Talk:Adderall

Shortages

Shortages section needs a lot of work. FDA actually first reported the shortage in I think may or june, then declared it to be over in I believe September. The actual shortage started back in 2021. There are references that mention that if people look hard enough.

It needs to be noted that shortages as reported by the FDA are based on voluntary reporting by manufacturers and is not required. And therefore do not accurately represent shortages as seen by consumers. If they choose not to report then it goes without being recognized by the FDA. So, when Teva waited till late spring I think of 2022 to bother to report their shortage, there was already a profound effect on users having issues getting their script filled and they got back lash for waiting too long. Also, manufactures tend to downplay the extent of the issue and underestimate the time to the shortage being over. All this is documented in articles if people look. I don't have the time to go back and dig every thing up again.

And if putting a shortages section. If people don't know when the other shortages were over the years, should at least mention that the most recent one is not the only one. I know there was one I believe in 2012 when I think Shire redirected the API to their Vyvanse instead of distributing it to the generic companies as they were contracted to. Causing the shortage.

There is a document in 2015 to congress from an investigation into the DEA noting all their shortcomings and failures in regards to their control of the amphetamine API and quota system from the 2012 shortage. Which can also show how they impacted and again exacerbated the current shortage.

There was at least 1 other shortage but not as bad between the 2012 and current one. Forget when it was exactly. So, I think the shortages section should be renamed to "Shortage 2021 to 2023" because "Shortages" implies more than one, and only 1 is listed skipping all the others, and the info is incorrect at that to begin with. Until someone feels like putting in effort for either title, it should be removed. 2601:86:600:A85:14B1:C34D:88DA:1EF1 (talk) 05:26, 16 May 2023 (UTC)

Please correct...

(1) Please correct the following appearing content to a scholarly understanding of molecular microbiology:

"Since the total number of microbial and viral cells..."

(2) Please do the same to the source of the content, in the referenced section of the Amphetamines article.

(3) More broadly, please consider whether this article needs such a long introductory paragraph as the one containing this sentence. The shorter following paragraph is indeed relevant to the article. In this editor's opinion, there is no need to spend as much time defining a field as presenting a specific result from it; the content giving explanatory and defining information (e.g., indicating numbers of microbial cells in the microbiome, etc.) is superfluous.

The entire first paragraph here could be replaced by one sentence with a wikilink and a citation or two (serving as an introductory sentence to the content of the current second paragraph). 73.8.193.28 (talk) 00:22, 3 December 2023 (UTC)

Insufflation

Why is insufflation listen as a method of administration of adderall in the sidebar? Themckinlay (talk) 13:52, 2 August 2024 (UTC)

Article is biased.

Article is very biased. Same rhetoric propagated all too often. Negative effects are in context of abuse. Adderall can cause the same issues at prescribed levels as at the abused levels, only slower. Always stating the negative in terms of abuse is a "blame the victim" narrative for anyone with issues at therapeutic doses. Even ICD10 and ICD11 codes for side effects from amphetamine states it can occur at therapeutic prescribed doses. Although the listed number of possible side effects is quite limiting. Research, especially in adults has shown this too.

I apologize for not having all the links for all these things as this is not being written on my computer.

Article mentions young children who start on Adderall are less likely to become addicts when they get older. What they fail to mention is that starting in adolescents or adulthood, people are more likely to become addicts as they are more willing to self medicate or seek a euphoric dose.

Missing is one of the primary effects of amphetamine is the AMPA/NMDA antagonism causing glutamate release. And believed by many researchers to be the primary way amphetamine builds tolerance.

Also lacking is many of the ways amphetamine causes downregulation and damage. --adderall can be exciteotoxic to the NMDA/glutamatergic pathways. Over excitement causes downregulation of receptors and excess ion flux causes oxidative stress in the cell that can lead to disregulation or even apoptosis. Excess glutamate triggers extrasynaptic NMDA receptors which is the trigger for the apoptosis cascade. Many researchers believe this to be the primary way amphetamine builds tolerance. And why some therapist prescribe the NMDA uncompetitive antagonist memantine to prevent or reduce tolerance. --Does mention the phosphorilization of DAT and NAT. But does not mention that this is acute tolerance and causes a need for a higher blood API concentration in the afternoon just to maintain the same therapeutic efficiency as the morning. And why the standard recommended dosage is the same dose separated by about 4 hours, which nearly doubles the BAC to maintain steady therapeutic effect and how Adderall XR was designed. I do have an article for the readily available. Shows acute tolerance, therapeutic dose curve during the day. But before they understood acute tolerance is from phosphorilization of DAT and NAT and likely other pathways like NMDA. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2547091/ --VMAT2 can get downregulated or cause dysfunction. --Amphetamine can diffuse through the cell wall, doesn't just use DAT or NAT transports. And can diffuse through mitochondria wall which it can cause oxidative stress in mitochondria. --Can't recall if MOA antagonism was mentioned, but it can cause damage or downregulation too. --A lot of the catecholamines get stuck in the cytosol which auto-oxidizes leading to oxidative stress. As does excess in the synapse and extra-synaptic space. --Does regulation of tyrosine hydroxylase has been shown can happen with long term use. --A know there are other neurological factors I don't recall.

