Lisdexamfetamine - wikipedia Lisdexamfetamine Not to be confused with Levoamphetamine. Lisdexamfetamine Clinical data Trade names Tyvense, Elvanse, Aduvanz, Venvanse, Vyvanse Synonyms Vyvanse AHFS / Drugs.com Monograph MedlinePlus a607047 License data US FDA : Lisdexamfetamine Pregnancy category AU : B3 US : C ( Risk not ruled out ) Dependence liability Physical : none Psychological : moderate Addiction liability Moderate Routes of administration Oral ( capsules ) ATC code N06BA12 ( WHO ) Legal status Legal status AU : S8 ( Controlled ) CA : Schedule I DE : Anlage III ( Special prescription form required ) UK : Class B US : Schedule II In general : ℞ ( Prescription only ) Pharmacokinetic data Bioavailability 96.4 % Metabolism Hydrolysis by enzymes in red blood cells initially. Subsequent metabolism follows Amphetamine # Pharmacokinetics. Onset of action 2 hours Biological half - life ≤ 1 hour ( prodrug molecule ) 9 -- 11 hours ( dextroamphetamine ) Duration of action 10 -- 12 hours Excretion Renal : ~ 2 % Identifiers IUPAC name ( 2S ) - 2, 6 - diamino - N - ( ( 2S ) - 1 - phenylpropan - 2 - yl ) hexanamide CAS Number 608137 - 32 - 2 PubChem CID 11597698 IUPHAR / BPS 7213 DrugBank DB01255 ChemSpider 9772458 UNII H645GUL8KJ ChEMBL CHEMBL1201222 Chemical and physical data Formula C H N O Molar mass 263.378 g / mol 3D model ( JSmol ) Interactive image SMILES O = C ( N ( C@H ) ( Cc1ccccc1 ) C ) ( C @ @ H ) ( N ) CCCCN InChI InChI = 1S / C15H25N3O / c1 - 12 ( 11 - 13 - 7 - 3 - 2 - 4 - 8 - 13 ) 18 - 15 ( 19 ) 14 ( 17 ) 9 - 5 - 6 - 10 - 16 / h2 - 4, 7 - 8, 12, 14H, 5 - 6, 9 - 11, 16 - 17H2, 1H3, ( H, 18, 19 ) / t12 -, 14 - / m0 / s1 Key : VOBHXZCDAVEXEY - JSGCOSHPSA - N ( what is this ? ) ( verify ) 30mg Vyvanse capsules Lisdexamfetamine ( contracted from L - lysine - dextroamphetamine ) is a prodrug of the central nervous system ( CNS ) stimulant dextroamphetamine, a phenethylamine of the amphetamine class that is used in the treatment of attention deficit hyperactivity disorder ( ADHD ) and binge eating disorder. Its chemical structure consists of dextroamphetamine coupled with the essential amino acid L - lysine. Lisdexamfetamine itself is inactive prior to its absorption and the subsequent rate - limited enzymatic cleavage of the molecule 's L - lysine portion, which produces the active metabolite ( dextroamphetamine ). Lisdexamfetamine can be prescribed for the treatment of attention deficit hyperactivity disorder ( ADHD ) in adults and children six and older, as well as for moderate to severe binge eating disorder in adults. The safety and the efficacy of lisdexamfetamine dimesylate in children with ADHD three to five years old have not been established. Lisdexamfetamine is a Class B / Schedule II substance in the United Kingdom and a Schedule II controlled substance in the United States ( DEA number 1205 ) and the aggregate production quota for 2016 in the United States is 29,750 kilograms of anhydrous acid or base. Lisdexamfetamine is currently in Phase III trials in Japan for ADHD. Contents 1 Uses 1.1 Medical 1.2 Enhancing performance 1.2. 1 Cognitive 1.2. 2 Physical 2 Contraindications 3 Side effects 3.1 Physical 3.2 Psychological 4 Overdose 4.1 Addiction 4.1. 1 Biomolecular mechanisms 4.1. 2 Pharmacological treatments 4.1. 3 Behavioral treatments 4.2 Dependence and withdrawal 4.3 Toxicity 4.4 Psychosis 5 Interactions 6 Pharmacology 6.1 Mechanism of action 6.2 Pharmacokinetics 7 Chemistry 7.1 Comparison to other formulations 8 History, society, and culture 8.1 Brand names 9 Research 9.1 Depression 10 Notes 11 Reference notes 12 References Uses Medical Part of this section is transcluded from Amphetamine. ( edit history ) Lisdexamfetamine is used primarily as a treatment for attention deficit hyperactivity disorder ( ADHD ) and binge eating disorder ; it has similar off - label uses as those of other pharmaceutical amphetamines. Individuals over the age of 65 were not commonly tested in clinical trials of lisdexamfetamine for ADHD. Long - term amphetamine exposure at sufficiently high doses in some animal species is known to produce abnormal dopamine system development or nerve damage, but, in humans with ADHD, pharmaceutical amphetamines appear to improve brain development and nerve growth. Reviews of magnetic resonance imaging ( MRI ) studies suggest that long - term treatment with amphetamine decreases abnormalities in brain structure and function found in subjects with ADHD, and improves function in several parts of the brain, such as the right caudate nucleus of the basal ganglia. Reviews of clinical stimulant research have established the safety and effectiveness of long - term continuous amphetamine use for the treatment of ADHD. Randomized controlled trials of continuous stimulant therapy for the treatment of ADHD spanning 2 years have demonstrated treatment effectiveness and safety. Two reviews have indicated that long - term continuous stimulant therapy for ADHD is effective for reducing the core symptoms of ADHD ( i.e., hyperactivity, inattention, and impulsivity ), enhancing quality of life and academic achievement, and producing improvements in a large number of functional outcomes across 9 categories of outcomes related to academics, antisocial behavior, driving, non-medicinal drug use, obesity, occupation, self - esteem, service use ( i.e., academic, occupational, health, financial, and legal services ), and social function. One review highlighted a nine - month randomized controlled trial in children with ADHD that found an average increase of 4.5 IQ points, continued increases in attention, and continued decreases in disruptive behaviors and hyperactivity. Another review indicated that, based upon the longest follow - up studies conducted to date, lifetime stimulant therapy that begins during childhood is continuously effective for controlling ADHD symptoms and reduces the risk of developing a substance use disorder as an adult. Current models of ADHD suggest that it is associated with functional impairments in some of the brain 's neurotransmitter systems ; these functional impairments involve impaired dopamine neurotransmission in the mesocorticolimbic projection and norepinephrine neurotransmission in the noradrenergic projections from the locus coeruleus to the prefrontal cortex. Psychostimulants like methylphenidate and amphetamine are effective in treating ADHD because they increase neurotransmitter activity in these systems. Approximately 80 % of those who use these stimulants see improvements in ADHD symptoms. Children with ADHD who use stimulant medications generally have better relationships with peers and family members, perform better in school, are less distractible and impulsive, and have longer attention spans. The Cochrane Collaboration 's reviews on the treatment of ADHD in children, adolescents, and adults with pharmaceutical amphetamines stated that while these drugs improve short - term symptoms, they have higher discontinuation rates than non-stimulant medications due to their adverse side effects. A Cochrane Collaboration review on the treatment of ADHD in children with tic disorders such as Tourette syndrome indicated that stimulants in general do not make tics worse, but high doses of dextroamphetamine could exacerbate tics in some individuals. Enhancing performance This section is transcluded from Amphetamine. ( edit history ) Cognitive In 2015, a systematic review and a meta - analysis of high quality clinical trials found that, when used at low ( therapeutic ) doses, amphetamine produces modest yet unambiguous improvements in cognition, including working memory, long - term episodic memory, inhibitory control, and some aspects of attention, in normal healthy adults ; these cognition - enhancing effects of amphetamine are known to be partially mediated through the indirect activation of both dopamine receptor D and adrenoceptor α in the prefrontal cortex. A systematic review from 2014 found that low doses of amphetamine also improve memory consolidation, in turn leading to improved recall of information. Therapeutic doses of amphetamine also enhance cortical network efficiency, an effect which mediates improvements in working memory in all individuals. Amphetamine and other ADHD stimulants also improve task saliency ( motivation to perform a task ) and increase arousal ( wakefulness ), in turn promoting goal - directed behavior. Stimulants such as amphetamine can improve performance on difficult and boring tasks and are used by some students as a study and test - taking aid. Based upon studies of self - reported illicit stimulant use, 5 -- 35 % of college students use diverted ADHD stimulants, which are primarily used for performance enhancement rather than as recreational drugs. However, high amphetamine doses that are above the therapeutic range can interfere with working memory and other aspects of cognitive control. Physical Amphetamine is used by some athletes for its psychological and athletic performance - enhancing effects, such as increased endurance and alertness ; however, non-medical amphetamine use is prohibited at sporting events that are regulated by collegiate, national, and international anti-doping agencies. In healthy people at oral therapeutic doses, amphetamine has been shown to increase muscle strength, acceleration, athletic performance in anaerobic conditions, and endurance ( i.e., it delays the onset of fatigue ), while improving reaction time. Amphetamine improves endurance and reaction time primarily through reuptake inhibition and effluxion of dopamine in the central nervous system. Amphetamine and other dopaminergic drugs also increase power output at fixed levels of perceived exertion by overriding a `` safety switch '' that allows the core temperature limit to increase in order to access a reserve capacity that is normally off - limits. At therapeutic doses, the adverse effects of amphetamine do not impede athletic performance ; however, at much higher doses, amphetamine can induce effects that severely impair performance, such as rapid muscle breakdown and elevated body temperature. Contraindications Pharmaceutical lisdexamfetamine dimesylate is contraindicated in patients with hypersensitivity to amphetamine products or any of the formulation 's inactive ingredients. It is also contraindicated in patients who have used a monoamine oxidase inhibitor ( MAOI ) within the last 14 days. Amphetamine products are contraindicated by the United States Food and Drug Administration ( USFDA ) in people with a history of drug abuse, heart disease, or severe agitation or anxiety, or in those currently experiencing arteriosclerosis, glaucoma, hyperthyroidism, or severe hypertension. The USFDA advises anyone with bipolar disorder, depression, elevated blood pressure, liver or kidney problems, mania, psychosis, Raynaud 's phenomenon, seizures, thyroid problems, tics, or Tourette syndrome to monitor their symptoms while taking amphetamine. Amphetamine is classified in US pregnancy category C. This means that detriments to the fetus have been observed in animal studies and adequate human studies have not been conducted ; amphetamine may still be prescribed to pregnant women if the potential benefits outweigh the risks. Amphetamine has also been shown to pass into breast milk, so the USFDA advises mothers to avoid breastfeeding when using it. Due to the potential for stunted growth, the USFDA advises monitoring the height and weight of children and adolescents prescribed amphetamines. Prescribing information approved by the Australian Therapeutic Goods Administration further contraindicates anorexia. Side effects Part of this section is transcluded from Amphetamine. ( edit history ) Products containing lisdexamfetamine have a side effect profile comparable to those containing amphetamine. Physical At normal therapeutic doses, the physical side effects of amphetamine vary widely by age and from person to person. Cardiovascular side effects can include hypertension or hypotension from a vasovagal response, Raynaud 's phenomenon ( reduced blood flow to the hands and feet ), and tachycardia ( increased heart rate ). Sexual side effects in males may include erectile dysfunction, frequent erections, or prolonged erections. Abdominal side effects may include abdominal pain, appetite loss, nausea, and weight loss. Other potential side effects include blurred vision, dry mouth, excessive grinding of the teeth, nosebleed, profuse sweating, rhinitis medicamentosa ( drug - induced nasal congestion ), reduced seizure threshold, and tics ( a type of movement disorder ). Dangerous physical side effects are rare at typical pharmaceutical doses. Amphetamine stimulates the medullary respiratory centers, producing faster and deeper breaths. In a normal person at therapeutic doses, this effect is usually not noticeable, but when respiration is already compromised, it may be evident. Amphetamine also induces contraction in the urinary bladder sphincter, the muscle which controls urination, which can result in difficulty urinating. This effect can be useful in treating bed wetting and loss of bladder control. The effects of amphetamine on the gastrointestinal tract are unpredictable. If intestinal activity is high, amphetamine may reduce gastrointestinal motility ( the rate at which content moves through the digestive system ) ; however, amphetamine may increase motility when the smooth muscle of the tract is relaxed. Amphetamine also has a slight analgesic effect and can enhance the pain relieving effects of opioids. USFDA - commissioned studies from 2011 indicate that in children, young adults, and adults there is no association between serious adverse cardiovascular events ( sudden death, heart attack, and stroke ) and the medical use of amphetamine or other ADHD stimulants. However, amphetamine pharmaceuticals are contraindicated in individuals with cardiovascular disease. Psychological At normal therapeutic doses, the most common psychological side effects of amphetamine include increased alertness, apprehension, concentration, initiative, self - confidence, and sociability, mood swings ( elated mood followed by mildly depressed mood ), insomnia or wakefulness, and decreased sense of fatigue. Less common side effects include anxiety, change in libido, grandiosity, irritability, repetitive or obsessive behaviors, and restlessness ; these effects depend on the user 's personality and current mental state. Amphetamine psychosis ( e.g., delusions and paranoia ) can occur in heavy users. Although very rare, this psychosis can also occur at therapeutic doses during long - term therapy. According to the USFDA, `` there is no systematic evidence '' that stimulants produce aggressive behavior or hostility. Amphetamine has also been shown to produce a conditioned place preference in humans taking therapeutic doses, meaning that individuals acquire a preference for spending time in places where they have previously used amphetamine. Overdose This section is transcluded from Amphetamine. ( edit history ) An amphetamine overdose can lead to many different symptoms, but is rarely fatal with appropriate care. The severity of overdose symptoms increases with dosage and decreases with drug tolerance to amphetamine. Tolerant individuals have been known to take as much as 5 grams of amphetamine in a day, which is roughly 100 times the maximum daily therapeutic dose. Symptoms of a moderate and extremely large overdose are listed below ; fatal amphetamine poisoning usually also involves convulsions and coma. In 2013, overdose on amphetamine, methamphetamine, and other compounds implicated in an `` amphetamine use disorder '' resulted in an estimated 3,788 deaths