آدرال

(تم التحويل من آديرال)
أمفيتامين/دكستروأمفيتامين
خليط ملحي (1:1)[note 1]
صورة للتركيب الهيكلي للأمفتيامين
a 3d image of the dextroamphetamine compound found in Adderall
أعلى: التركيب الهيكلي للأمفيتامين
Bottom: نموذج الكرة والعصا لـ(د)-أمفيتامين
البيانات السريرية
الأسماء التجاريةAdderall, Adderall XR, Mydayis
أسماء أخرىMixed amphetamine salts; MAS
AHFS/Drugs.comMonograph
MedlinePlusa601234
License data
إحتمالية
الإدمان		Moderate[3][4] – high[5][6][7]
مسارات
الدواء		By mouth, insufflation, rectal, sublingual
فئة الدواءCNS stimulant
رمز ATC
الحالة القانونية
الحالة القانونية
بيانات الحركية الدوائية
التوافر الحيويOral: ~90%[9]
المعرفات
رقم CAS
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
  (verify)

الآدرال (Adderall) والميدايس (Mydayis)[10] هما الاسمان التجاريان [note 2] لدواء مركب يحتوي على أملاح الأمفيتامين. يتكون الخليط من أجزاء متساوية من الأمفيتامين الراسيمي ودكستروأمفيتامين، والذي ينتج نسبة (3:1) بين الدكستروأمفيتامين ولڤوأمفيتامين، وهما المتماكبان المتقابلان للأمفيتامين.[12] كلا المتماكبان من المنشطات، لكنهما يختلفان بدرجة كافية لإعطاء الآدرال ملف تأثيرات مختلف عن تلك الموجودة في الأمفيتامين الراسيمي أو الدكستروأمفيتامين،[1][2] الذي يتم تسويقهما باسم Evekeo دكسدرين/زنزدي على التوالي.[1][13][14] يُستخدم الآدرال في علاج اضطراب قصور الإنتباه وفرط الحركة (ADHD) وخدار. كما يُستخدم بشكل غير مشروع كمُحسِّن للأداء الرياضي، ومُحسِّن للإدراك، ومُثبِّط للشهية، ومادة مبهجة. وهو منشط للجهاز العصبي المركزي من فئة الفنثيلامين.[1]

بالجرعات العلاجية، يسبب الآدرال تأثيرات عاطفية وإدراكية مثل البهجة، وتغير في الدافع الجنسية، وزيادة اليقظة، وتحسين التحكم الإدراكي. عند تناول هذه الجرعات، يسبب الآدرال آثاراً جسدية مثل سرعة رد الفعل ومقاومة التعب وزيادة قوة العضلات. وعلى النقيض من ذلك، يمكن لجرعات أكبر بكثير من الأدرال أن تضعف التحكم الإدراكي، تسبب الانحلال العضلي السريع، تثير نوبات الذعر، أو تحفز الذهان (على سبيل المثال، جنون الارتياب، الوهام، الهلاوس). تختلف الآثار الجانبية بشكل كبير بين الأشخاص، لكن أكثرها شيوعاً يشمل الأرق، جفاف الفم، فقدان الشهية وفقدان الوزن. إن خطر الإصابة بالإدمان أو إدمان المواد ضئيل عند استخدام الآدرال وفقاً للوصفة الطبية وبجرعات يومية منخفضة إلى حد ما، مثل تلك المستخدمة لعلاج قصور الإنتباه وفرط الحركة. ومع ذلك، فإن الاستخدام الروتيني للآدرال بجرعات يومية أكبر يشكل خطراً كبيراً للإدمان أو الاعتياد بسبب التأثيرات التعزيزية الواضحة الموجودة في الجرعات العالية. تكون الجرعات الترفيهية من الآدرال أكبر بكثير من الجرعات العلاجية الموصوفة كما تحمل أيضاً خطراً أكبر بكثير من الآثار الجانبية الخطيرة.[sources 1]

