine racemic (1:1)
EVEKEO
“Amped Eve’s key hole”
1:1 racemic mixture of L- and D-amphetamine
What it isRacemic norepinephrine-, dopamine-, and serotonin-releasing amphetamine for ADHD (EVEKEO, 2012; approved ages 3-17).
Why this oneIts 1:1 l:d amphetamine mix produces more peripheral adrenergic effect than dextroamphetamine-heavy formulations; an ODT (2019) supplements the tablet, with 3-5 h (Carlat Table 1) of action.
What limits itAbuse and dependence are boxed risks; appetite loss, insomnia, tachycardia, and blood-pressure elevation commonly limit use.
FDA-approved for
- ADHD (2012)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Narcolepsy | Adults and children ≥6 years | 6–12 y: 5 mg QD; ≥12 y: 10 mg QD; raise 5 mg (6–12 y) or 10 mg (≥12 y) at weekly intervals | Usual 5–60 mg/day in divided doses; give first dose on awakening, additional doses q4–6h | 60 mg/day |
| Attention Deficit Disorder with Hyperactivity | Children (3–5 y and ≥6 y); not for children under 3 years | 3–5 y: 2.5 mg QD; ≥6 y: 5 mg QD or BID; raise 2.5 mg (3–5 y) or 5 mg (≥6 y) at weekly intervals | First dose on awakening; 1–2 additional doses q4–6h | Rarely exceed 40 mg/day |
| Exogenous obesity (short-term adjunct) | Adults and children ≥12 years | Up to 30 mg/day in divided doses of 5–10 mg, 30–60 min before meals | 30 mg/day |
Titration Increase at weekly intervals
Renal Undefined
Hepatic Undefined
Additional doses at intervals of 4 to 6 hours.
Instructions
- Administer at lowest effective dosage, individually adjusted
- Give first dose on awakening; avoid late-evening doses (insomnia)
- Interrupt drug periodically to assess need (ADHD)
Available strengths
- tab 5, 10 mg
- ER tab 5, 10, 15, 20 mg
- ODT 3.1, 6.3, 9.4, 12.5, 15.7, 18.8 mg
- ER susp 2.5 mg/mL
Contraindications
- During or within 14 days following the administration of monoamine oxidase inhibitors (hypertensive crises may result)
Cautions
- Serious cardiac disease — sudden death reported; avoid in structural cardiac abnormalities/serious cardiac disease
- Increased blood pressure and heart rate
- Psychiatric adverse reactions — exacerbation of psychosis, induction of mania, new psychotic/manic symptoms
- Long-term suppression of growth in pediatric patients
- Seizures (may lower convulsive threshold)
- Peripheral vasculopathy, including Raynaud's phenomenon
- Serotonin syndrome with serotonergic drugs
- Motor/verbal tics and worsening of Tourette's syndrome
Adverse reactions
- Palpitations, tachycardia, elevated blood pressure
- Overstimulation, restlessness, insomnia, dizziness, tremor, headache
- Dry mouth, unpleasant taste, diarrhea, constipation
- Anorexia and weight loss; urticaria; changes in libido
Pregnancy Use during pregnancy only if potential benefit justifies potential risk; amphetamine dependence linked to premature delivery, low birth weight, and neonatal withdrawal.
Lactation Amphetamines are excreted in human milk; mothers should refrain from nursing.
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 5 mg | tab | 4 q-wk | $1.83 | not offered |
| 10 mg | tab | 4 q-wk | $1.80 | not offered |
Other forms: Amphetamine XR-ODT (ADZENYS XR-ODT)
Available combined with: Amphetamine (ADDERALL) · Amphetamine XR suspension (DYANAVEL XR) · Mixed amphetamine salts (triple-bead) (MYDAYIS) · Mixed amphetamine salts XR (ADDERALL XR)
⚠ BOXED WARNING
- Abuse, misuse and addiction
Classes and tags
Clinical profile
Serotonin and MAOI
Provisional washout figures
Elevating mechanismNone identified
Exposure dependenceNo serotonin-elevating mechanism identified
Evidence confidenceModerate
InterpretationNo clinically meaningful serotonin-elevating mechanism identified in this first-pass Gillman-based review.
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