worldwide ( 3,425 -- 4,145 deaths, 95 % confidence ). Pathological overactivation of the mesolimbic pathway, a dopamine pathway that connects the ventral tegmental area to the nucleus accumbens, plays a central role in amphetamine addiction. Individuals who frequently overdose on amphetamine during recreational use have a high risk of developing an amphetamine addiction, since repeated overdoses gradually increase the level of accumbal ΔFosB, a `` molecular switch '' and `` master control protein '' for addiction. Once nucleus accumbens ΔFosB is sufficiently overexpressed, it begins to increase the severity of addictive behavior ( i.e., compulsive drug - seeking ) with further increases in its expression. While there are currently no effective drugs for treating amphetamine addiction, regularly engaging in sustained aerobic exercise appears to reduce the risk of developing such an addiction. Sustained aerobic exercise on a regular basis also appears to be an effective treatment for amphetamine addiction ; exercise therapy improves clinical treatment outcomes and may be used as a combination therapy with cognitive behavioral therapy, which is currently the best clinical treatment available. Overdose symptoms by system System Minor or moderate overdose Severe overdose Cardiovascular Abnormal heartbeat High or low blood pressure Cardiogenic shock ( heart not pumping enough blood ) Cerebral hemorrhage ( bleeding in the brain ) Circulatory collapse ( partial or complete failure of the circulatory system ) Central nervous system Confusion Abnormally fast reflexes Severe agitation Tremor ( involuntary muscle twitching ) Acute amphetamine psychosis ( e.g., delusions and paranoia ) Compulsive and repetitive movement Serotonin syndrome ( excessive serotonergic nerve activity ) Sympathomimetic toxidrome ( excessive adrenergic nerve activity ) Musculoskeletal Muscle pain Rhabdomyolysis ( rapid muscle breakdown ) Respiratory Rapid breathing Pulmonary edema ( fluid accumulation in the lungs ) Pulmonary hypertension ( high blood pressure in the arteries of the lung ) Respiratory alkalosis ( reduced blood CO ) Urinary Painful urination Urinary retention ( inability to urinate ) No urine production Kidney failure Other Elevated body temperature Mydriasis ( dilated pupils ) Elevated or low blood potassium Hyperpyrexia ( extremely elevated core body temperature ) Metabolic acidosis ( excessively acidic bodily fluids ) Addiction Addiction and dependence glossary addiction -- a brain disorder characterized by compulsive engagement in rewarding stimuli despite adverse consequences addictive behavior -- a behavior that is both rewarding and reinforcing addictive drug -- a drug that is both rewarding and reinforcing dependence -- an adaptive state associated with a withdrawal syndrome upon cessation of repeated exposure to a stimulus ( e.g., drug intake ) drug sensitization or reverse tolerance -- the escalating effect of a drug resulting from repeated administration at a given dose drug withdrawal -- symptoms that occur upon cessation of repeated drug use physical dependence -- dependence that involves persistent physical -- somatic withdrawal symptoms ( e.g., fatigue and delirium tremens ) psychological dependence -- dependence that involves emotional -- motivational withdrawal symptoms ( e.g., dysphoria and anhedonia ) reinforcing stimuli -- stimuli that increase the probability of repeating behaviors paired with them rewarding stimuli -- stimuli that the brain interprets as intrinsically positive and desirable or as something to be approached sensitization -- an amplified response to a stimulus resulting from repeated exposure to it substance use disorder - a condition in which the use of substances leads to clinically and functionally significant impairment or distress tolerance -- the diminishing effect of a drug resulting from repeated administration at a given dose ( edit history ) Signaling cascade in the nucleus accumbens that results in amphetamine addiction v t e Note : colored text contains article links. Nuclear pore Nuclear membrane Plasma membrane Ca 1.2 NMDAR AMPAR DRD1 DRD5 DRD2 DRD3 DRD4 AC cAMP cAMP PKA CaM CaMKII DARPP - 32 PP1 PP2B CREB ΔFosB JunD c - Fos SIRT1 HDAC1 This diagram depicts the signaling events in the brain 's reward center that are induced by chronic high - dose exposure to psychostimulants that increase the concentration of synaptic dopamine, like amphetamine, methamphetamine, and phenethylamine. Following presynaptic dopamine and glutamate co-release by such psychostimulants, postsynaptic receptors for these neurotransmitters trigger internal signaling events through a cAMP - dependent pathway and a calcium - dependent pathway that ultimately result in increased CREB phosphorylation. Phosphorylated CREB increases levels of ΔFosB, which in turn represses the c - Fos gene with the help of corepressors ; c - Fos repression acts as a molecular switch that enables the accumulation of ΔFosB in the neuron. A highly stable ( phosphorylated ) form of ΔFosB, one that persists in neurons for 1 -- 2 months, slowly accumulates following repeated high - dose exposure to stimulants through this process. ΔFosB functions as `` one of the master control proteins '' that produces addiction - related structural changes in the brain, and upon sufficient accumulation, with the help of its downstream targets ( e.g., nuclear factor kappa B ), it induces an addictive state. Addiction is a serious risk with heavy recreational amphetamine use but is unlikely to arise from typical long - term medical use at therapeutic doses. Compared to other amphetamine pharmaceuticals, lisdexamfetamine may have a lower liability for abuse as a recreational drug. Drug tolerance develops rapidly in amphetamine abuse ( i.e., a recreational amphetamine overdose ), so periods of extended use require increasingly larger doses of the drug in order to achieve the same effect. Biomolecular mechanisms Chronic use of amphetamine at excessive doses causes alterations in gene expression in the mesocorticolimbic projection, which arise through transcriptional and epigenetic mechanisms. The most important transcription factors that produce these alterations are ΔFosB, cAMP response element binding protein ( CREB ), and nuclear factor kappa B ( NF - κB ). ΔFosB is the most significant biomolecular mechanism in addiction because the overexpression of ΔFosB in the D1 - type medium spiny neurons in the nucleus accumbens is necessary and sufficient for many of the neural adaptations and behavioral effects ( e.g., expression - dependent increases in drug self - administration and reward sensitization ) seen in drug addiction. Once ΔFosB is sufficiently overexpressed, it induces an addictive state that becomes increasingly more severe with further increases in ΔFosB expression. It has been implicated in addictions to alcohol, cannabinoids, cocaine, methylphenidate, nicotine, opioids, phencyclidine, propofol, and substituted amphetamines, among others. ΔJunD, a transcription factor, and G9a, a histone methyltransferase enzyme, both oppose the function of ΔFosB and inhibit increases in its expression. Sufficiently overexpressing ΔJunD in the nucleus accumbens with viral vectors can completely block many of the neural and behavioral alterations seen in chronic drug abuse ( i.e., the alterations mediated by ΔFosB ). ΔFosB also plays an important role in regulating behavioral responses to natural rewards, such as palatable food, sex, and exercise. Since both natural rewards and addictive drugs induce expression of ΔFosB ( i.e., they cause the brain to produce more of it ), chronic acquisition of these rewards can result in a similar pathological state of addiction. Consequently, ΔFosB is the most significant factor involved in both amphetamine addiction and amphetamine - induced sex addictions, which are compulsive sexual behaviors that result from excessive sexual activity and amphetamine use. These sex addictions are associated with a dopamine dysregulation syndrome which occurs in some patients taking dopaminergic drugs. The effects of amphetamine on gene regulation are both dose - and route - dependent. Most of the research on gene regulation and addiction is based upon animal studies with intravenous amphetamine administration at very high doses. The few studies that have used equivalent ( weight - adjusted ) human therapeutic doses and oral administration show that these changes, if they occur, are relatively minor. This suggests that medical use of amphetamine does not significantly affect gene regulation. Pharmacological treatments Further information : Addiction § Research As of May 2014, there is no effective pharmacotherapy for amphetamine addiction. Reviews from 2015 and 2016 indicated that TAAR1 - selective agonists have significant therapeutic potential as a treatment for psychostimulant addictions ; however, as of February 2016, the only compounds which are known to function as TAAR1 - selective agonists are experimental drugs. Amphetamine addiction is largely mediated through increased activation of dopamine receptors and co-localized NMDA receptors in the nucleus accumbens ; magnesium ions inhibit NMDA receptors by blocking the receptor calcium channel. One review suggested that, based upon animal testing, pathological ( addiction - inducing ) psychostimulant use significantly reduces the level of intracellular magnesium throughout the brain. Supplemental magnesium treatment has been shown to reduce amphetamine self - administration ( i.e., doses given to oneself ) in humans, but it is not an effective monotherapy for amphetamine addiction. Behavioral treatments Cognitive behavioral therapy is currently the most effective clinical treatment for psychostimulant addictions. Additionally, research on the neurobiological effects of physical exercise suggests that daily aerobic exercise, especially endurance exercise ( e.g., marathon running ), prevents the development of drug addiction and is an effective adjunct therapy ( i.e., a supplemental treatment ) for amphetamine addiction. Exercise leads to better treatment outcomes when used as an adjunct treatment, particularly for psychostimulant addictions. In particular, aerobic exercise decreases psychostimulant self - administration, reduces the reinstatement ( i.e., relapse ) of drug - seeking, and induces increased dopamine receptor D ( DRD2 ) density in the striatum. This is the opposite of pathological stimulant use, which induces decreased striatal DRD2 density. One review noted that exercise may also prevent the development of a drug addiction by altering ΔFosB or c - Fos immunoreactivity in the striatum or other parts of the reward system. Summary of addiction - related plasticity Form of neuroplasticity or behavioral plasticity Type of reinforcer Sources Opiates Psychostimulants High fat or sugar food Sexual intercourse Physical exercise ( aerobic ) Environmental enrichment ΔFosB expression in nucleus accumbens D1 - type MSNs ↑ ↑ ↑ ↑ ↑ ↑ Behavioral plasticity Escalation of intake Yes Yes Yes Psychostimulant cross-sensitization Yes Not applicable Yes Yes Attenuated Attenuated Psychostimulant self - administration ↑ ↑ ↓ ↓ ↓ Psychostimulant conditioned place preference ↑ ↑ ↓ ↑ ↓ ↑ Reinstatement of drug - seeking behavior ↑ ↑ ↓ ↓ Neurochemical plasticity CREB phosphorylation in the nucleus accumbens ↓ ↓ ↓ ↓ ↓ Sensitized dopamine response in the nucleus accumbens No Yes No Yes Altered striatal dopamine signaling ↓ DRD2, ↑ DRD3 ↑ DRD1, ↓ DRD2, ↑ DRD3 ↑ DRD1, ↓ DRD2, ↑ DRD3 ↑ DRD2 ↑ DRD2 Altered striatal opioid signaling No change or ↑ μ - opioid receptors ↑ μ - opioid receptors ↑ κ - opioid receptors ↑ μ - opioid receptors ↑ μ - opioid receptors No change No change Changes in striatal opioid peptides ↑ dynorphin No change : enkephalin ↑ dynorphin ↓ enkephalin ↑ dynorphin ↑ dynorphin Mesocorticolimbic synaptic plasticity Number of dendrites in the nucleus accumbens ↓ ↑ ↑ Dendritic spine density in the nucleus accumbens ↓ ↑ ↑ Dependence and withdrawal According to another Cochrane Collaboration review on withdrawal in individuals who compulsively use amphetamine and methamphetamine, `` when chronic heavy users abruptly discontinue amphetamine use, many report a time - limited withdrawal syndrome that occurs within 24 hours of their last dose. '' This review noted that withdrawal symptoms in chronic, high - dose users are frequent, occurring in roughly 88 % of cases, and persist for 3 -- 4 weeks with a marked `` crash '' phase occurring during the first week. Amphetamine withdrawal symptoms can include anxiety, drug craving, depressed mood, fatigue, increased appetite, increased movement or decreased movement, lack of motivation, sleeplessness or sleepiness, and lucid dreams. The review indicated that the severity of withdrawal symptoms is positively correlated with the age of the individual and the extent of their dependence. Mild withdrawal symptoms from the discontinuation of amphetamine treatment at therapeutic doses can be avoided by tapering the dose. Toxicity In rodents and primates, sufficiently high doses of amphetamine cause dopaminergic neurotoxicity, or damage to dopamine neurons, which is characterized by dopamine terminal degeneration and reduced transporter and receptor function. There is no evidence that amphetamine is directly neurotoxic in humans. However, large doses of amphetamine may indirectly cause dopaminergic neurotoxicity as a result of hyperpyrexia, the excessive formation of reactive oxygen species, and increased autoxidation of dopamine. Animal models of neurotoxicity from high - dose amphetamine exposure indicate that the occurrence of hyperpyrexia ( i.e., core body temperature ≥ 40 ° C ) is necessary for the development of amphetamine - induced neurotoxicity. Prolonged elevations of brain temperature above 40 ° C likely promote the development of amphetamine - induced neurotoxicity in laboratory animals by facilitating the production of reactive oxygen species, disrupting cellular protein function, and transiently increasing blood -- brain barrier permeability. Psychosis See also : Stimulant psychosis A severe amphetamine overdose can result in a stimulant psychosis that may involve a variety of symptoms, such as delusions and paranoia. A Cochrane Collaboration review on treatment for amphetamine, dextroamphetamine, and methamphetamine psychosis states that about 5 -- 15 % of users fail to recover completely. According to the same review, there is at least one trial that shows antipsychotic medications effectively resolve the symptoms of acute amphetamine psychosis. Psychosis very rarely arises from therapeutic use. Interactions Acidifying Agents : Drugs that acidify the urine, such as ascorbic acid, increase urinary excretion of dextroamphetamine, thus decreasing the half - life of dextroamphetamine in the body. Alkalinizing Agents : Drugs that alkalinize the urine, such as sodium bicarbonate, decrease urinary excretion of dextroamphetamine, thus increasing the half - life of dextroamphetamine in the body. Monoamine Oxidase Inhibitors : Concomitant use of MAOIs and central nervous system stimulants such as lisdexamfetamine can cause a hypertensive crisis. Pharmacology Main section : Amphetamine § Pharmacodynamics Mechanism of action Pharmacodynamics of amphetamine in a dopamine neuron v t e via AADC Amphetamine enters the presynaptic neuron across the neuronal membrane or through DAT. Once inside, it binds to TAAR1 or enters synaptic vesicles through VMAT2. When amphetamine enters synaptic vesicles through VMAT2, it collapses the vesicular pH gradient, which in turn causes dopamine to be released into the cytosol ( light tan - colored area ) through VMAT2. When amphetamine binds to TAAR1, it reduces the firing rate of the dopamine neuron via potassium channels and activates protein kinase A ( PKA ) and protein kinase C ( PKC ), which subsequently phosphorylate DAT. PKA - phosphorylation causes DAT to withdraw into the presynaptic neuron ( internalize ) and cease transport. PKC - phosphorylated DAT may either operate in reverse or, like PKA - phosphorylated DAT, internalize and cease transport. Amphetamine is also known to increase intracellular calcium, an effect which is associated with DAT phosphorylation through a CAMKIIα - dependent pathway, in turn producing dopamine efflux. Lisdexamfetamine is an inactive prodrug that is converted in the body to dextroamphetamine, a pharmacologically active compound which is responsible for the drug 's activity. After oral ingestion, lisdexamfetamine is broken down by enzymes in red blood cells to form L - lysine, a naturally occurring essential amino acid, and dextroamphetamine. The conversion of lisdexamfetamine to dextroamphetamine is not affected by gastrointestinal pH and is unlikely to be affected by alterations in normal gastrointestinal transit times. The optical isomers of amphetamine, i.e., dextroamphetamine and levoamphetamine, are TAAR1 agonists and vesicular monoamine transporter 2 inhibitors that can enter monoamine neurons ; this allows them to release monoamine neurotransmitters ( dopamine, norepinephrine, and serotonin, among others ) from their storage sites in the presynaptic neuron, as well as prevent the reuptake of these neurotransmitters from the synaptic cleft. Lisdexamfetamine was developed with the goal of providing a long duration of effect that is consistent throughout the day, with reduced potential for abuse. The attachment of the amino acid lysine slows down the relative amount of dextroamphetamine available to the blood stream. Because no free dextroamphetamine is present in lisdexamfetamine capsules, dextroamphetamine does not become available through mechanical manipulation, such as crushing or simple extraction. A relatively sophisticated biochemical process is needed to produce dextroamphetamine from lisdexamfetamine. As opposed to Adderall, which contains roughly equal parts of racemic amphetamine and dextroamphetamine salts, lisdexamfetamine is a single - enantiomer dextroamphetamine formula. Studies conducted show that lisdexamfetamine dimesylate may have less abuse potential than dextroamphetamine and an abuse profile similar to diethylpropion at dosages that are FDA - approved for treatment of ADHD, but still has a high abuse potential when this dosage is exceeded by over 100 %. Pharmacokinetics This section is transcluded from Amphetamine. ( edit history ) The oral bioavailability of amphetamine varies with gastrointestinal pH ; it is well absorbed from the gut, and bioavailability is typically over 75 % for dextroamphetamine. Amphetamine is a weak base with a pK of 9.9 ; consequently, when the pH is basic, more of the drug is in its lipid soluble free base form, and more is absorbed through the lipid - rich cell membranes of the gut epithelium. Conversely, an acidic pH means the drug is predominantly in a water - soluble cationic ( salt ) form, and less is absorbed. Approximately 15 -- 40 % of amphetamine circulating in the bloodstream is bound to plasma proteins. Following absorption, amphetamine readily distributes into most tissues in the body, with high concentrations occurring in cerebrospinal fluid and brain tissue. The half - life of amphetamine enantiomers differ and vary with urine pH. At normal urine pH, the half - lives of dextroamphetamine and levoamphetamine are 9 -- 11 hours and 11 -- 14 hours, respectively. Highly acidic urine will reduce the enantiomer half - lives to 7 hours ; highly alkaline urine will increase the half - lives up to 34 hours. The immediate - release and extended release variants of salts of both isomers reach peak plasma concentrations at 3 hours and 7 hours post-dose respectively. Amphetamine is eliminated via the kidneys, with 30 -- 40 % of the drug being excreted unchanged at normal urinary pH. When the urinary pH is basic, amphetamine is in its free base form, so less is excreted. When urine pH is abnormal, the urinary recovery of amphetamine may range from a low of 1 % to a high of 75 %, depending mostly upon whether urine is too basic or acidic, respectively. Following oral administration, amphetamine appears in urine within 3 hours. Roughly 90 % of ingested amphetamine is eliminated 3 days after the last oral dose. The prodrug lisdexamfetamine is not as sensitive to pH as amphetamine when being absorbed in the gastrointestinal tract ; following absorption into the blood stream, it is converted by red blood cell - associated enzymes to dextroamphetamine via hydrolysis. The elimination half - life of lisdexamfetamine is generally less than 1 hour. CYP2D6, dopamine β - hydroxylase ( DBH ), flavin - containing monooxygenase 3 ( FMO3 ), butyrate - CoA ligase ( XM - ligase ), and glycine N - acyltransferase ( GLYAT ) are the enzymes known to metabolize amphetamine or its metabolites in humans. Amphetamine has a variety of excreted metabolic products, including 4 - hydroxyamphetamine, 4 - hydroxynorephedrine, 4 - hydroxyphenylacetone, benzoic acid, hippuric acid, norephedrine, and phenylacetone. Among these metabolites, the active sympathomimetics are 4 - hydroxyamphetamine, 4 - hydroxynorephedrine, and norephedrine. The main metabolic pathways involve aromatic para-hydroxylation, aliphatic alpha - and beta - hydroxylation, N - oxidation, N - dealkylation, and deamination. The known metabolic pathways, detectable metabolites, and metabolizing enzymes in humans include the following : Metabolic pathways of amphetamine in humans 4 - Hydroxyphenylacetone Phenylacetone Benzoic acid Hippuric acid Amphetamine Norephedrine 4 - Hydroxyamphetamine 4 - Hydroxynorephedrine Para - Hydroxylation Para - Hydroxylation Para - Hydroxylation CYP2D6 CYP2D6 unidentified Beta - Hydroxylation Beta - Hydroxylation DBH DBH Oxidative Deamination FMO3 Oxidation unidentified Glycine Conjugation XM - ligase GLYAT The primary active metabolites of amphetamine are 4 - hydroxyamphetamine and norephedrine ; at normal urine pH, about 30 -- 40 % of amphetamine is excreted unchanged and roughly 50 % is excreted as the inactive metabolites ( bottom row ). The remaining 10 -- 20 % is excreted as the active metabolites. Benzoic acid is metabolized by XM - ligase into an intermediate product, benzoyl - CoA, which is then metabolized by GLYAT into hippuric acid. Chemistry This section needs expansion. You can help by adding to it. ( September 2015 ) Lisdexamfetamine dimesylate is a water - soluble ( 792 mg / mL ) powder with a white to off - white color. Comparison to other formulations Lisdexamfetamine dimesylate is one marketed formulation delivering dextroamphetamine. The following table compares the drug to other amphetamine pharmaceuticals. Amphetamine base in marketed amphetamine medications drug formula molecular mass amphetamine base amphetamine base in equal doses doses with equal base content ( g / mol ) ( percent ) ( 30 mg dose ) total base total dextro - levo - dextro - levo - dextroamphetamine sulfate ( C H N ) H SO 368.49 270.41 73.38 % 73.38 % -- 22.0 mg -- 30.0 mg amphetamine sulfate ( C H N ) H SO 368.49 270.41 73.38 % 36.69 % 36.69 % 11.0 mg 11.0 mg 30.0 mg Adderall 62.57 % 47.49 % 15.08 % 14.2 mg 4.5 mg 35.2 mg 25 % dextroamphetamine sulfate ( C H N ) H SO 368.49 270.41 73.38 % 73.38 % -- 25 % amphetamine sulfate ( C H N ) H SO 368.49 270.41 73.38 % 36.69 % 36.69 % 25 % dextroamphetamine saccharate ( C H N ) C H O 480.55 270.41 56.27 % 56.27 % -- 25 % amphetamine aspartate monohydrate ( C H N ) C H NO H O 286.32 135.21 47.22 % 23.61 % 23.61 % lisdexamfetamine dimesylate C H N O ( CH O S ) 455.49 135.21 29.68 % 29.68 % -- 8.9 mg -- 74.2 mg amphetamine base suspension 135.21 135.21 100 % 76.19 % 23.81 % 22.9 mg 7.1 mg 22.0 mg History, society, and culture See also : History and culture of substituted amphetamines Lisdexamfetamine was developed by New River Pharmaceuticals, who were bought by Shire Pharmaceuticals shortly before lisdexamfetamine began being marketed. It was developed for the intention of creating a longer - lasting and less - easily abused version of dextroamphetamine, as the requirement of conversion into dextroamphetamine via enzymes in the red blood cells increases its onset of action, regardless of the route of ingestion. On 23 April 2008, Vyvanse received FDA approval for the adult population. On 19 February 2009, Health Canada approved 30 mg and 50 mg capsules of lisdexamfetamine for treatment of ADHD. In January 2015, lisdexamfetamine was approved by the U.S. Food and Drug Administration for treatment of binge eating disorder in adults. Brand names As of July 2014 lisdexamfetamine was sold the under the following brands : Elvanse, Samexid, Tyvense, Venvanse, and Vyvanse. Research Depression Some clinical trials that used lisdexamfetamine as an add - on therapy with a selective serotonin reuptake inhibitor ( SSRI ) or serotonin - norepinephrine reuptake inhibitor ( SNRI ) for treatment - resistant depression indicated that this is no more effective than the use of an SSRI or SNRI alone. Other studies indicated that psychostimulants potentiated antidepressants, and were under - prescribed for treatment resistant depression. In those studies patients showed significant improvement in energy, mood, and psychomotor activity. In February 2014, Shire announced that two late - stage clinical trials had shown that Vyvanse was not an effective treatment for depression. Notes Jump up ^ The ADHD - related outcome domains with the greatest proportion of significantly improved outcomes from long - term continuous stimulant therapy include academics ( ~ 55 % of academic outcomes improved ), driving ( 100 % of driving outcomes improved ), non-medical drug use ( 47 % of addiction - related outcomes improved ), obesity ( ~ 65 % of obesity - related outcomes improved ), self esteem ( 50 % of self - esteem outcomes improved ), and social function ( 67 % of social function outcomes improved ). The largest effect sizes for outcome improvements from long - term stimulant therapy occur in the domains involving academics ( e.g., grade point average, achievement test scores, length of education, and education level ), self - esteem ( e.g., self - esteem questionnaire assessments, number of suicide attempts, and suicide rates ), and social function ( e.g., peer nomination scores, social skills, and quality of peer, family, and romantic relationships ). Long - term combination therapy for ADHD ( i.e., treatment with both a stimulant and behavioral therapy ) produces even larger effect sizes for outcome improvements and improves a larger proportion of outcomes across each domain compared to long - term stimulant therapy alone. Jump up ^ Cochrane Collaboration reviews are high quality meta - analytic systematic reviews of randomized controlled trials. Jump up ^ The 95 % confidence interval indicates that there is a 95 % probability that the true number of deaths lies between 3,425 and 4,145. Jump up ^ Transcription factors are proteins that increase or decrease the expression of specific genes. Jump up ^ In simpler terms, this necessary and sufficient relationship means that ΔFosB overexpression in the nucleus accumbens and addiction - related behavioral and neural adaptations always occur together and never occur alone. Jump up ^ NMDA receptors are voltage - dependent ligand - gated ion channels that requires simultaneous binding of glutamate and a co-agonist ( D - serine ) ) or glycine ) to open the ion channel. Jump up ^ The review indicated that magnesium L - aspartate and magnesium chloride produce significant changes in addictive behavior ; other forms of magnesium were not mentioned. Jump up ^ 4 - Hydroxyamphetamine has been shown to be metabolized into 4 - hydroxynorephedrine by dopamine beta - hydroxylase ( DBH ) in vitro and it is presumed to be metabolized similarly in vivo. Evidence from studies that measured the effect of serum DBH concentrations on 4 - hydroxyamphetamine metabolism in humans suggests that a different enzyme may mediate the conversion of 4 - hydroxyamphetamine to 4 - hydroxynorephedrine ; however, other evidence from animal studies suggests that this reaction is catalyzed by DBH in synaptic vesicles within noradrenergic neurons in the brain. Jump up ^ For uniformity, molecular masses were calculated using the Lenntech Molecular Weight Calculator and were within 0.01 g / mol of published pharmaceutical values. Jump up ^ Amphetamine base percentage = molecular mass / molecular mass. Amphetamine base percentage for Adderall = sum of component percentages / 4. Jump up ^ dose = ( 1 / amphetamine base percentage ) × scaling factor = ( molecular mass / molecular mass ) × scaling factor. The values in this column were scaled to a 30 mg dose of dextroamphetamine sulfate. Due to pharmacological differences between these medications ( e.g., differences in the release, absorption, conversion, concentration, differing effects of enantiomers, half - life, etc. ), the listed values should not be considered equipotent doses. Jump up ^ This product ( Dyanavel XR ) is an oral suspension ( i.e., a drug that is suspended in a liquid and taken by mouth ) that contains 2.5 mg / mL of amphetamine base. The amphetamine base contains dextro - to levo - amphetamine in a ratio of 3.2 : 1, which is approximately the ratio in Adderall. The product uses an ion exchange resin to achieve extended release of the amphetamine base. Image legend Jump up ^ Ion channel G proteins & linked receptors ( Text color ) Transcription factors Reference notes Jump up ^ Jump up ^ Jump up ^ Jump up ^ ^ Jump up to : Jump up ^ Jump up ^ Jump up ^ ^ Jump up to : References ^ Jump up to : Stahl SM ( March 2017 ). `` Amphetamine ( D, L ) ''. Prescriber 's Guide : Stahl 's Essential Psychopharmacology ( 6th ed. ). Cambridge, United Kingdom : Cambridge University Press. pp. 45 -- 51. ISBN 9781108228749. Retrieved 5 August 2017. ^ Jump up to : Stahl SM ( March 2017 ). `` Lisdexamfetamine ''. Prescriber 's Guide : Stahl 's Essential Psychopharmacology ( 6th ed. ). Cambridge, United Kingdom : Cambridge University Press. pp. 379 -- 384. ISBN 9781108228749. access - date = requires url = ( help ) Jump up ^ `` Public Assessment Report Decentralised Procedure '' ( PDF ). MHRA. p. 14. Retrieved 23 August 2014. ^ Jump up to : Millichap JG ( 2010 ). `` Chapter 9 : Medications for ADHD ''. In Millichap JG. Attention Deficit Hyperactivity Disorder Handbook : A Physician 's Guide to ADHD ( 2nd ed. ). New York, USA : Springer. p. 112. ISBN 9781441913968. Table 9.2 Dextroamphetamine formulations of stimulant medication Dexedrine ( Peak : 2 -- 3 h ) ( Duration : 5 -- 6 h )... Adderall ( Peak : 2 -- 3 h ) ( Duration : 5 -- 7 h ) Dexedrine spansules ( Peak : 7 -- 8 h ) ( Duration : 12 h )... Adderall XR ( Peak : 7 -- 8 h ) ( Duration : 12 h ) Vyvanse ( Peak : 3 -- 4 h ) ( Duration : 12 h ) ^ Jump up to : Brams M, Mao AR, Doyle RL ( September 2008 ). `` Onset of efficacy of long - acting psychostimulants in pediatric attention - deficit / hyperactivity disorder ''. Postgrad. Med. 120 ( 3 ) : 69 -- 88. PMID 18824827. doi : 10.3810 / pgm. 2008.09. 1909. Onset of efficacy was earliest for d - MPH - ER at 0.5 hours, followed by d, l - MPH - LA at 1 to 2 hours, MCD at 1.5 hours, d, l - MPH - OR at 1 to 2 hours, MAS - XR at 1.5 to 2 hours, MTS at 2 hours, and LDX at approximately 2 hours... MAS - XR, and LDX have a long duration of action at 12 hours postdose ^ Jump up to : `` Vyvanse Prescribing Information '' ( PDF ). United States Food and Drug Administration. Shire US Inc. May 2017. pp. 3 -- 13, 17 -- 21. Retrieved 10 July 2017. Jump up ^ Heal DJ, Smith SL, Gosden J, Nutt DJ ( June 2013 ). `` Amphetamine, past and present -- a pharmacological and clinical perspective ''. J. Psychopharmacol. 