Endocrine side effects was not even mentioned. Less research but it does exist. Even the FDA approved accompanying literature mentions endocrine effects but very lacking in longer term effects. --A THE and cortisol decrease during the day. amphetamine has the opposite effect on it. --Can cause testosterone/estrogen imbalance in part due to weak estrogenic property of amphetamine. But likely due to other reasons too. Which in men has low T symptoms. --Can decrease LH and FSH which can effect fertility. --Can cause stimulant induced secondary gynecomastia. Which can be distinguished from other forms of gynecomastia by stimulant use, estrogen dominance, normal or low levels of LH and FSH. --Can increase cAMP, which I don't recall for sure but may have been a side effect of high ACTH. --There are some others I forget off the top of my head.

Only references an article in which it states higher dose users can take up to 4 weeks to recover from stopping medication. Doesn't mention that is not true for everyone and although not frequent, some people can take 6 months to a year, even from prescribed high doses. Has been shown in other studies that even at low doses there is a significant number of patients who show accumulated tolerance and stopping medication worsens ADHD symptoms for a while. Amphetamine can also cause irreversible damage for some people while addicts can also often make a full recovery.

There is some study on how adults respond differently to the medication, especially in the long run. But also acknowledge adult research is still lacking in many ways.

Many studies on CNS stimulants stunting growth say on stopping medication, growth resumes and is unaffected. While other studies show a decrease final height even after stopping medication that is statistically significant compared to placebo group. Think on average it may have been a 1/2 inch shorter but not sure. Don't recall reading studies on children who stayed on longer after stunted growth was recognized. Which doesn't mention the underlying cause but likely something in the endocrine system.

My opinion, but shared by many researchers. Pharmacology for ADHD drugs are based on short term studies in young and adolescent children to establish therapeutic efficiency, short term side effects profile, and therapeutic dosage range. Performed and paid for by drug companies to pass FDA approval to make money selling their product. These are reflected as the guidelines in the DSM-V as well as psychiatrist and neurologist curriculum. Which includes the drug companies taking points framing the narrative to their benefit. Adult dosage range was assumed from child studies. Research in adults just showed effect for the existing adolescents dosage range. None of these account for the dynamic therapeutic dosage range caused by tolerance. There is plenty of funding from big pharma for things in their interest. But a lack of funding for things that go against their narratives. If someone gets bored, they can compare the approved accompanying literature changes between releases and see how lacking info was till more recently. Which is still very lacking. Even some contradictions between Adderall and Adderall XR if you've read the XR design article

HCStymie (talk) 21:58, 5 August 2024 (UTC)

1. Can you reword your concerns as bullet point sentences instead of paragraphs? It's quite difficult to understand what content you believe violates policy a la WP:NPOV.

2. If/when rewording your concerns as bullet point sentences, can you also quote specific excerpts from the article that you believe violate policy?

Thanks. Professional Crastination (talk) 12:38, 6 August 2024 (UTC)

I will try but won't be for quite a while as I am recovering from long term damage caused by prescription Adderall. 2601:8C:4E80:7578:6138:2331:E1B3:6E99 (talk) 12:07, 13 November 2024 (UTC)

Forgot to mention, a few answers are in the actual FDA approved prescriber documentation for Adderall. This is an annoying cut and past of some notes but it is one step further. Shows toxic even at low doses, not just abused! Shows some endocrine effects and adverse reactions, again, at prescribed and even low doses. Other good documentation in the history like never established an adult dosage range, just allowed doctors to assume it etc. Also, mentions there are no long term studies which shows guidelines are from short term studies done in children. More info I didn't cover from FDA docs that is relevant to the page. Similar with Adderall XR docs where it actually contradicts some Adderall docs info unless person knows underlying context.

Official FDA approved label for adderall with excerpts

2024

https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=f22635fe-821d-4cde-aa12-419f8b53db81&type=display

Amphetamines can cause a significant elevation in plasma corticosteroid levels. This increase is greatest in the evening.

—--

ADVERSE REACTIONS

Central Nervous System

Psychotic episodes at recommended doses, overstimulation, restlessness, irritability, euphoria, dyskinesia, dysphoria, depression, tremor, motor and verbal tics, aggression, anger, logorrhea, dermatillomania.

Gastrointestinal

intestinal ischemia, and other gastrointestinal disturbances.

