Dextroamphetamine patch
XELSTRYM
Pronunciation: dex-troe-am-FET-a-meen (ZEL-strim)
“Zelda strums”
Amp → amphetamine
What it isTransdermal dopamine-releasing dextroamphetamine for ADHD; Approved ages (ADHD label): 6-17, adults.
Why this oneDuration of action ~12 h (Carlat Table 1); wear 9 h, with removal providing a duration control oral amphetamine cannot offer.
What limits itSkin reactions, appetite loss, insomnia, cardiovascular stimulation, and misuse risk limit use; external heat can raise absorption.
FDA-approved for
- ADHD (2022)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| ADHD | Adults | 9 mg/9h QD | 18 mg/9h QD | |
| ADHD | Pediatric 6–17 y | 4.5 mg/9h QD | 18 mg/9h QD |
Titration Pediatric: adjust in weekly increments of 4.5 mg
Renal Severe (GFR 15–<30): max 13.5 mg/9h; ESRD (GFR <15): max 9 mg/9h
Hepatic Undefined
Not recommended in pediatric patients <6 years (higher exposure/adverse reactions)
Instructions
- Apply one patch 2 h before effect needed; remove within 9 h; one patch per 24 h
- Apply to clean, dry, intact skin (hip, upper arm, chest, upper back, or flank); rotate sites
- Avoid external heat sources during wear
- Do not substitute for other amphetamine products on a mg-per-mg basis
Available strengths
- patch 4.5, 9, 13.5, 18 mg/9 hr
- tab 2.5, 5, 7.5, 10, 15, 20, 30 mg
- ER cap 5, 10, 15 mg
- sol 5 mg/5 mL
Contraindications
- Use with monoamine oxidase inhibitor (MAOI), or within 14 days of stopping MAOIs (including MAOIs such as linezolid or intravenous methylene blue), because of an increased risk of hypertensive crisis
Cautions
- Serious cardiac disease/sudden death
- Increased blood pressure and heart rate
- Psychiatric adverse reactions (psychosis/mania)
- Long-term growth suppression in pediatrics
- Peripheral vasculopathy incl. Raynaud's phenomenon
- Serotonin syndrome
- Contact sensitization
- Application site reactions
- Motor/verbal tics, worsening of Tourette's
Adverse reactions
- Decreased appetite
- Insomnia
- Headache
- Irritability
- Abdominal pain
- Application site pain/pruritus
- Nausea
- Vomiting
- Tic
- Blood pressure/heart rate increased
- Dry mouth (adults)
- Anxiety (adults)
Pregnancy No clear drug-associated major-defect/miscarriage risk; possible premature delivery and low birth weight
Lactation Amphetamine present in human milk; breastfeeding not recommended during treatment
Cost
| Strength | #/mo | generic $/unit | brand $/unit | CostPlus | |
|---|---|---|---|---|---|
| 4.5 mg/9 hr | patch | per unit | — | $16.23/ea | not offered |
| 9 mg/9 hr | patch | per unit | — | $16.26/ea | not offered |
| 13.5 mg/9 hr | patch | per unit | — | $16.26/ea | not offered |
| 18 mg/9 hr | patch | per unit | — | $16.23/ea | not offered |
Other forms: Dextro amphetamine (DEXEDRINE) · Dextroamphetamine IR tablets (ZENZEDI) · Dextroamphetamine spansule (DEXEDRINE SPANSULE) · Dextroamphetamine oral solution (PROCENTRA)
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
Legacy pregnancy categoryC
Defining liabilityMisuse, hypertension, hyperthermia, psychosis and potentially fatal sympathomimetic toxicity.
Serotonin and MAOI
Provisional washout figures
Elevating mechanismNone identified
Non-elevating actionNone recorded
Exposure dependenceNo serotonin-elevating mechanism identified
Evidence confidenceModerate
InterpretationNo clinically meaningful serotonin-elevating mechanism identified in this first-pass Gillman-based review.