إن اثنين من المتماكبات المتقابلة الأمفيتامينية التي تشكل الآدرال، مثل أقراص/كبسولات آدرال (لڤوأمفيتامين ودكستروأمفيتامين)، تخفف من أعراض اضطراب قصور الإنتباه وفرط الحركة والنوم القهري عن طريق زيادة نشاط الناقل العصبي نورإپي‌نفرين ودوپامين في المخ البشري، والذي ينتج جزئيًا عن تفاعلهما مع مستقبلات الأمين البشري المرتبطة بالأثر 1 (hTAAR1) وناقل الأمين الأحادي الحويصلي 2 (VMAT2) في العصبونات. دكستروأمفيتامين هو منشط أقوى للجهاز العصبي المركزي من اللڤوأمفيتامين، لكن اللڤوأمفيتامين له تأثيرات قلبية وعائية ومحيطية أقوى قليلاً وعمر النصف الحيوي أطول من الدكستروأمفيتامين. أُبلغ عن أن مكون اللڤوأمفيتامين في الآدرال[weasel words] يحسن استجابة العلاج لدى بعض الأشخاص مقارنة بالدكستروأمفيتامين وحده[بحاجة لمصدر]. المادة الفعالة في الآدرال، الأمفيتامين، تشترك في العديد من الخصائص الكيميائية والدوائية مع الأمينات النزرة البشرية، وخاصة الفنثيلامين وN-مثيلفنثيلامين، والأخير هو متزامِر موضعي للأمفيتامين.[sources 2] عام 2022، احتل الآدرال الترتيب 14 كأكثر الأدوية الموصوفة في الولايات المتحدة، بأكثر من 34 مليون وصفة طبية.[34][35]

--->

الاستخدامات

30 Adderall XR 10 mg capsules
30 capsules of 10 mg Adderall XR
Adderall 20 mg tablets
A group of 20 mg Adderall tablets, some broken in half, with a lengthwise-folded US dollar bill along the bottom (3.07 inches; 7.8 cm) for size comparison


الطبية

Adderall is commonly used to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy (a sleep disorder).[1][16]

قصور الإنتباه وفرط الحركة

الخدار

الأشكال المتوافرة

Adderall is available as immediate-release (IR) tablets and extended-release (XR) capsules.[16][36] Mydayis is only available as an extended-release formulation.[37] Adderall XR is approved to treat ADHD for up to 12 hours in individuals 6 years and older and uses a double-bead formulation. The capsule can be swallowed like a tablet, or it can be opened and the beads sprinkled over applesauce for comparable absorption.[36] Upon ingestion, half of the beads provide immediate administration of medication, while the other half are enveloped in a coating that must dissolve, delaying absorption of its contents. It is designed to provide a therapeutic effect and plasma concentrations identical to taking two doses of Adderall IR four hours apart.[36] Mydayis uses a longer-lasting triple-bead formulation and is approved to treat ADHD for up to 16 hours in individuals 13 years and older.[37] In the United States, the immediate and extended-release formulations of Adderall are both available as generic drugs.[38][39] Generic formulations of Mydayis became available in the US in October 2023.[40]

تحسين الأداء

Adderall has been banned in the National Football League (NFL), Major League Baseball (MLB), National Basketball Association (NBA), and the National Collegiate Athletics Association (NCAA).[41] In leagues such as the NFL, there is a very rigorous process required to obtain an exemption to this rule even when the athlete has been medically prescribed the drug by their physician.[41]

Recreational

انظر أيضاً: History and culture of substituted amphetamines

Adderall has a high potential for misuse as a recreational drug.[42][43][44] Adderall tablets can either be swallowed, crushed and snorted, or dissolved in water and injected.[45] Injection into the bloodstream can be dangerous because insoluble fillers within the tablets can block small blood vessels.[45]

Many postsecondary students have reported using Adderall for study purposes in different parts of the developed world.[44] Among these students, some of the risk factors for misusing ADHD stimulants recreationally include: possessing deviant personality characteristics (i.e., exhibiting delinquent or deviant behavior), inadequate accommodation of disability, basing one's self-worth on external validation, low self-efficacy, earning poor grades, and having an untreated mental health disorder.[44]

موانع الاستخدام

section-not-found

الآثار الجانبية

جزء من هذا القسم متضمن من Amphetamine. (edit | history)