27 ( 6 ) : 479 -- 496. PMC 3666194. PMID 23539642. doi : 10.1177 / 0269881113482532. Jump up ^ `` Lisdexamfetamine dimesylate ( generic ). '' Brown University Psychopharmacology Update 19.7 ( 2008 ) : 1 -- 2. Academic Search Premier. EBSCO. Web. 12 September 2010. Jump up ^ `` DEA -- Department of Justice '' ( PDF ). DEA -- Department of Justice. Retrieved 1 July 2014. Jump up ^ `` DEA Office of Diversion Control '' ( PDF ). DEA. Retrieved 1 July 2014. Jump up ^ `` Phase - III clinical trials in Attention - deficit hyperactivity disorder ( In children, In adolescents ) in Japan ( PO ) ''. Retrieved 20 March 2016. ^ Jump up to : Carvalho M, Carmo H, Costa VM, Capela JP, Pontes H, Remião F, Carvalho F, Bastos Mde L ( August 2012 ). `` Toxicity of amphetamines : an update ''. Arch. Toxicol. 86 ( 8 ) : 1167 -- 1231. PMID 22392347. doi : 10.1007 / s00204 - 012 - 0815 - 5. Jump up ^ Berman S, O'Neill J, Fears S, Bartzokis G, London ED ( October 2008 ). `` Abuse of amphetamines and structural abnormalities in the brain ''. Ann. N.Y. Acad. Sci. 1141 : 195 -- 220. PMC 2769923. PMID 18991959. doi : 10.1196 / annals. 1441.031. ^ Jump up to : Hart H, Radua J, Nakao T, Mataix - Cols D, Rubia K ( February 2013 ). `` Meta - analysis of functional magnetic resonance imaging studies of inhibition and attention in attention - deficit / hyperactivity disorder : exploring task - specific, stimulant medication, and age effects ''. JAMA Psychiatry. 70 ( 2 ) : 185 -- 198. PMID 23247506. doi : 10.1001 / jamapsychiatry. 2013.277. ^ Jump up to : Spencer TJ, Brown A, Seidman LJ, Valera EM, Makris N, Lomedico A, Faraone SV, Biederman J ( September 2013 ). `` Effect of psychostimulants on brain structure and function in ADHD : a qualitative literature review of magnetic resonance imaging - based neuroimaging studies ''. J. Clin. Psychiatry. 74 ( 9 ) : 902 -- 917. PMC 3801446. PMID 24107764. doi : 10.4088 / JCP. 12r08287. ^ Jump up to : Frodl T, Skokauskas N ( February 2012 ). `` Meta - analysis of structural MRI studies in children and adults with attention deficit hyperactivity disorder indicates treatment effects. ''. Acta psychiatrica Scand. 125 ( 2 ) : 114 -- 126. PMID 22118249. doi : 10.1111 / j. 1600 - 0447.2011. 01786. x. Basal ganglia regions like the right globus pallidus, the right putamen, and the nucleus caudatus are structurally affected in children with ADHD. These changes and alterations in limbic regions like ACC and amygdala are more pronounced in non-treated populations and seem to diminish over time from child to adulthood. Treatment seems to have positive effects on brain structure. ^ Jump up to : Millichap JG ( 2010 ). `` Chapter 9 : Medications for ADHD ''. In Millichap JG. Attention Deficit Hyperactivity Disorder Handbook : A Physician 's Guide to ADHD ( 2nd ed. ). New York, USA : Springer. pp. 121 -- 123, 125 -- 127. ISBN 9781441913968. Ongoing research has provided answers to many of the parents ' concerns, and has confirmed the effectiveness and safety of the long - term use of medication. ^ Jump up to : Arnold LE, Hodgkins P, Caci H, Kahle J, Young S ( February 2015 ). `` Effect of treatment modality on long - term outcomes in attention - deficit / hyperactivity disorder : a systematic review ''. PLoS ONE. 10 ( 2 ) : e0116407. PMC 4340791. PMID 25714373. doi : 10.1371 / journal. pone. 0116407. The highest proportion of improved outcomes was reported with combination treatment ( 83 % of outcomes ). Among significantly improved outcomes, the largest effect sizes were found for combination treatment. The greatest improvements were associated with academic, self - esteem, or social function outcomes. Figure 3 : Treatment benefit by treatment type and outcome group ^ Jump up to : Huang YS, Tsai MH ( July 2011 ). `` Long - term outcomes with medications for attention - deficit hyperactivity disorder : current status of knowledge ''. CNS Drugs. 25 ( 7 ) : 539 -- 554. PMID 21699268. doi : 10.2165 / 11589380 - 000000000 - 00000. Recent studies have demonstrated that stimulants, along with the non-stimulants atomoxetine and extended - release guanfacine, are continuously effective for more than 2 - year treatment periods with few and tolerable adverse effects. The effectiveness of long - term therapy includes not only the core symptoms of ADHD, but also improved quality of life and academic achievements. The most concerning short - term adverse effects of stimulants, such as elevated blood pressure and heart rate, waned in long - term follow - up studies... In the longest follow - up study ( of more than 10 years ), lifetime stimulant treatment for ADHD was effective and protective against the development of adverse psychiatric disorders. ^ Jump up to : Malenka RC, Nestler EJ, Hyman SE ( 2009 ). `` Chapter 6 : Widely Projecting Systems : Monoamines, Acetylcholine, and Orexin ''. In Sydor A, Brown RY. Molecular Neuropharmacology : A Foundation for Clinical Neuroscience ( 2nd ed. ). New York, USA : McGraw - Hill Medical. pp. 154 -- 157. ISBN 9780071481274. ^ Jump up to : Malenka RC, Nestler EJ, Hyman SE ( 2009 ). `` Chapter 13 : Higher Cognitive Function and Behavioral Control ''. In Sydor A, Brown RY. Molecular Neuropharmacology : A Foundation for Clinical Neuroscience ( 2nd ed. ). New York, USA : McGraw - Hill Medical. pp. 318, 321. ISBN 9780071481274. Therapeutic ( relatively low ) doses of psychostimulants, such as methylphenidate and amphetamine, improve performance on working memory tasks both in normal subjects and those with ADHD... stimulants act not only on working memory function, but also on general levels of arousal and, within the nucleus accumbens, improve the saliency of tasks. Thus, stimulants improve performance on effortful but tedious tasks... through indirect stimulation of dopamine and norepinephrine receptors... Beyond these general permissive effects, dopamine ( acting via D1 receptors ) and norepinephrine ( acting at several receptors ) can, at optimal levels, enhance working memory and aspects of attention. Jump up ^ Bidwell LC, McClernon FJ, Kollins SH ( August 2011 ). `` Cognitive enhancers for the treatment of ADHD ''. Pharmacol. Biochem. Behav. 99 ( 2 ) : 262 -- 274. PMC 3353150. PMID 21596055. doi : 10.1016 / j. pbb. 2011.05. 002. Jump up ^ Parker J, Wales G, Chalhoub N, Harpin V ( September 2013 ). `` The long - term outcomes of interventions for the management of attention - deficit hyperactivity disorder in children and adolescents : a systematic review of randomized controlled trials ''. Psychol. Res. Behav. Manag. 6 : 87 -- 99. PMC 3785407. PMID 24082796. doi : 10.2147 / PRBM. S49114. Only one paper examining outcomes beyond 36 months met the review criteria... There is high level evidence suggesting that pharmacological treatment can have a major beneficial effect on the core symptoms of ADHD ( hyperactivity, inattention, and impulsivity ) in approximately 80 % of cases compared with placebo controls, in the short term. Jump up ^ Millichap JG ( 2010 ). `` Chapter 9 : Medications for ADHD ''. In Millichap JG. Attention Deficit Hyperactivity Disorder Handbook : A Physician 's Guide to ADHD ( 2nd ed. ). New York, USA : Springer. pp. 111 -- 113. ISBN 9781441913968. Jump up ^ `` Stimulants for Attention Deficit Hyperactivity Disorder ''. WebMD. Healthwise. 12 April 2010. Retrieved 12 November 2013. Jump up ^ Scholten RJ, Clarke M, Hetherington J ( August 2005 ). `` The Cochrane Collaboration ''. Eur. J. Clin. Nutr. 59 Suppl 1 : S147 -- S149 ; discussion S195 -- S196. PMID 16052183. doi : 10.1038 / sj. ejcn. 1602188. ^ Jump up to : Castells X, Ramos - Quiroga JA, Bosch R, Nogueira M, Casas M ( June 2011 ). Castells X, ed. `` Amphetamines for Attention Deficit Hyperactivity Disorder ( ADHD ) in adults ''. Cochrane Database Syst. Rev. ( 6 ) : CD007813. PMID 21678370. doi : 10.1002 / 14651858. CD007813. pub2. Jump up ^ Punja S, Shamseer L, Hartling L, Urichuk L, Vandermeer B, Nikles J, Vohra S ( February 2016 ). `` Amphetamines for attention deficit hyperactivity disorder ( ADHD ) in children and adolescents ''. Cochrane Database Syst. Rev. 2 : CD009996. PMID 26844979. doi : 10.1002 / 14651858. CD009996. pub2. Jump up ^ Pringsheim T, Steeves T ( April 2011 ). Pringsheim T, ed. `` Pharmacological treatment for Attention Deficit Hyperactivity Disorder ( ADHD ) in children with comorbid tic disorders ''. Cochrane Database Syst. Rev. ( 4 ) : CD007990. PMID 21491404. doi : 10.1002 / 14651858. CD007990. pub2. ^ Jump up to : Spencer RC, Devilbiss DM, Berridge CW ( June 2015 ). `` The Cognition - Enhancing Effects of Psychostimulants Involve Direct Action in the Prefrontal Cortex ''. Biol. Psychiatry. 77 ( 11 ) : 940 -- 950. PMC 4377121. PMID 25499957. doi : 10.1016 / j. biopsych. 2014.09. 013. The procognitive actions of psychostimulants are only associated with low doses. Surprisingly, despite nearly 80 years of clinical use, the neurobiology of the procognitive actions of psychostimulants has only recently been systematically investigated. Findings from this research unambiguously demonstrate that the cognition - enhancing effects of psychostimulants involve the preferential elevation of catecholamines in the PFC and the subsequent activation of norepinephrine α2 and dopamine D1 receptors... This differential modulation of PFC - dependent processes across dose appears to be associated with the differential involvement of noradrenergic α2 versus α1 receptors. Collectively, this evidence indicates that at low, clinically relevant doses, psychostimulants are devoid of the behavioral and neurochemical actions that define this class of drugs and instead act largely as cognitive enhancers ( improving PFC - dependent function )... In particular, in both animals and humans, lower doses maximally improve performance in tests of working memory and response inhibition, whereas maximal suppression of overt behavior and facilitation of attentional processes occurs at higher doses. Jump up ^ Ilieva IP, Hook CJ, Farah MJ ( January 2015 ). `` Prescription Stimulants ' Effects on Healthy Inhibitory Control, Working Memory, and Episodic Memory : A Meta - analysis ''. J. Cogn. Neurosci. 27 : 1 -- 21. PMID 25591060. doi : 10.1162 / jocn_a_00776. Specifically, in a set of experiments limited to high - quality designs, we found significant enhancement of several cognitive abilities... The results of this meta - analysis... do confirm the reality of cognitive enhancing effects for normal healthy adults in general, while also indicating that these effects are modest in size. Jump up ^ Bagot KS, Kaminer Y ( April 2014 ). `` Efficacy of stimulants for cognitive enhancement in non-attention deficit hyperactivity disorder youth : a systematic review ''. Addiction. 109 ( 4 ) : 547 -- 557. PMC 4471173. PMID 24749160. doi : 10.1111 / add. 12460. Amphetamine has been shown to improve consolidation of information ( 0.02 ≥ P ≤ 0.05 ), leading to improved recall. Jump up ^ Devous MD, Trivedi MH, Rush AJ ( April 2001 ). `` Regional cerebral blood flow response to oral amphetamine challenge in healthy volunteers ''. J. Nucl. Med. 42 ( 4 ) : 535 -- 542. PMID 11337538. Jump up ^ Malenka RC, Nestler EJ, Hyman SE ( 2009 ). `` Chapter 10 : Neural and Neuroendocrine Control of the Internal Milieu ''. In Sydor A, Brown RY. Molecular Neuropharmacology : A Foundation for Clinical Neuroscience ( 2nd ed. ). New York, USA : McGraw - Hill Medical. p. 266. ISBN 9780071481274. Dopamine acts in the nucleus accumbens to attach motivational significance to stimuli associated with reward. ^ Jump up to : Wood S, Sage JR, Shuman T, Anagnostaras SG ( January 2014 ). `` Psychostimulants and cognition : a continuum of behavioral and cognitive activation ''. Pharmacol. Rev. 66 ( 1 ) : 193 -- 221. PMID 24344115. doi : 10.1124 / pr. 112.007054. Jump up ^ Twohey M ( 26 March 2006 ). `` Pills become an addictive study aid ''. JS Online. Archived from the original on 15 August 2007. Retrieved 2 December 2007. Jump up ^ Teter CJ, McCabe SE, LaGrange K, Cranford JA, Boyd CJ ( October 2006 ). `` Illicit use of specific prescription stimulants among college students : prevalence, motives, and routes of administration ''. Pharmacotherapy. 26 ( 10 ) : 1501 -- 1510. PMC 1794223. PMID 16999660. doi : 10.1592 / phco. 26.10. 1501. Jump up ^ Weyandt LL, Oster DR, Marraccini ME, Gudmundsdottir BG, Munro BA, Zavras BM, Kuhar B ( September 2014 ). `` Pharmacological interventions for adolescents and adults with ADHD : stimulant and nonstimulant medications and misuse of prescription stimulants ''. Psychol. Res. Behav. Manag. 7 : 223 -- 249. PMC 4164338. PMID 25228824. doi : 10.2147 / PRBM. S47013. misuse of prescription stimulants has become a serious problem on college campuses across the US and has been recently documented in other countries as well... Indeed, large numbers of students claim to have engaged in the nonmedical use of prescription stimulants, which is reflected in lifetime prevalence rates of prescription stimulant misuse ranging from 5 % to nearly 34 % of students. Jump up ^ Clemow DB, Walker DJ ( September 2014 ). `` The potential for misuse and abuse of medications in ADHD : a review ''. Postgrad. Med. 126 ( 5 ) : 64 -- 81. PMID 25295651. doi : 10.3810 / pgm. 2014.09. 2801. Overall, the data suggest that ADHD medication misuse and diversion are common health care problems for stimulant medications, with the prevalence believed to be approximately 5 % to 10 % of high school students and 5 % to 35 % of college students, depending on the study. ^ Jump up to : Liddle DG, Connor DJ ( June 2013 ). `` Nutritional supplements and ergogenic AIDS ''. Prim. Care. 40 ( 2 ) : 487 -- 505. PMID 23668655. doi : 10.1016 / j. pop. 2013.02. 009. Amphetamines and caffeine are stimulants that increase alertness, improve focus, decrease reaction time, and delay fatigue, allowing for an increased intensity and duration of training... Physiologic and performance effects Amphetamines increase dopamine / norepinephrine release and inhibit their reuptake, leading to central nervous system ( CNS ) stimulation Amphetamines seem to enhance athletic performance in anaerobic conditions 39 40 Improved reaction time Increased muscle strength and delayed muscle fatigue Increased acceleration Increased alertness and attention to task ^ Jump up to : Westfall DP, Westfall TC ( 2010 ). `` Miscellaneous Sympathomimetic Agonists ''. In Brunton LL, Chabner BA, Knollmann BC. Goodman & Gilman 's Pharmacological Basis of Therapeutics ( 12th ed. ). New York, USA : McGraw - Hill. ISBN 9780071624428. Jump up ^ Bracken NM ( January 2012 ). `` National Study of Substance Use Trends Among NCAA College Student - Athletes '' ( PDF ). NCAA Publications. National Collegiate Athletic Association. Retrieved 8 October 2013. Jump up ^ Docherty JR ( June 2008 ). `` Pharmacology of stimulants prohibited by the World Anti-Doping Agency ( WADA ) ''. Br. J. Pharmacol. 154 ( 3 ) : 606 -- 622. PMC 2439527. PMID 18500382. doi : 10.1038 / bjp. 2008.124. ^ Jump up to : Parr JW ( July 2011 ). `` Attention - deficit hyperactivity disorder and the athlete : new advances and understanding ''. Clin. Sports Med. 30 ( 3 ) : 591 -- 610. PMID 21658550. doi : 10.1016 / j. csm. 2011.03. 