Endocrine

Impotence, changes in libido, frequent or prolonged erections.

Skin

Alopecia.

Musculoskeletal

Rhabdomyolysis.

—-------

Dependence

Physical Dependence

Adderall® may produce physical dependence. Physical dependence is a state that develops as a result of physiological adaptation in response to repeated drug use, manifested by withdrawal signs and symptoms after abrupt discontinuation or a significant dose reduction of a drug.

Withdrawal signs and symptoms after abrupt discontinuation or dose reduction following prolonged use of CNS stimulants including Adderall® include dysphoric mood; depression; fatigue; vivid, unpleasant dreams; insomnia or hypersomnia; increased appetite; and psychomotor retardation or agitation.

Tolerance

Adderall® may produce tolerance. Tolerance is a physiological state characterized by a reduced response to a drug after repeated administration (i.e., a higher dose of a drug is required to produce the same effect that was once obtained at a lower dose).

—------------------------------------------------------------------------------------

https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=011522

From 2017 documentation: No mention of adult dosing or indication for adult disorders.

Long-Term Use

The effectiveness of Adderall® for long-term use has not been systematically evaluated in controlled trials. Therefore, the physician who elects to use Adderall® for extended periods should periodically reevaluate the long-term usefulness of the drug for the individual patient.

2007

OVERDOSAGE: Individual patient response to amphetamines varies widely. Toxic symptoms may occur idiosyncratically at low doses. Symptoms:

From 2005

Drug/Laboratory Test Interactions:

• Amphetamines can cause a significant elevation in plasma corticosteroid levels. This increase is greatest in the evening.

ADVERSE REACTIONS

Endocrine:

Impotence, changes in libido.

OVERDOSAGE:

Individual patient response to amphetamines varies widely. While toxic symptoms occasionally occur as an idiosyncrasy at doses as low as 2 mg, they are rare with doses of less than 15 mg; 30 mg can produce severe reactions, yet doses of 400 to 500 mg are not necessarily fatal.

—-------

FDA doc mentions high corticosteroids from Adderall. Here are symptoms of chronically high cortisol which would also be side effects caused by Adderall.

https://www.google.com/search?q=side+effects+of+high+cortisol&rlz=1CADRLH_enUS1010&oq=side+effects+of+high+cortisol&gs_lcrp=EgZjaHJvbWUyBggAEEUYOdIBCDcyOTNqMGo3qAIAsAIA&sourceid=chrome&ie=UTF-8

Here is a list of chronically high cortisol symptoms.

–Brain fog: Difficulty concentrating, focusing, and a slower thought process

–Sleep disturbance: Lack of energy

–Decreased libido: Cortisol suppresses sex hormones and decreases testosterone

–Weight gain: Especially in the face and abdomen, and sometimes with a rounded face

–High blood pressure: Also known as hypertension

–High blood sugar: Which can lead to type 2 diabetes

–Fatty deposits: Between the shoulder blades

–Stretch marks: Wide, purple stretch marks on the abdomen

–Muscle weakness: In the upper arms and thighs

–Bone loss: Also known as osteoporosis, which can lead to fractures

–Susceptibility to infection: Cortisol can impair the immune system

–Heart palpitations: A racing heart

–Restlessness: Anxiety

–Constipation: Feeling bloated

–Headaches: 2601:8C:4E80:7578:6138:2331:E1B3:6E99 (talk) 12:39, 13 November 2024 (UTC)

I'm still not sure what you want changed in the article/what specifically violates WP:NPOV. I requested bullet point sentences and quoted examples of WP:NPOV violations, but instead you've essentially source dumped the USFDA prescribing info - which is already covered extensively in Adderall#Adverse effects (NB: much of that section is transcluded from Amphetamine#Adverse effects and happens to be featured article compliant) - and supplied a google search URL for "side effects of high cortisol", which isn't a MEDRS citation, let alone a citation that discusses side effects of pharmaceutical amphetamine. Professional Crastination (talk) 08:48, 2 December 2024 (UTC)

MAS title usage

@Gobucks821 I've reverted the changes you made Re: substituting Adderall for "MAS products" throughout the article.

Adderall is the title of this article and the usage of Adderall to refer to the specific amphetamine salt composition in both Adderall and Mydayis dosage formulations is underpinned by previous consensus on this article's talk page. Moreover, the note in the title sentence of this article clarifies the usage of Adderall throughout the article.

For those reasons, in future you need to gain consensus on this article's talk page before making a change like that. Professional Crastination (talk) 05:02, 7 August 2024 (UTC)

Contra TAAR1 agonism as the mediator of amphetamine actions

Requesting input on this topic here at WikiProject Pharmacology. Thanks. – AlyInWikiWonderland (talk, contribs) 16:00, 13 December 2024 (UTC)