The adverse side effects of Adderall are many and varied, but the amount of substance consumed is the primary factor in determining the likelihood and severity of side effects.[19][30] Adderall is currently approved for long-term therapeutic use by the USFDA.[19] Recreational use of Adderall generally involves far larger doses and is therefore significantly more dangerous, involving a much greater risk of serious adverse drug effects than dosages used for therapeutic purposes.[30]


الجرعات الزائدة

section-not-found

التداخلات الدوائية


علم الأدوية

آلية الحركة

لمعلومات عن a more complete and detailed description of amphetamine pharmacodynamics، انظر Amphetamine#Pharmacodynamics.
Monoamine release of amphetamine and related agents (EC50, nM)
Compound NE DA 5-HT Ref
Phenethylamine 10.9 39.5 >10000 [56][57][58]
Dextroamphetamine 6.6–7.2 5.8–24.8 698–1765 [59][60]
Levoamphetamine 9.5 27.7 ND [57][58]
Dextromethamphetamine 12.3–13.8 8.5–24.5 736–1291.7 [59][61]
Levomethamphetamine 28.5 416 4640 [59]
Notes: The smaller the value, the more strongly the drug releases the neurotransmitter. See also Monoamine releasing agent § Activity profiles for a larger table with more compounds. Refs: [62][63]
الديناميكية الدوائية للأمفيتامين في العصبو الدوپاميني
The image above contains clickable links
يدخل الأمفيتامين إلى الخلية العصبية قبل المشبكية عبر الغشاء العصبي أو من خلال ناقل الدوپامين. [27] بمجرد دخوله، يرتبط بالمستقبل المرتبط بأمين النزر 1 (TAAR1) أو يدخل الحوصيلات المشبكية عن طريق مستقبل الأمين الأحادي الحوصيلي 2 (VMAT2).[27][28] عندما يدخل الأمفيتامين إلى الحويصلات المشبكية من خلال مستقبل الأمين الأحادي الحوصيلي 2، فإنه يتسبب في انهيار تدرج الأس الهيدروجيني الحويصلي، مما يؤدي بدوره إلى إطلاق الدوپامين في السيتوزول (المنطقة ذات اللون بني فاتح) من خلال مستقبل الأمين الأحادي الحوصيلي 2.[28][64] عندما يرتبط الأمفيتامين بالمستقبل المرتبط بأمين النزر 1، فإنه يقلل من معدل إطلاق العصبون الدوپاميني عبر قنوات الپوتاسيوم المقترنة بالبروتين جي (GIRKs) وينشط الپروتين كيناز إيه (PKA) والپروتين كيناز سي (PKC)، والذي يفسفر بعد ذلك ناقل الدوپامين]].[27][65][66] PKA phosphorylation مما يؤدي إلى انسحاب ناقل الدوپامين إلى ما قبل عصبون قبل المشبكي (يتم استيعابه) ويتوقف النقل.[27] PKC-phosphorylated قد يعمل ناقل الدوپامين إما بشكل معاكس، مثل PKA-phosphorylated، ويتم استيعاب ناقل الدوپامين ويتوقف النقل.[27] من المعروف أيضًا أن الأمفيتامين يزيد من الكالسيوم داخل الخلايا، وهو التأثير المرتبط بفسفرة ناقل الدوپامين من خلال مسار يعتمد على CAMKIIα، مما يؤدي بدوره إلى تدفق الدوپامين.[67][68]

Amphetamine, the active ingredient of Adderall, works primarily by increasing the activity of the neurotransmitters dopamine and norepinephrine in the brain.[26][69] It also triggers the release of several other hormones (e.g., epinephrine) and neurotransmitters (e.g., serotonin and histamine) as well as the synthesis of certain neuropeptides (e.g., cocaine and amphetamine regulated transcript (CART) peptides).[28][70] Both active ingredients of Adderall, dextroamphetamine and levoamphetamine, bind to the same biological targets,[30][31] but their binding affinities (that is, potency) differ somewhat.[30][31] Dextroamphetamine and levoamphetamine are both potent full agonists (activating compounds) of trace amine-associated receptor 1 (TAAR1) and interact with vesicular monoamine transporter 2 (VMAT2), with dextroamphetamine being the more potent agonist of TAAR1.[31] Consequently, dextroamphetamine produces more CNS stimulation than levoamphetamine;[31][71] however, levoamphetamine has slightly greater cardiovascular and peripheral effects.[30] It has been reported that certain children have a better clinical response to levoamphetamine.[32][33]