007. In 1980, Chandler and Blair showed significant increases in knee extension strength, acceleration, anaerobic capacity, time to exhaustion during exercise, pre-exercise and maximum heart rates, and time to exhaustion during maximal oxygen consumption ( VO2 max ) testing after administration of 15 mg of dextroamphetamine versus placebo. Most of the information to answer this question has been obtained in the past decade through studies of fatigue rather than an attempt to systematically investigate the effect of ADHD drugs on exercise. ^ Jump up to : Roelands B, de Koning J, Foster C, Hettinga F, Meeusen R ( May 2013 ). `` Neurophysiological determinants of theoretical concepts and mechanisms involved in pacing ''. Sports Med. 43 ( 5 ) : 301 -- 311. PMID 23456493. doi : 10.1007 / s40279 - 013 - 0030 - 4. In high - ambient temperatures, dopaminergic manipulations clearly improve performance. The distribution of the power output reveals that after dopamine reuptake inhibition, subjects are able to maintain a higher power output compared with placebo... Dopaminergic drugs appear to override a safety switch and allow athletes to use a reserve capacity that is ' off - limits ' in a normal ( placebo ) situation. Jump up ^ Parker KL, Lamichhane D, Caetano MS, Narayanan NS ( October 2013 ). `` Executive dysfunction in Parkinson 's disease and timing deficits ''. Front. Integr. Neurosci. 7 : 75. PMC 3813949. PMID 24198770. doi : 10.3389 / fnint. 2013.00075. Manipulations of dopaminergic signaling profoundly influence interval timing, leading to the hypothesis that dopamine influences internal pacemaker, or `` clock, '' activity. For instance, amphetamine, which increases concentrations of dopamine at the synaptic cleft advances the start of responding during interval timing, whereas antagonists of D2 type dopamine receptors typically slow timing ;... Depletion of dopamine in healthy volunteers impairs timing, while amphetamine releases synaptic dopamine and speeds up timing. Jump up ^ Rattray B, Argus C, Martin K, Northey J, Driller M ( March 2015 ). `` Is it time to turn our attention toward central mechanisms for post-exertional recovery strategies and performance ? ''. Front. Physiol. 6 : 79. PMC 4362407. PMID 25852568. doi : 10.3389 / fphys. 2015.00079. Aside from accounting for the reduced performance of mentally fatigued participants, this model rationalizes the reduced RPE and hence improved cycling time trial performance of athletes using a glucose mouthwash ( Chambers et al., 2009 ) and the greater power output during a RPE matched cycling time trial following amphetamine ingestion ( Swart, 2009 )... Dopamine stimulating drugs are known to enhance aspects of exercise performance ( Roelands et al., 2008 ) Jump up ^ Roelands B, De Pauw K, Meeusen R ( June 2015 ). `` Neurophysiological effects of exercise in the heat ''. Scand. J. Med. Sci. Sports. 25 Suppl 1 : 65 -- 78. PMID 25943657. doi : 10.1111 / sms. 12350. This indicates that subjects did not feel they were producing more power and consequently more heat. The authors concluded that the `` safety switch '' or the mechanisms existing in the body to prevent harmful effects are overridden by the drug administration ( Roelands et al., 2008b ). Taken together, these data indicate strong ergogenic effects of an increased DA concentration in the brain, without any change in the perception of effort. ^ Jump up to : `` Adderall XR Prescribing Information '' ( PDF ). United States Food and Drug Administration. Shire US Inc. December 2013. p. 11. Retrieved 30 December 2013. ^ Jump up to : `` Adderall XR Prescribing Information '' ( PDF ). United States Food and Drug Administration. Shire US Inc. December 2013. pp. 4 -- 8. Retrieved 30 December 2013. ^ Jump up to : Heedes G ; Ailakis J. `` Amphetamine ( PIM 934 ) ''. INCHEM. International Programme on Chemical Safety. Retrieved 24 June 2014. ^ Jump up to : `` Adderall XR Prescribing Information '' ( PDF ). United States Food and Drug Administration. Shire US Inc. December 2013. pp. 4 -- 6. Retrieved 30 December 2013. Jump up ^ `` FDA Pregnancy Categories '' ( PDF ). United States Food and Drug Administration. 21 October 2004. Retrieved 31 October 2013. Jump up ^ `` Dexamphetamine tablets ''. Therapeutic Goods Administration. Retrieved 12 April 2014. Jump up ^ `` Adderall XR Prescribing Information '' ( PDF ). United States Food and Drug Administration. Shire US Inc. December 2013. pp. 4 -- 8, 11. Retrieved 30 December 2013. ^ Jump up to : Vitiello B ( April 2008 ). `` Understanding the risk of using medications for attention deficit hyperactivity disorder with respect to physical growth and cardiovascular function ''. Child Adolesc. Psychiatr. Clin. N. Am. 17 ( 2 ) : 459 -- 474. PMC 2408826. PMID 18295156. doi : 10.1016 / j. chc. 2007.11. 010. ^ Jump up to : `` Dyanavel XR Prescribing Information '' ( PDF ). United States Food and Drug Administration. Tris Pharma, Inc. May 2017. pp. 1 -- 14. Retrieved 4 August 2017. DYANAVEL XR contains d - amphetamine and l - amphetamine in a ratio of 3.2 to 1... The most common ( ≥ 2 % in the DYANAVEL XR group and greater than placebo ) adverse reactions reported in the Phase 3 controlled study conducted in 108 patients with ADHD ( aged 6 -- 12 years ) were : epistaxis, allergic rhinitis and upper abdominal pain... DOSAGE FORMS AND STRENGTHS Extended - release oral suspension contains 2.5 mg amphetamine base per mL. Jump up ^ Ramey JT, Bailen E, Lockey RF ( 2006 ). `` Rhinitis medicamentosa '' ( PDF ). J. Investig. Allergol. Clin. Immunol. 16 ( 3 ) : 148 -- 155. PMID 16784007. Retrieved 29 April 2015. Table 2. Decongestants Causing Rhinitis Medicamentosa -- Nasal decongestants : -- Sympathomimetic : Amphetamine ^ Jump up to : `` FDA Drug Safety Communication : Safety Review Update of Medications used to treat Attention - Deficit / Hyperactivity Disorder ( ADHD ) in children and young adults ''. United States Food and Drug Administration. 20 December 2011. Retrieved 4 November 2013. Jump up ^ Cooper WO, Habel LA, Sox CM, Chan KA, Arbogast PG, Cheetham TC, Murray KT, Quinn VP, Stein CM, Callahan ST, Fireman BH, Fish FA, Kirshner HS, O'Duffy A, Connell FA, Ray WA ( November 2011 ). `` ADHD drugs and serious cardiovascular events in children and young adults ''. N. Engl. J. Med. 365 ( 20 ) : 1896 -- 1904. PMC 4943074. PMID 22043968. doi : 10.1056 / NEJMoa1110212. ^ Jump up to : `` FDA Drug Safety Communication : Safety Review Update of Medications used to treat Attention - Deficit / Hyperactivity Disorder ( ADHD ) in adults ''. United States Food and Drug Administration. 15 December 2011. Retrieved 4 November 2013. Jump up ^ Habel LA, Cooper WO, Sox CM, Chan KA, Fireman BH, Arbogast PG, Cheetham TC, Quinn VP, Dublin S, Boudreau DM, Andrade SE, Pawloski PA, Raebel MA, Smith DH, Achacoso N, Uratsu C, Go AS, Sidney S, Nguyen - Huynh MN, Ray WA, Selby JV ( December 2011 ). `` ADHD medications and risk of serious cardiovascular events in young and middle - aged adults ''. JAMA. 306 ( 24 ) : 2673 -- 2683. PMC 3350308. PMID 22161946. doi : 10.1001 / jama. 2011.1830. Jump up ^ Montgomery KA ( June 2008 ). `` Sexual desire disorders ''. Psychiatry ( Edgmont ). 5 ( 6 ) : 50 -- 55. PMC 2695750. PMID 19727285. Jump up ^ O'Connor PG ( February 2012 ). `` Amphetamines ''. Merck Manual for Health Care Professionals. Merck. Retrieved 8 May 2012. ^ Jump up to : Shoptaw SJ, Kao U, Ling W ( January 2009 ). Shoptaw SJ, Ali R, ed. `` Treatment for amphetamine psychosis ''. Cochrane Database Syst. Rev. ( 1 ) : CD003026. PMID 19160215. doi : 10.1002 / 14651858. CD003026. pub3. A minority of individuals who use amphetamines develop full - blown psychosis requiring care at emergency departments or psychiatric hospitals. In such cases, symptoms of amphetamine psychosis commonly include paranoid and persecutory delusions as well as auditory and visual hallucinations in the presence of extreme agitation. More common ( about 18 % ) is for frequent amphetamine users to report psychotic symptoms that are sub-clinical and that do not require high - intensity intervention... About 5 -- 15 % of the users who develop an amphetamine psychosis fail to recover completely ( Hofmann 1983 )... Findings from one trial indicate use of antipsychotic medications effectively resolves symptoms of acute amphetamine psychosis. ^ Jump up to : Greydanus D. `` Stimulant Misuse : Strategies to Manage a Growing Problem '' ( PDF ). American College Health Association ( Review Article ). ACHA Professional Development Program. p. 20. Archived from the original ( PDF ) on 3 November 2013. Retrieved 2 November 2013. ^ Jump up to : Childs E, de Wit H ( May 2009 ). `` Amphetamine - induced place preference in humans ''. Biol. Psychiatry. 65 ( 10 ) : 900 -- 904. PMC 2693956. PMID 19111278. doi : 10.1016 / j. biopsych. 2008.11. 016. This study demonstrates that humans, like nonhumans, prefer a place associated with amphetamine administration. These findings support the idea that subjective responses to a drug contribute to its ability to establish place conditioning. ^ Jump up to : Malenka RC, Nestler EJ, Hyman SE ( 2009 ). `` Chapter 15 : Reinforcement and Addictive Disorders ''. In Sydor A, Brown RY. Molecular Neuropharmacology : A Foundation for Clinical Neuroscience ( 2nd ed. ). New York : McGraw - Hill Medical. pp. 364 -- 375. ISBN 9780071481274. ^ Jump up to : Spiller HA, Hays HL, Aleguas A ( June 2013 ). `` Overdose of drugs for attention - deficit hyperactivity disorder : clinical presentation, mechanisms of toxicity, and management ''. CNS Drugs. 27 ( 7 ) : 531 -- 543. PMID 23757186. doi : 10.1007 / s40263 - 013 - 0084 - 8. Amphetamine, dextroamphetamine, and methylphenidate act as substrates for the cellular monoamine transporter, especially the dopamine transporter ( DAT ) and less so the norepinephrine ( NET ) and serotonin transporter. The mechanism of toxicity is primarily related to excessive extracellular dopamine, norepinephrine, and serotonin. Jump up ^ Collaborators ( 2015 ). `` Global, regional, and national age - sex specific all - cause and cause - specific mortality for 240 causes of death, 1990 -- 2013 : a systematic analysis for the Global Burden of Disease Study 2013 '' ( PDF ). Lancet. 385 ( 9963 ) : 117 -- 171. PMC 4340604. PMID 25530442. doi : 10.1016 / S0140 - 6736 ( 14 ) 61682 - 2. Retrieved 3 March 2015. Amphetamine use disorders... 3,788 ( 3,425 -- 4,145 ) Jump up ^ Kanehisa Laboratories ( 10 October 2014 ). `` Amphetamine -- Homo sapiens ( human ) ''. KEGG Pathway. Retrieved 31 October 2014. ^ Jump up to : Nechifor M ( March 2008 ). `` Magnesium in drug dependences ''. Magnes. Res. 21 ( 1 ) : 5 -- 15. PMID 18557129. ^ Jump up to : Ruffle JK ( November 2014 ). `` Molecular neurobiology of addiction : what 's all the ( Δ ) FosB about ? ''. Am. J. Drug Alcohol Abuse. 40 ( 6 ) : 428 -- 437. PMID 25083822. doi : 10.3109 / 00952990.2014. 933840. ΔFosB is an essential transcription factor implicated in the molecular and behavioral pathways of addiction following repeated drug exposure. ^ Jump up to : Nestler EJ ( December 2013 ). `` Cellular basis of memory for addiction ''. Dialogues Clin. Neurosci. 15 ( 4 ) : 431 -- 443. PMC 3898681. PMID 24459410. Despite the importance of numerous psychosocial factors, at its core, drug addiction involves a biological process : the ability of repeated exposure to a drug of abuse to induce changes in a vulnerable brain that drive the compulsive seeking and taking of drugs, and loss of control over drug use, that define a state of addiction... A large body of literature has demonstrated that such ΔFosB induction in D1 - type ( nucleus accumbens ) neurons increases an animal 's sensitivity to drug as well as natural rewards and promotes drug self - administration, presumably through a process of positive reinforcement... Another ΔFosB target is cFos : as ΔFosB accumulates with repeated drug exposure it represses c - Fos and contributes to the molecular switch whereby ΔFosB is selectively induced in the chronic drug - treated state.... Moreover, there is increasing evidence that, despite a range of genetic risks for addiction across the population, exposure to sufficiently high doses of a drug for long periods of time can transform someone who has relatively lower genetic loading into an addict. Jump up ^ Robison AJ, Nestler EJ ( November 2011 ). `` Transcriptional and epigenetic mechanisms of addiction ''. Nat. Rev. Neurosci. 12 ( 11 ) : 623 -- 637. PMC 3272277. PMID 21989194. doi : 10.1038 / nrn3111. ΔFosB serves as one of the master control proteins governing this structural plasticity. ^ Jump up to : Olsen CM ( December 2011 ). `` Natural rewards, neuroplasticity, and non-drug addictions ''. Neuropharmacology. 61 ( 7 ) : 1109 -- 1122. PMC 3139704. PMID 21459101. doi : 10.1016 / j. neuropharm. 2011.03. 010. Similar to environmental enrichment, studies have found that exercise reduces self - administration and relapse to drugs of abuse ( Cosgrove et al., 2002 ; Zlebnik et al., 2010 ). There is also some evidence that these preclinical findings translate to human populations, as exercise reduces withdrawal symptoms and relapse in abstinent smokers ( Daniel et al., 2006 ; Prochaska et al., 2008 ), and one drug recovery program has seen success in participants that train for and compete in a marathon as part of the program ( Butler, 2005 )... In humans, the role of dopamine signaling in incentive - sensitization processes has recently been highlighted by the observation of a dopamine dysregulation syndrome in some patients taking dopaminergic drugs. This syndrome is characterized by a medication - induced increase in ( or compulsive ) engagement in non-drug rewards such as gambling, shopping, or sex ( Evans et al., 2006 ; Aiken, 2007 ; Lader, 2008 ). ^ Jump up to : Lynch WJ, Peterson AB, Sanchez V, Abel J, Smith MA ( September 2013 ). `` Exercise as a novel treatment for drug addiction : a neurobiological and stage - dependent hypothesis ''. Neurosci. Biobehav. Rev. 37 ( 8 ) : 1622 -- 1644. PMC 3788047. PMID 23806439. doi : 10.1016 / j. neubiorev. 2013.06. 011. These findings suggest that exercise may `` magnitude '' - dependently prevent the development of an addicted phenotype possibly by blocking / reversing behavioral and neuroadaptive changes that develop during and following extended access to the drug... Exercise has been proposed as a treatment for drug addiction that may reduce drug craving and risk of relapse. Although few clinical studies have investigated the efficacy of exercise for preventing relapse, the few studies that have been conducted generally report a reduction in drug craving and better treatment outcomes... Taken together, these data suggest that the potential benefits of exercise during relapse, particularly for relapse to psychostimulants, may be mediated via chromatin remodeling and possibly lead to greater treatment outcomes. ^ Jump up to : Zhou Y, Zhao M, Zhou C, Li R ( July 2015 ). `` Sex differences in drug addiction and response to exercise intervention : From human to animal studies ''. Front. Neuroendocrinol. 40 : 24 -- 41. PMID 26182835. doi : 10.1016 / j. yfrne. 2015.07. 001. Collectively, these findings demonstrate that exercise may serve as a substitute or competition for drug abuse by changing ΔFosB or cFos immunoreactivity in the reward system to protect against later or previous drug use... The postulate that exercise serves as an ideal intervention for drug addiction has been widely recognized and used in human and animal rehabilitation. ^ Jump up to : Linke SE, Ussher M ( January 2015 ). `` Exercise - based treatments for substance use disorders : evidence, theory, and practicality ''. Am. J. Drug Alcohol Abuse. 41 ( 1 ) : 7 -- 15. PMC 4831948. PMID 25397661. doi : 10.3109 / 00952990.2014. 976708. The limited research conducted suggests that exercise may be an effective adjunctive treatment for SUDs. In contrast to the scarce intervention trials to date, a relative abundance of literature on the theoretical and practical reasons supporting the investigation of this topic has been published... numerous theoretical and practical reasons support exercise - based treatments for SUDs, including psychological, behavioral, neurobiological, nearly universal safety profile, and overall positive health effects. ^ Jump up to : Malenka RC, Nestler EJ, Hyman SE ( 2009 ). `` Chapter 15 : Reinforcement and Addictive Disorders ''. In Sydor A, Brown RY. Molecular Neuropharmacology : A Foundation for Clinical Neuroscience ( 2nd ed. ). New York, USA : McGraw - Hill Medical. p. 386. ISBN 9780071481274. Currently, cognitive -- behavioral therapies are the most successful treatment available for preventing the relapse of psychostimulant use. Jump up ^ Greene SL, Kerr F, Braitberg G ( October 2008 ). `` Review article : amphetamines and related drugs of abuse ''. Emerg. Med. Australas. 20 ( 5 ) : 391 -- 402. PMID 18973636. doi : 10.1111 / j. 1742 - 6723.2008. 01114. x. Jump up ^ Albertson TE ( 2011 ). `` Amphetamines ''. In Olson KR, Anderson IB, Benowitz NL, Blanc PD, Kearney TE, Kim - Katz SY, Wu AH. Poisoning & Drug Overdose ( 6th ed. ). New York : McGraw - Hill Medical. pp. 77 -- 79. ISBN 9780071668330. Jump up ^ `` Glossary of Terms ''. Mount Sinai School of Medicine. Department of Neuroscience. Retrieved 9 February 2015. Jump up ^ Volkow ND, Koob GF, McLellan AT ( January 2016 ). `` Neurobiologic Advances from the Brain Disease Model of Addiction ''. N. Engl. J. Med. 374 ( 4 ) : 363 -- 371. PMID 26816013. doi : 10.1056 / NEJMra1511480. Substance - use disorder : A diagnostic term in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM - 5 ) referring to recurrent use of alcohol or other drugs that causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. Depending on the level of severity, this disorder is classified as mild, moderate, or severe. Addiction : A term used to indicate the most severe, chronic stage of substance - use disorder, in which there is a substantial loss of self - control, as indicated by compulsive drug taking despite the desire to stop taking the drug. In the DSM - 5, the term addiction is synonymous with the classification of severe substance - use disorder. ^ Jump up to : Renthal W, Nestler EJ ( September 2009 ). `` Chromatin regulation in drug addiction and depression ''. Dialogues Clin. Neurosci. 11 ( 3 ) : 257 -- 268. PMC 2834246. PMID 19877494. ( Psychostimulants ) increase cAMP levels in striatum, which activates protein kinase A ( PKA ) and leads to phosphorylation of its targets. This includes the cAMP response element binding protein ( CREB ), the phosphorylation of which induces its association with the histone acetyltransferase, CREB binding protein ( CBP ) to acetylate histones and facilitate gene activation. This is known to occur on many genes including fosB and c - fos in response to psychostimulant exposure. ΔFosB is also upregulated by chronic psychostimulant treatments, and is known to activate certain genes ( eg, cdk5 ) and repress others ( eg, c - fos ) where it recruits HDAC1 as a corepressor... Chronic exposure to psychostimulants increases glutamatergic ( signaling ) from the prefrontal cortex to the NAc. Glutamatergic signaling elevates Ca2+ levels in NAc postsynaptic elements where it activates CaMK ( calcium / calmodulin protein kinases ) signaling, which, in addition to phosphorylating CREB, also phosphorylates HDAC5. Figure 2 : Psychostimulant - induced signaling events Jump up ^ Broussard JI ( January 2012 ). `` Co-transmission of dopamine and glutamate ''. J. Gen. Physiol. 139 ( 1 ) : 93 -- 96. PMC 3250102. PMID 22200950. doi : 10.1085 / jgp. 201110659. Coincident and convergent input often induces plasticity on a postsynaptic neuron. The NAc integrates processed information about the environment from basolateral amygdala, hippocampus, and prefrontal cortex ( PFC ), as well as projections from midbrain dopamine neurons. Previous studies have demonstrated how dopamine modulates this integrative process. For example, high frequency stimulation potentiates hippocampal inputs to the NAc while simultaneously depressing PFC synapses ( Goto and Grace, 2005 ). The converse was also shown to be true ; stimulation at PFC potentiates PFC -- NAc synapses but depresses hippocampal -- NAc synapses. In light of the new functional evidence of midbrain dopamine / glutamate co-transmission ( references above ), new experiments of NAc function will have to test whether midbrain glutamatergic inputs bias or filter either limbic or cortical inputs to guide goal - directed behavior. Jump up ^ Kanehisa Laboratories ( 10 October 2014 ). `` Amphetamine -- Homo sapiens ( human ) ''. KEGG Pathway. Retrieved 31 October 2014. Most addictive drugs increase extracellular concentrations of dopamine ( DA ) in nucleus accumbens ( NAc ) and medial prefrontal cortex ( mPFC ), projection areas of mesocorticolimbic DA neurons and key components of the `` brain reward circuit ''. Amphetamine achieves this elevation in extracellular levels of DA by promoting efflux from synaptic terminals... Chronic exposure to amphetamine induces a unique transcription factor delta FosB, which plays an essential role in long - term adaptive changes in the brain. Jump up ^ Cadet JL, Brannock C, Jayanthi S, Krasnova IN ( 2015 ). `` Transcriptional and epigenetic substrates of methamphetamine addiction and withdrawal : evidence from a long - access self - administration model in the rat ''. Mol. Neurobiol. 51 ( 2 ) : 696 -- 717. PMC 4359351. PMID 24939695. doi : 10.1007 / s12035 - 014 - 8776 - 8. Figure 1 ^ Jump up to : Robison AJ, Nestler EJ ( November 2011 ). `` Transcriptional and epigenetic mechanisms of addiction ''. Nat. Rev. Neurosci. 12 ( 11 ) : 623 -- 637. PMC 3272277. PMID 21989194. doi : 10.1038 / nrn3111. ΔFosB serves as one of the master control proteins governing this structural plasticity... ΔFosB also represses G9a expression, leading to reduced repressive histone methylation at the cdk5 gene. The net result is gene activation and increased CDK5 expression... In contrast, ΔFosB binds to the c - fos gene and recruits several co-repressors, including HDAC1 ( histone deacetylase 1 ) and SIRT 1 ( sirtuin 1 )... The net result is c - fos gene repression. Figure 4 : Epigenetic basis of drug regulation of gene expression ^ Jump up to : Nestler EJ ( December 2012 ). `` Transcriptional mechanisms of drug addiction ''. Clin. Psychopharmacol. Neurosci. 10 ( 3 ) : 136 -- 143. PMC 3569166. PMID 23430970. doi : 10.9758 / cpn. 2012.10. 3.136. The 35 - 37 kD ΔFosB isoforms accumulate with chronic drug exposure due to their extraordinarily long half - lives... As a result of its stability, the ΔFosB protein persists in neurons for at least several weeks after cessation of drug exposure... ΔFosB overexpression in nucleus accumbens induces NFκB... In contrast, the ability of ΔFosB to repress the c - Fos gene occurs in concert with the recruitment of a histone deacetylase and presumably several other repressive proteins such as a repressive histone methyltransferase Jump up ^ Nestler EJ ( October 2008 ). `` Review. Transcriptional mechanisms of addiction : role of DeltaFosB ''. Philos. Trans. R. Soc. Lond., B, Biol. Sci. 363 ( 1507 ) : 3245 -- 3255. PMC 2607320. PMID 18640924. doi : 10.1098 / rstb. 2008.0067. Recent evidence has shown that ΔFosB also represses the c - fos gene that helps create the molecular switch -- from the induction of several short - lived Fos family proteins after acute drug exposure to the predominant accumulation of ΔFosB after chronic drug exposure Jump up ^ Malenka RC, Nestler EJ, Hyman SE ( 2009 ). `` Chapter 15 : Reinforcement and Addictive Disorders ''. In Sydor A, Brown RY. Molecular Neuropharmacology : A Foundation for Clinical Neuroscience ( 2nd ed. ). New York : McGraw - Hill Medical. p. 368. ISBN 9780071481274. Such agents also have important therapeutic uses ; cocaine, for example, is used as a local anesthetic ( Chapter 2 ), and amphetamines and methylphenidate are used in low doses to treat attention deficit hyperactivity disorder and in higher doses to treat narcolepsy ( Chapter 12 ). Despite their clinical uses, these drugs are strongly reinforcing, and their long - term use at high doses is linked with potential addiction, especially when they are rapidly administered or when high - potency forms are given. Jump up ^ Kollins SH ( May 2008 ). `` A qualitative review of issues arising in the use of psycho - stimulant medications in patients with ADHD and co-morbid substance use disorders ''. Curr. Med. Res. Opin. 24 ( 5 ) : 1345 -- 1357. PMID 18384709. doi : 10.1185 / 030079908X280707. When oral formulations of psychostimulants are used at recommended doses and frequencies, they are unlikely to yield effects consistent with abuse potential in patients with ADHD. Jump up ^ Stolerman IP ( 2010 ). Stolerman IP, ed. Encyclopedia of Psychopharmacology. Berlin, Germany ; London, England : Springer. p. 78. ISBN 9783540686989. Jump up ^ Coghill DR, Caballero B, Sorooshian S, Civil R ( June 2014 ). `` A systematic review of the safety of lisdexamfetamine dimesylate ''. CNS Drugs. 28 ( 6 ) : 497 -- 511. PMC 4057639. PMID 24788672. doi : 10.1007 / s40263 - 014 - 0166 - 2. The prodrug formulation of LDX may also lead to reduced abuse potential of LDX compared with immediate - release d - AMP. Jump up ^ `` Amphetamines : Drug Use and Abuse ''. Merck Manual Home Edition. Merck. February 2003. Archived from the original on 17 February 2007. Retrieved 28 February 2007. Jump up ^ Perez - Mana C, Castells X, Torrens M, Capella D, Farre M ( September 2013 ). Pérez - Mañá C, ed. `` Efficacy of psychostimulant drugs for amphetamine abuse or dependence ''. Cochrane Database Syst. Rev. 9 : CD009695. PMID 23996457. doi : 10.1002 / 14651858. CD009695. pub2. Jump up ^ Hyman SE, Malenka RC, Nestler EJ ( July 2006 ). `` Neural mechanisms of addiction : the role of reward - related learning and memory ''. Annu. Rev. Neurosci. 29 : 565 -- 598. PMID 16776597. doi : 10.1146 / annurev. neuro. 29.051605. 113009. ^ Jump up to : Robison AJ, Nestler EJ ( November 2011 ). `` Transcriptional and epigenetic mechanisms of addiction ''. Nat. Rev. Neurosci. 12 ( 11 ) : 623 -- 637. PMC 3272277. PMID 21989194. doi : 10.1038 / nrn3111. ^ Jump up to : Steiner H, Van Waes V ( January 2013 ). `` Addiction - related gene regulation : risks of exposure to cognitive enhancers vs. other psychostimulants ''. Prog. Neurobiol. 100 : 60 -- 80. PMC 3525776. PMID 23085425. doi : 10.1016 / j. pneurobio. 2012.10. 001. Jump up ^ Malenka RC, Nestler EJ, Hyman SE ( 2009 ). `` Chapter 4 : Signal Transduction in the Brain ''. In Sydor A, Brown RY. Molecular Neuropharmacology : A Foundation for Clinical Neuroscience ( 2nd ed. ). New York, USA : McGraw - Hill Medical. p. 94. ISBN 9780071481274. Jump up ^ Kanehisa Laboratories ( 29 October 2014 ). `` Alcoholism -- Homo sapiens ( human ) ''. KEGG Pathway. Retrieved 31 October 2014. Jump up ^ Kim Y, Teylan MA, Baron M, Sands A, Nairn AC, Greengard P ( February 2009 ). `` Methylphenidate - induced dendritic spine formation and DeltaFosB expression in nucleus accumbens ''. Proc. Natl. Acad. Sci. U.S.A. 106 ( 8 ) : 2915 -- 2920. PMC 2650365. PMID 19202072. doi : 10.1073 / pnas. 0813179106. Jump up ^ Nestler EJ ( January 2014 ). `` Epigenetic mechanisms of drug addiction ''. Neuropharmacology. 76 Pt B : 259 -- 268. PMC 3766384. PMID 23643695. doi : 10.1016 / j. neuropharm. 2013.04. 004. ^ Jump up to : Blum K, Werner T, Carnes S, Carnes P, Bowirrat A, Giordano J, Oscar - Berman M, Gold M ( March 2012 ). `` Sex, drugs, and rock ' n ' roll : hypothesizing common mesolimbic activation as a function of reward gene polymorphisms ''. J. Psychoactive Drugs. 44 ( 1 ) : 38 -- 55. PMC 4040958. PMID 22641964. doi : 10.1080 / 02791072.2012. 662112. Jump up ^ Pitchers KK, Vialou V, Nestler EJ, Laviolette SR, Lehman MN, Coolen LM ( February 2013 ). `` Natural and drug rewards act on common neural plasticity mechanisms with ΔFosB as a key mediator ''. J. Neurosci. 33 ( 8 ) : 3434 -- 3442. PMC 3865508. PMID 23426671. doi : 10.1523 / JNEUROSCI. 4881 - 12.2013. Jump up ^ Beloate LN, Weems PW, Casey GR, Webb IC, Coolen LM ( February 2016 ). `` Nucleus accumbens NMDA receptor activation regulates amphetamine cross-sensitization and deltaFosB expression following sexual experience in male rats ''. Neuropharmacology. 101 : 154 -- 164. PMID 26391065. doi : 10.1016 / j. neuropharm. 2015.09. 023. Jump up ^ Stoops WW, Rush CR ( May 2014 ). `` Combination pharmacotherapies for stimulant use disorder : a review of clinical findings and recommendations for future research ''. Expert Rev Clin Pharmacol. 7 ( 3 ) : 363 -- 374. PMC 4017926. PMID 24716825. doi : 10.1586 / 17512433.2014. 909283. Despite concerted efforts to identify a pharmacotherapy for managing stimulant use disorders, no widely effective medications have been approved. Jump up ^ Perez - Mana C, Castells X, Torrens M, Capella D, Farre M ( September 2013 ). `` Efficacy of psychostimulant drugs for amphetamine abuse or dependence ''. Cochrane Database Syst. Rev. 9 : CD009695. PMID 23996457. doi : 10.1002 / 14651858. CD009695. pub2. To date, no pharmacological treatment has been approved for ( addiction ), and psychotherapy remains the mainstay of treatment... Results of this review do not support the use of psychostimulant medications at the tested doses as a replacement therapy Jump up ^ Forray A, Sofuoglu M ( February 2014 ). `` Future pharmacological treatments for substance use disorders ''. Br. J. Clin. Pharmacol. 77 ( 2 ) : 382 -- 400. PMC 4014020. PMID 23039267. doi : 10.1111 / j. 1365 - 2125.2012. 04474. x. ^ Jump up to : Grandy DK, Miller GM, Li JX ( February 2016 ). `` '' TAARgeting Addiction `` - The Alamo Bears Witness to Another Revolution : An Overview of the Plenary Symposium of the 2015 Behavior, Biology and Chemistry Conference ''. Drug Alcohol Depend. 159 : 9 -- 16. PMID 26644139. doi : 10.1016 / j. drugalcdep. 2015.11. 014. When considered together with the rapidly growing literature in the field a compelling case emerges in support of developing TAAR1 - selective agonists as medications for preventing relapse to psychostimulant abuse. ^ Jump up to : Jing L, Li JX ( August 2015 ). `` Trace amine - associated receptor 1 : A promising target for the treatment of psychostimulant addiction ''. Eur. J. Pharmacol. 761 : 345 -- 352. PMC 4532615. PMID 26092759. doi : 10.1016 / j. ejphar. 2015.06. 019. Existing data provided robust preclinical evidence supporting the development of TAAR1 agonists as potential treatment for psychostimulant abuse and addiction. ^ Jump up to : Malenka RC, Nestler EJ, Hyman SE ( 2009 ). `` Chapter 5 : Excitatory and Inhibitory Amino Acids ''. In Sydor A, Brown RY. Molecular Neuropharmacology : A Foundation for Clinical Neuroscience ( 2nd ed. ). New York, USA : McGraw - Hill Medical. pp. 124 -- 125. ISBN 9780071481274. ^ Jump up to : Carroll ME, Smethells JR ( February 2016 ). `` Sex Differences in Behavioral Dyscontrol : Role in Drug Addiction and Novel Treatments ''. Front. Psychiatry. 6 : 175. PMC 4745113. PMID 26903885. doi : 10.3389 / fpsyt. 2015.00175. Physical Exercise There is accelerating evidence that physical exercise is a useful treatment for preventing and reducing drug addiction... In some individuals, exercise has its own rewarding effects, and a behavioral economic interaction may occur, such that physical and social rewards of exercise can substitute for the rewarding effects of drug abuse... The value of this form of treatment for drug addiction in laboratory animals and humans is that exercise, if it can substitute for the rewarding effects of drugs, could be self - maintained over an extended period of time. Work to date in ( laboratory animals and humans ) regarding exercise as a treatment for drug addiction supports this hypothesis... Animal and human research on physical exercise as a treatment for stimulant addiction indicates that this is one of the most promising treatments on the horizon. ^ Jump up to : Shoptaw SJ, Kao U, Heinzerling K, Ling W ( April 2009 ). Shoptaw SJ, ed. `` Treatment for amphetamine withdrawal ''. Cochrane Database Syst. Rev. ( 2 ) : CD003021. PMID 19370579. doi : 10.1002 / 14651858. CD003021. pub2. Jump up ^ Advokat C ( July 2007 ). `` Update on amphetamine neurotoxicity and its relevance to the treatment of ADHD ''. J. Atten. Disord. 11 ( 1 ) : 8 -- 16. PMID 17606768. doi : 10.1177 / 1087054706295605. ^ Jump up to : Bowyer JF, Hanig JP ( November 2014 ). `` Amphetamine - and methamphetamine - induced hyperthermia : Implications of the effects produced in brain vasculature and peripheral organs to forebrain neurotoxicity ''. Temperature ( Austin ). 1 ( 3 ) : 172 -- 182. PMC 5008711. PMID 27626044. doi : 10.4161 / 23328940.2014. 982049. Hyperthermia alone does not produce amphetamine - like neurotoxicity but AMPH and METH exposures that do not produce hyperthermia ( ≥ 40 ° C ) are minimally neurotoxic. Hyperthermia likely enhances AMPH and METH neurotoxicity directly through disruption of protein function, ion channels and enhanced ROS production... The hyperthermia and the hypertension produced by high doses amphetamines are a primary cause of transient breakdowns in the blood - brain barrier ( BBB ) resulting in concomitant regional neurodegeneration and neuroinflammation in laboratory animals... In animal models that evaluate the neurotoxicity of AMPH and METH, it is quite clear that hyperthermia is one of the essential components necessary for the production of histological signs of dopamine terminal damage and neurodegeneration in cortex, striatum, thalamus and hippocampus. Jump up ^ `` Amphetamine ''. United States National Library of Medicine -- Toxicology Data Network. Hazardous Substances Data Bank. Archived from the original on 2 October 2017. Retrieved 2 October 2017. Direct toxic damage to vessels seems unlikely because of the dilution that occurs before the drug reaches the cerebral circulation. Jump up ^ Malenka RC, Nestler EJ, Hyman SE ( 2009 ). `` Chapter 15 : Reinforcement and addictive disorders ''. In Sydor A, Brown RY. Molecular Neuropharmacology : A Foundation for Clinical Neuroscience ( 2nd ed. ). New York, USA : McGraw - Hill Medical. p. 370. ISBN 9780071481274. Unlike cocaine and amphetamine, methamphetamine is directly toxic to midbrain dopamine neurons. Jump up ^ Sulzer D, Zecca L ( February 2000 ). `` Intraneuronal dopamine - quinone synthesis : a review ''. Neurotox. Res. 1 ( 3 ) : 181 -- 195. PMID 12835101. doi : 10.1007 / BF03033289. Jump up ^ Miyazaki I, Asanuma M ( June 2008 ). `` Dopaminergic neuron - specific oxidative stress caused by dopamine itself '' ( PDF ). Acta Med. Okayama. 62 ( 3 ) : 141 -- 150. PMID 18596830. Jump up ^ Hofmann FG ( 1983 ). A Handbook on Drug and Alcohol Abuse : The Biomedical Aspects ( 2nd ed. ). New York, USA : Oxford University Press. p. 329. ISBN 9780195030570. ^ Jump up to : `` Adderall XR Prescribing Information '' ( PDF ). United States Food and Drug Administration. Shire US Inc. December 2013. pp. 8 -- 10. Retrieved 30 December 2013. ^ Jump up to : Miller GM ( January 2011 ). `` The emerging role of trace amine - associated receptor 1 in the functional regulation of monoamine transporters and dopaminergic activity ''. J. Neurochem. 116 ( 2 ) : 164 -- 176. PMC 3005101. PMID 21073468. doi : 10.1111 / j. 1471 - 4159.2010. 07109. x. ^ Jump up to : Eiden LE, Weihe E ( January 2011 ). `` VMAT2 : a dynamic regulator of brain monoaminergic neuronal function interacting with drugs of abuse ''. Ann. N.Y. Acad. Sci. 1216 : 86 -- 98. Bibcode : 2011NYASA1216... 86E. PMC 4183197. PMID 21272013. doi : 10.1111 / j. 1749 - 6632.2010. 05906. x. VMAT2 is the CNS vesicular transporter for not only the biogenic amines DA, NE, EPI, 5 - HT, and HIS, but likely also for the trace amines TYR, PEA, and thyronamine ( THYR )... ( Trace aminergic ) neurons in mammalian CNS would be identifiable as neurons expressing VMAT2 for storage, and the biosynthetic enzyme aromatic amino acid decarboxylase ( AADC ). Jump up ^ Sulzer D, Cragg SJ, Rice ME ( August 2016 ). `` Striatal dopamine neurotransmission : regulation of release and uptake ''. Basal Ganglia. 6 ( 3 ) : 123 -- 148. PMC 4850498. PMID 27141430. doi : 10.1016 / j. baga. 2016.02. 001. Despite the challenges in determining synaptic vesicle pH, the proton gradient across the vesicle membrane is of fundamental importance for its function. Exposure of isolated catecholamine vesicles to protonophores collapses the pH gradient and rapidly redistributes transmitter from inside to outside the vesicle... Amphetamine and its derivatives like methamphetamine are weak base compounds that are the only widely used class of drugs known to elicit transmitter release by a non-exocytic mechanism. As substrates for both DAT and VMAT, amphetamines can be taken up to the cytosol and then sequestered in vesicles, where they act to collapse the vesicular pH gradient. Jump up ^ Ledonne A, Berretta N, Davoli A, Rizzo GR, Bernardi G, Mercuri NB ( July 2011 ). `` Electrophysiological effects of trace amines on mesencephalic dopaminergic neurons ''. Front. Syst. Neurosci. 5 : 56. PMC 3131148. PMID 21772817. doi : 10.3389 / fnsys. 2011.00056. Three important new aspects of TAs action have recently emerged : ( a ) inhibition of firing due to increased release of dopamine ; ( b ) reduction of D2 and GABAB receptor - mediated inhibitory responses ( excitatory effects due to disinhibition ) ; and ( c ) a direct TA1 receptor - mediated activation of GIRK channels which produce cell membrane hyperpolarization. Jump up ^ `` TAAR1 ''. GenAtlas. University of Paris. 28 January 2012. Retrieved 29 May 2014. tonically activates inwardly rectifying K ( + ) channels, which reduces the basal firing frequency of dopamine ( DA ) neurons of the ventral tegmental area ( VTA ) Jump up ^ Underhill SM, Wheeler DS, Li M, Watts SD, Ingram SL, Amara SG ( July 2014 ). `` Amphetamine modulates excitatory neurotransmission through endocytosis of the glutamate transporter EAAT3 in dopamine neurons ''. Neuron. 83 ( 2 ) : 404 -- 416. PMC 4159050. PMID 25033183. doi : 10.1016 / j. neuron. 2014.05. 043. AMPH also increases intracellular calcium ( Gnegy et al., 2004 ) that is associated with calmodulin / CamKII activation ( Wei et al., 2007 ) and modulation and trafficking of the DAT ( Fog et al., 2006 ; Sakrikar et al., 2012 )... For example, AMPH increases extracellular glutamate in various brain regions including the striatum, VTA and NAc ( Del Arco et al., 1999 ; Kim et al., 1981 ; Mora and Porras, 1993 ; Xue et al., 1996 ), but it has not been established whether this change can be explained by increased synaptic release or by reduced clearance of glutamate... DHK - sensitive, EAAT2 uptake was not altered by AMPH ( Figure 1A ). The remaining glutamate transport in these midbrain cultures is likely mediated by EAAT3 and this component was significantly decreased by AMPH Jump up ^ Vaughan RA, Foster JD ( September 2013 ). `` Mechanisms of dopamine transporter regulation in normal and disease states ''. Trends Pharmacol. Sci. 34 ( 9 ) : 489 -- 496. PMC 3831354. PMID 23968642. doi : 10.1016 / j. tips. 2013.07. 005. AMPH and METH also stimulate DA efflux, which is thought to be a crucial element in their addictive properties ( 80 ), although the mechanisms do not appear to be identical for each drug ( 81 ). These processes are PKCβ -- and CaMK -- dependent ( 72, 82 ), and PKCβ knock - out mice display decreased AMPH - induced efflux that correlates with reduced AMPH - induced locomotion ( 72 ). ^ Jump up to : `` Identification ''. Lisdexamfetamine. DrugBank. University of Alberta. 16 September 2013. Retrieved 13 June 2014. ^ Jump up to : Jasinski DR, Krishnan S ( June 2009 ). `` Abuse liability and safety of oral lisdexamfetamine dimesylate in individuals with a history of stimulant abuse ''. J. Psychopharmacol. ( Oxford ). 23 ( 4 ) : 419 -- 427. PMID 19329547. doi : 10.1177 / 0269881109103113. Jump up ^ `` Adderall XR Prescribing Information '' ( PDF ). United States Food and Drug Administration. pp. 1 -- 18. Retrieved 7 October 2013. Jump up ^ `` Pharmacology ''. Dextroamphetamine. DrugBank. University of Alberta. 8 February 2013. Retrieved 5 November 2013. ^ Jump up to : `` Adderall XR Prescribing Information '' ( PDF ). United States Food and Drug Administration. Shire US Inc. December 2013. pp. 12 -- 13. Retrieved 30 December 2013. Jump up ^ `` Pharmacology ''. Amphetamine. DrugBank. University of Alberta. 8 February 2013. Retrieved 5 November 2013. ^ Jump up to : `` Metabolism / Pharmacokinetics ''. Amphetamine. United States National Library of Medicine -- Toxicology Data Network. Hazardous Substances Data Bank. Archived from the original on 2 October 2017. Retrieved 2 October 2017. Duration of effect varies depending on agent and urine pH. Excretion is enhanced in more acidic urine. Half - life is 7 to 34 hours and is, in part, dependent on urine pH ( half - life is longer with alkaline urine )... Amphetamines are distributed into most body tissues with high concentrations occurring in the brain and CSF. Amphetamine appears in the urine within about 3 hours following oral administration... Three days after a dose of ( + or - ) - amphetamine, human subjects had excreted 91 % of the ( 14 ) C in the urine ^ Jump up to : Santagati NA, Ferrara G, Marrazzo A, Ronsisvalle G ( September 2002 ). `` Simultaneous determination of amphetamine and one of its metabolites by HPLC with electrochemical detection ''. J. Pharm. Biomed. Anal. 30 ( 2 ) : 247 -- 255. PMID 12191709. doi : 10.1016 / S0731 - 7085 ( 02 ) 00330 - 8. Jump up ^ `` Compound Summary ''. p - Hydroxyamphetamine. PubChem Compound. United States National Library of Medicine -- National Center for Biotechnology Information. Retrieved 15 October 2013. Jump up ^ `` Compound Summary ''. p - Hydroxynorephedrine. PubChem Compound. United States National Library of Medicine -- National Center for Biotechnology Information. Retrieved 15 October 2013. Jump up ^ `` Compound Summary ''. Phenylpropanolamine. PubChem Compound. United States National Library of Medicine -- National Center for Biotechnology Information. Retrieved 15 October 2013. Jump up ^ `` Pharmacology and Biochemistry ''. Amphetamine. Pubchem Compound. United States National Library of Medicine -- National Center for Biotechnology Information. Retrieved 12 October 2013. ^ Jump up to : Glennon RA ( 2013 ). `` Phenylisopropylamine stimulants : amphetamine - related agents ''. In Lemke TL, Williams DA, Roche VF, Zito W. Foye 's principles of medicinal chemistry ( 7th ed. ). Philadelphia, USA : Wolters Kluwer Health / Lippincott Williams & Wilkins. pp. 646 -- 648. ISBN 9781609133450. The simplest unsubstituted phenylisopropylamine, 1 - phenyl - 2 - aminopropane, or amphetamine, serves as a common structural template for hallucinogens and psychostimulants. Amphetamine produces central stimulant, anorectic, and sympathomimetic actions, and it is the prototype member of this class ( 39 )... The phase 1 metabolism of amphetamine analogs is catalyzed by two systems : cytochrome P450 and flavin monooxygenase... Amphetamine can also undergo aromatic hydroxylation to p - hydroxyamphetamine... Subsequent oxidation at the benzylic position by DA β - hydroxylase affords p - hydroxynorephedrine. Alternatively, direct oxidation of amphetamine by DA β - hydroxylase can afford norephedrine. Jump up ^ Taylor KB ( January 1974 ). `` Dopamine - beta - hydroxylase. Stereochemical course of the reaction '' ( PDF ). J. Biol. Chem. 249 ( 2 ) : 454 -- 458. PMID 4809526. Retrieved 6 November 2014. Dopamine - β - hydroxylase catalyzed the removal of the pro-R hydrogen atom and the production of 1 - norephedrine, ( 2S, 1R ) - 2 - amino - 1 - hydroxyl - 1 - phenylpropane, from d - amphetamine. Jump up ^ Krueger SK, Williams DE ( June 2005 ). `` Mammalian flavin - containing monooxygenases : structure / function, genetic polymorphisms and role in drug metabolism ''. Pharmacol. Ther. 106 ( 3 ) : 357 -- 387. PMC 1828602. PMID 15922018. doi : 10.1016 / j. pharmthera. 2005.01. 001. Table 5 : N - containing drugs and xenobiotics oxygenated by FMO Jump up ^ Cashman JR, Xiong YN, Xu L, Janowsky A ( March 1999 ). `` N - oxygenation of amphetamine and methamphetamine by the human flavin - containing monooxygenase ( form 3 ) : role in bioactivation and detoxication ''. J. Pharmacol. Exp. Ther. 288 ( 3 ) : 1251 -- 1260. PMID 10027866. ^ Jump up to : Sjoerdsma A, von Studnitz W ( April 1963 ). `` Dopamine - beta - oxidase activity in man, using hydroxyamphetamine as substrate ''. Br. J. Pharmacol. Chemother. 20 : 278 -- 284. PMC 1703637. PMID 13977820. Hydroxyamphetamine was administered orally to five human subjects... Since conversion of hydroxyamphetamine to hydroxynorephedrine occurs in vitro by the action of dopamine - β - oxidase, a simple method is suggested for measuring the activity of this enzyme and the effect of its inhibitors in man... The lack of effect of administration of neomycin to one patient indicates that the hydroxylation occurs in body tissues... a major portion of the β - hydroxylation of hydroxyamphetamine occurs in non-adrenal tissue. Unfortunately, at the present time one can not be completely certain that the hydroxylation of hydroxyamphetamine in vivo is accomplished by the same enzyme which converts dopamine to noradrenaline. ^ Jump up to : Badenhorst CP, van der Sluis R, Erasmus E, van Dijk AA ( September 2013 ). `` Glycine conjugation : importance in metabolism, the role of glycine N - acyltransferase, and factors that influence interindividual variation ''. Expert Opin. Drug Metab. Toxicol. 9 ( 9 ) : 1139 -- 1153. PMID 23650932. doi : 10.1517 / 17425255.2013. 796929. Figure 1. Glycine conjugation of benzoic acid. The glycine conjugation pathway consists of two steps. First benzoate is ligated to CoASH to form the high - energy benzoyl - CoA thioester. This reaction is catalyzed by the HXM - A and HXM - B medium - chain acid : CoA ligases and requires energy in the form of ATP... The benzoyl - CoA is then conjugated to glycine by GLYAT to form hippuric acid, releasing CoASH. In addition to the factors listed in the boxes, the levels of ATP, CoASH, and glycine may influence the overall rate of the glycine conjugation pathway. Jump up ^ Horwitz D, Alexander RW, Lovenberg W, Keiser HR ( May 1973 ). `` Human serum dopamine - β - hydroxylase. Relationship to hypertension and sympathetic activity ''. Circ. Res. 32 ( 5 ) : 594 -- 599. PMID 4713201. doi : 10.1161 / 01. RES. 32.5. 594. The biologic significance of the different levels of serum DβH activity was studied in two ways. First, in vivo ability to β - hydroxylate the synthetic substrate hydroxyamphetamine was compared in two subjects with low serum DβH activity and two subjects with average activity... In one study, hydroxyamphetamine ( Paredrine ), a synthetic substrate for DβH, was administered to subjects with either low or average levels of serum DβH activity. The percent of the drug hydroxylated to hydroxynorephedrine was comparable in all subjects ( 6.5 - 9.62 ) ( Table 3 ). Jump up ^ Freeman JJ, Sulser F ( December 1974 ). `` Formation of p - hydroxynorephedrine in brain following intraventricular administration of p - hydroxyamphetamine ''. Neuropharmacology. 13 ( 12 ) : 1187 -- 1190. PMID 4457764. In species where aromatic hydroxylation of amphetamine is the major metabolic pathway, p - hydroxyamphetamine ( POH ) and p - hydroxynorephedrine ( PHN ) may contribute to the pharmacological profile of the parent drug... The location of the p - hydroxylation and β - hydroxylation reactions is important in species where aromatic hydroxylation of amphetamine is the predominant pathway of metabolism. Following systemic administration of amphetamine to rats, POH has been found in urine and in plasma. The observed lack of a significant accumulation of PHN in brain following the intraventricular administration of ( + ) - amphetamine and the formation of appreciable amounts of PHN from ( + ) - POH in brain tissue in vivo supports the view that the aromatic hydroxylation of amphetamine following its systemic administration occurs predominantly in the periphery, and that POH is then transported through the blood - brain barrier, taken up by noradrenergic neurones in brain where ( + ) - POH is converted in the storage vesicles by dopamine β - hydroxylase to PHN. Jump up ^ Matsuda LA, Hanson GR, Gibb JW ( December 1989 ). `` Neurochemical effects of amphetamine metabolites on central dopaminergic and serotonergic systems ''. J. Pharmacol. Exp. Ther. 251 ( 3 ) : 901 -- 908. PMID 2600821. The metabolism of p - OHA to p - OHNor is well documented and dopamine - β hydroxylase present in noradrenergic neurons could easily convert p - OHA to p - OHNor after intraventricular administration. Jump up ^ `` Molecular Weight Calculator ''. Lenntech. Retrieved 19 August 2015. ^ Jump up to : `` Dextroamphetamine Sulfate USP ''. Mallinckrodt Pharmaceuticals. March 2014. Retrieved 19 August 2015. ^ Jump up to : `` D - amphetamine sulfate ''. Tocris. 2015. Retrieved 19 August 2015. ^ Jump up to : `` Amphetamine Sulfate USP ''. Mallinckrodt Pharmaceuticals. March 2014. Retrieved 19 August 2015. Jump up ^ `` Dextroamphetamine Saccharate ''. Mallinckrodt Pharmaceuticals. March 2014. Retrieved 19 August 2015. Jump up ^ `` Amphetamine Aspartate ''. Mallinckrodt Pharmaceuticals. March 2014. Retrieved 19 August 2015. Jump up ^ Mattingly, G ( May 2010 ). `` Lisdexamfetamine dimesylate : a prodrug stimulant for the treatment of ADHD in children and adults. ''. CNS spectrums. 15 ( 5 ) : 315 -- 25. PMID 20448522. doi : 10.1017 / S1092852900027541. Jump up ^ `` FDA Adult Approval of Vyvanse -- FDA Label and Approval History '' ( PDF ). Jump up ^ Health Canada Notice of Compliance -- Vyvanse. 19 February 2009, retrieved on 9 March 2009. Jump up ^ `` Press Announcements -- FDA expands uses of Vyvanse to treat binge - eating disorder ''. FDA. January 30, 2015. Jump up ^ `` Lisdexamfetamine international brands ''. Drugs.com. Retrieved 10 July 2017. Jump up ^ Dale E, Bang - Andersen B, Sánchez C ( May 2015 ). `` Emerging mechanisms and treatments for depression beyond SSRIs and SNRIs ''. Biochem. Pharmacol. 95 ( 2 ) : 81 -- 97. PMID 25813654. doi : 10.1016 / j. bcp. 2015.03. 011. Jump up ^ `` Psychostimulants in the therapy of treatment - resistant depression Review of the literature and findings from a retrospective study in 65 depressed patients ''. Dialogues Clin Neurosci. 1 : 165 -- 74. 1999. PMC 3181580. PMID 22034135. Jump up ^ Hirschler, Ben ( 7 February 2014 ). `` UPDATE 2 - Shire scraps Vyvanse for depression after failed trials ''. Reuters. Retrieved 13 February 2014. Amphetamine Main articles and pharmaceuticals Amphetamine Adderall Adzenys Dyanavel Evekeo Levoamphetamine N / A Dextroamphetamine Dexedrine ProCentra Zenzedi Lisdexamfetamine Vyvanse Neuropharmacology Biomolecular targets TAAR1 ( full agonist ) CART ( mRNA inducer ) 5 - HT1A receptor ( low affinity ligand ) MAO ( weak competitive inhibitor ) Inhibited transporters DAT NET SERT VMAT1 VMAT2 EAAT3 SLC22A3 SLC22A5 Active metabolites 4 - Hydroxyamphetamine 4 - Hydroxynorephedrine Norephedrine Related articles ADHD ADHD management Amphetamine psychosis Dopamine Doping in sport Formetorex ΔFosB History and culture of substituted amphetamines History of Benzedrine Methamphetamine Methylphenidate N - Methylphenethylamine Narcolepsy Neurobiological effects of physical exercise § Attention deficit hyperactivity disorder Nootropic Norepinephrine Obesity Performance - enhancing substance Pharmaceutical drug Phenethylamine Phentermine Phenylacetone Recreational drug use Serotonin Substituted amphetamine Trace amine ADHD pharmacotherapies CNS stimulants Amphetamine Adderall Adzenys Dyanavel Evekeo Dextroamphetamine Dexedrine ProCentra Zenzedi Lisdexamfetamine Vyvanse Methamphetamine Desoxyn Methylphenidate Ritalin Concerta Aptensio Biphentin Daytrana Equasym Medikinet Metadate Methylin Quillivant Dexmethylphenidate Focalin Non-classical CNS stimulants Atomoxetine Modafinil α - adrenoceptor agonists Clonidine Guanfacine Antidepressants Amitriptyline Bupropion Buspirone Desipramine Duloxetine Imipramine Milnacipran Moclobemide Nortriptyline Reboxetine Venlafaxine Miscellaneous / others Amantadine Carbamazepine Memantine Related articles Attention deficit hyperactivity disorder ( ADHD ) Attention deficit hyperactivity disorder management Monoamine releasing agent Dopamine ( DA ) Dopamine transporter ( DAT ) Dopamine reuptake inhibitor ( DRI ) Norepinephrine ( NE ) Norepinephrine transporter ( NET ) Norepinephrine reuptake inhibitor ( NRI ) Serotonin ( 5 - HT ) Serotonin transporter ( SERT ) Selective serotonin reuptake inhibitor ( SSRI ) Serotonin - norepinephrine reuptake inhibitor ( SNRI ) Norepinephrine - dopamine reuptake inhibitor ( NDRI ) Serotonin - norepinephrine - dopamine reuptake inhibitor ( SNDRI ) Monoamine releasing agents DRAs Morpholines : Fenbutrazate Fenmetramide Morazone Morforex Phendimetrazine Phenmetrazine Pseudophenmetrazine Oxazolines : 4 - MAR Aminorex Clominorex Cyclazodone Fenozolone Fluminorex Pemoline Thozalinone Phenethylamines : 2 - OH - PEA 4 - CAB 4 - FA 4 - FMA 4 - MA 4 - MMA Alfetamine Amfecloral Amfepentorex Amfepramone Amphetamine ( Dextroamphetamine Levoamphetamine ) Amphetaminil β - Me - PEA BDB BOH Benzphetamine Buphedrone Butylone Cathine Cathinone Clobenzorex Clortermine D - Deprenyl DMA DMMA Dimethylamphetamine Ephedrine Ethcathinone EBDB Ethylone Etilamfetamine Famprofazone Fenethylline Fenproporex Flephedrone Fludorex Furfenorex Hordenine 4 - Hydroxyamphetamine Iofetamine ( 123I ) Lophophine Mefenorex Mephedrone Metamfepramone Methamphetamine Dextromethamphetamine Levomethamphetamine Methcathinone Methedrone MMDA MMDMA MBDB MDA ( tenamfetamine ) MDEA MDMA ( midomafetamine ) MDMPEA MDOH MDPEA Methylone Morforex Ortetamine pBA pCA pIA Pholedrine Phenethylamine Pholedrine Phenpromethamine Prenylamine Propylamphetamine Pseudoephedrine Tiflorex Tyramine Xylopropamine Zylofuramine Piperazines : 2C - B - BZP BZP MBZP MDBZP MeOPP oMPP Others : 2 - ADN 2 - AI 2 - AT 4 - BP 5 - APDI 5 - IAI Amineptine Clofenciclan Cyclopentamine Cypenamine Cyprodenate Feprosidnine Gilutensin Heptaminol Hexacyclonate Indanorex Isometheptene Methylhexanamine Naphthylaminopropane Octodrine Phthalimidopropiophenone Phenylbiguanide Propylhexedrine Levopropylhexedrine NRAs Morpholines : Fenbutrazate Fenmetramide Morazone Morforex Phendimetrazine Phenmetrazine Pseudophenmetrazine Oxazolines : 4 - MAR Aminorex Clominorex Cyclazodone Fenozolone Fluminorex Pemoline Thozalinone Phenethylamines : 2 - OH - PEA 4 - CAB 4 - FA 4 - FMA 4 - MA 4 - MMA Alfetamine Amfecloral Amfepentorex Amfepramone Amphetamine Dextroamphetamine Levoamphetamine Amphetaminil β - Me - PEA BDB Benzphetamine BOH Buphedrone Butylone Cathine Cathinone Clobenzorex Clortermine Dimethylamphetamine DMA DMMA EBDB Ephedrine Ethcathinone Ethylone Etilamfetamine Famprofazone Fenethylline Fenproporex Flephedrone Fludorex Furfenorex Hordenine 4 - Hydroxyamphetamine 5 - APDI ( IAP ) 5 - MAPDI ( IMP ) Iofetamine ( 123I ) Lisdexamfetamine Lophophine MBDB MDA ( tenamfetamine ) MDEA MDMA ( midomafetamine ) Metamfepramone MDMPEA MDOH MDPEA Mefenorex Mephedrone Mephentermine Methamphetamine Dextromethamphetamine Levomethamphetamine Methcathinone Methedrone Methylone Morforex Naphthylaminopropane Ortetamine pBA pCA Pentorex Phenethylamine Pholedrine Phenpromethamine Phentermine Phenylpropanolamine pIA Prenylamine Propylamphetamine Pseudoephedrine Selegiline ( also D - Deprenyl ) Tiflorex Tyramine Xylopropamine Zylofuramine Piperazines : 2C - B - BZP BZP MBZP mCPP MDBZP MeOPP oMPP pFPP Others : 2 - ADN 2 - AI 2 - AT 2 - BP 4 - BP 5 - IAI Clofenciclan Cyclopentamine Cypenamine Cyprodenate Feprosidnine Gilutensin Heptaminol Hexacyclonate Indanorex Isometheptene Methylhexanamine Octodrine Phthalimidopropiophenone Propylhexedrine ( Levopropylhexedrine ) Tuaminoheptane SRAs Aminoindanes : 5 - IAI AMMI ETAI MDAI MDMAI MMAI TAI Aminotetralins : 6 - CAT 8 - OH - DPAT MDAT MDMAT Oxazolines : 4 - Methylaminorex Aminorex Clominorex Fluminorex Phenethylamines : 2 - Methyl - MDA 4 - CAB 4 - FA 4 - FMA 4 - HA 4 - MTA 5 - APDB 5 - Methyl - MDA 6 - APDB 6 - Methyl - MDA AEMMA Amiflamine BDB BOH Brephedrone Butylone Chlorphentermine Cloforex Amfepramone Metamfepramone DCA Dexfenfluramine DFMDA DMA DMMA EBDB EDMA Ethylone Etolorex Fenfluramine Flephedrone Flucetorex IAP IMP Iofetamine Levofenfluramine Lophophine MBDB MDA ( tenamfetamine ) MDEA MDHMA MDMA ( midomafetamine ) MDMPEA MDOH MDPEA Mephedrone Methedrone Methylone MMA MMDA MMDMA MMMA NAP Norfenfluramine 4 - TFMA pBA pCA pIA PMA PMEA PMMA TAP Piperazines : 2C - B - BZP 3 - MeOPP BZP DCPP MBZP mCPP MDBZP MeOPP Mepiprazole oMPP pCPP pFPP pTFMPP TFMPP Tryptamines : 4 - Methyl - αET 4 - Methyl - αMT 5 - CT 5 - MeO - αET 5 - MeO - αMT 5 - MT αET αMT DMT Tryptamine Others : Indeloxazine Viqualine Others Monoamine activity enhancers : BPAP PPAP DAT modulators : Agonist - like : SoRI - 9804 SoRI - 20040 ; Antagonist - like : SoRI - 20041 Adrenergic release blockers : Bethanidine Bretylium Guanadrel Guanazodine Guanethidine Guanoxan See also : Receptor / signaling modulators Monoamine reuptake inhibitors Adrenergics Dopaminergics Serotonergics Monoamine metabolism modulators Monoamine neurotoxins Phenethylamines Phenethylamines Psychedelics : 25B - NBOMe 25C - NBOMe 25D - NBOMe 25I - NBOMe 25N - NBOMe 2C - B 2C - B - AN 2C - B - FLY βk - 2C - B 2C - C 2C - D 2C - E 2C - EF 2C - F 2C - G 2C - I 2C - N 2C - P 2C - SE 2C - T 2C - T - 2 2C - T - 4 2C - T - 7 2C - T - 8 2C - T - 9 2C - T - 13 2C - T - 15 2C - T - 16 2C - T - 17 2C - T - 21 2C - TFM 2C - YN Allylescaline DESOXY Escaline Isoproscaline Jimscaline Macromerine MEPEA Mescaline Metaescaline Methallylescaline Proscaline Psi - 2C - T - 4 TCB - 2 Stimulants : Phenylethanolamine Hordenine Phenethylamine α - Methylphenethylamine ( amphetamine ) β - Methylphenethylamine m - Methylphenethylamine N - Methylphenethylamine o - Methylphenethylamine p - Methylphenethylamine Entactogens : Lophophine MDPEA MDMPEA Others : BOH DMPEA Amphetamines Psychedelics : 3C - BZ 3C - E 3C - P Aleph Beatrice Bromo - DragonFLY D - Deprenyl DMA DMCPA DMMDA DOB DOC DOEF DOET DOI DOM DON DOPR DOTFM Ganesha MMDA MMDA - 2 Psi - DOM TMA TeMA Stimulants : 2 - FA 2 - FMA 3 - FA 3 - FMA Acridorex Alfetamine Amfecloral Amfepentorex Amphetamine ( Dextroamphetamine, Levoamphetamine ) Amphetaminil Benfluorex Benzphetamine Cathine Clobenzorex Dimethylamphetamine Ephedrine Etilamfetamine Fencamfamin Fencamine Fenethylline Fenfluramine ( Dexfenfluramine, Levofenfluramine ) Fenproporex Flucetorex Fludorex Formetorex Furfenorex Gepefrine 4 - Hydroxyamphetamine Iofetamine Isopropylamphetamine Lefetamine Lisdexamfetamine Mefenorex Metaraminol Methamphetamine ( Dextromethamphetamine, Levomethamphetamine ) Methoxyphenamine MMA Morforex Norfenfluramine L - Norpseudoephedrine N, alpha - Diethylphenylethylamine Oxifentorex Oxilofrine Ortetamine PBA PCA Phenpromethamine PFA PFMA PIA PMA PMEA PMMA Phenylpropanolamine Pholedrine Prenylamine Propylamphetamine Pseudoephedrine Sibutramine Tiflorex Tranylcypromine Xylopropamine Zylofuramine Entactogens : 4 - FA 4 - FMA 4 - MA 4 - MMA 4 - MTA 5 - APB 5 - APDB 5 - EAPB 5 - IT 5 - MAPB 5 - MAPDB 6 - APB 6 - APDB 6 - Chloro - MDMA 6 - EAPB 6 - IT 6 - MAPB 6 - MAPDB EDA IAP 2, 3 - MDA 3, 4 - MDA ( tenamfetamine ) MDEA MDHMA MDMA ( midomafetamine ) MDOH Methamnetamine MMDMA Naphthylaminopropane TAP Others : 3, 4 - DCA Amiflamine DiFMDA Selegiline ( also D - Deprenyl ) Phentermines Stimulants : Chlorphentermine Cloforex Clortermine Etolorex Mephentermine Pentorex Phentermine Entactogens : MDPH MDMPH Others : Cericlamine Cathinones Stimulants : 3 - FMC 4 - MC 4 - BMC 4 - CMC 4 - EMC 4 - FMC 4 - MEC 4 - MeMABP 4 - MPD Amfepramone Benzedrone Brephedrone Buphedrone Bupropion Cathinone Dimethylcathinone Ethcathinone Eutylone Hydroxybupropion Methcathinone Methedrone NEB Pentedrone Pentylone Radafaxine Entactogens : 3, 4 - DMMC 3 - MMC Butylone Ethylone Methylone Methylenedioxycathinone Mephedrone Phenylisobutylamines Entactogens : 4 - CAB 4 - MAB Ariadne BDB Butylone EBDB Eutylone MBDB Stimulants : Phenylisobutylamine Phenylalkylpyrrolidines Stimulants : α - PBP α - PHP α - PPP α - PVP MDPBP MDPPP MDPV 4 - MePBP 4 - MePHP 4 - MePPP MOPPP MOPVP MPBP MPHP MPPP Naphyrone PEP Prolintane Pyrovalerone Catecholamines ( and close relatives ) 6 - FNE 6 - OHDA a-Me - DA a-Me - TRA Adrenochrome Ciladopa D - DOPA ( Dextrodopa ) Dimetofrine Dopamine Epinephrine Epinine Etilefrine Ethylnorepinephrine Fenclonine Ibopamine Isoprenaline Isoetarine L - DOPA ( Levodopa ) L - DOPS ( Droxidopa ) L - Phenylalanine L - Tyrosine m - Tyramine Metanephrine Metaraminol Metaterol Metirosine Methyldopa N, N - Dimethyldopamine Nordefrin ( Levonordefrin ) Norepinephrine Norfenefrine ( m - Octopamine ) Normetanephrine Orciprenaline p - Octopamine p - Tyramine Phenylephrine Synephrine Miscellaneous AL - LAD Amidephrine Arbutamine Cafedrine Denopamine Desvenlafaxine Diphenidine Dizocilpine Dobutamine Dopexamine Ephenidine Etafedrine ETH - LAD Famprofazone Fluorolintane Hexapradol IP - LAD Lysergic acid amide Lysergic acid 2 - butyl amide Lysergic acid 2, 4 - dimethylazetidide Lysergic acid diethylamide Methoxamine Methoxphenidine MT - 45 PARGY - LAD Phenibut PRO-LAD Pronethalol Salbutamol ( Levosalbutamol ) Solriamfetol Theodrenaline Thiamphenicol UWA - 101 Retrieved from `` https://en.wikipedia.org/w/index.php?title=Lisdexamfetamine&oldid=803867349 '' Categories : Amphetamine Drugs acting on the cardiovascular system Drugs acting on the nervous system Norepinephrine - dopamine releasing agents Prodrugs Substituted amphetamines TAAR1 agonists Treatment and management of attention deficit hyperactivity disorder Hidden categories : Pages using citations with accessdate and no URL Use dmy dates from June 2015 Template : drugs.com link with non-standard subpage Drugs with non-standard legal status Articles without KEGG source Drugboxes which contain changes to verified fields Drugboxes which contain changes to watched fields Articles containing potentially dated statements from May 2014 All articles containing potentially dated statements Articles containing potentially dated statements from February 2016 Articles to be expanded from September 2015 All articles to be expanded Articles using small message boxes Talk Contents About Wikipedia Deutsch Español Français עברית Русский Српски / srpski Srpskohrvatski / српскохрватски Suomi Svenska 中文 Edit links This page was last edited on 5 October 2017, at 04 : 16. Text is available under the Creative Commons Attribution - ShareAlike License ; additional terms may apply. By using this site, you agree to the Terms of Use and Privacy Policy. Wikipedia ® is a registered trademark of the Wikimedia Foundation, Inc., a non-profit organization. About Wikipedia

Question: what kind of drug is vyvanse classified as
Answer: prodrug