In the absence of amphetamine, VMAT2 will normally move monoamines (e.g., dopamine, histamine, serotonin, norepinephrine, etc.) from the intracellular fluid of a monoamine neuron into its synaptic vesicles, which store neurotransmitters for later release (via exocytosis) into the synaptic cleft.[28] When amphetamine enters a neuron and interacts with VMAT2, the transporter reverses its direction of transport, thereby releasing stored monoamines inside synaptic vesicles back into the neuron's intracellular fluid.[28] Meanwhile, when amphetamine activates TAAR1, the receptor causes the neuron's cell membrane-bound monoamine transporters (i.e., the dopamine transporter, norepinephrine transporter, or serotonin transporter) to either stop transporting monoamines altogether (via transporter internalization) or transport monoamines out of the neuron;[27] in other words, the reversed membrane transporter will push dopamine, norepinephrine, and serotonin out of the neuron's intracellular fluid and into the synaptic cleft.[27] In summary, by interacting with both VMAT2 and TAAR1, amphetamine releases neurotransmitters from synaptic vesicles (the effect from VMAT2) into the intracellular fluid where they subsequently exit the neuron through the membrane-bound, reversed monoamine transporters (the effect from TAAR1).[27][28]

الحركية الدوائية

هذا القسم متضمن من Amphetamine#Pharmacokinetics. (edit | history)


الميكروبيومات الدوائية

section-not-found

المركبات الداخلية المتعلقة

هذا القسم متضمن من Amphetamine#Related endogenous compounds. (edit | history)

التاريخ

المقالة الرئيسية: تاريخ وثقافة بدائل الأمفيتامينات

The pharmaceutical company Rexar reformulated their popular weight loss drug Obetrol following its mandatory withdrawal from the market in 1973 under the Kefauver Harris Amendment to the Federal Food, Drug, and Cosmetic Act due to the results of the Drug Efficacy Study Implementation (DESI) program (which indicated a lack of efficacy). The new formulation simply replaced the two methamphetamine components with dextroamphetamine and amphetamine components of the same weight (the other two original dextroamphetamine and amphetamine components were preserved), preserved the Obetrol branding, and despite it lacking FDA approval, it still made it onto the market and was marketed and sold by Rexar for many years.

In 1994, Richwood Pharmaceuticals acquired Rexar and began promoting Obetrol as a treatment for ADHD (and later narcolepsy as well), now marketed under the new brand name of Adderall, a contraction of the phrase "A.D.D. for All" intended to convey that "it was meant to be kind of an inclusive thing" for marketing purposes.[72] The FDA cited the company for numerous significant CGMP violations related to Obetrol discovered during routine inspections following the acquisition (including issuing a formal warning letter for the violations), then later issued a second formal warning letter to Richwood Pharmaceuticals specifically due to violations of "the new drug and misbranding provisions of the FD&C Act". Following extended discussions with Richwood Pharmaceuticals regarding the resolution of a large number of issues related to the company's numerous violations of FDA regulations, the FDA formally approved the first Obetrol labeling/sNDA revisions in 1996, including a name change to Adderall and a restoration of its status as an approved drug product.[73][74] In 1997 Richwood Pharmaceuticals was acquired by Shire Pharmaceuticals in a $186 million transaction.[72]

Richwood Pharmaceuticals, which later merged with Shire plc, introduced the current Adderall brand in 1996 as an instant-release tablet.[75] In 2006, Shire agreed to sell rights to the Adderall name for the instant-release form of the medication to Duramed Pharmaceuticals.[76] DuraMed Pharmaceuticals was acquired by Teva Pharmaceuticals in 2008 during their acquisition of Barr Pharmaceuticals, including Barr's Duramed division.[77]

The first generic version of Adderall IR was introduced to the market in 2002.[11] Later on, Barr and Shire reached a settlement agreement permitting Barr to offer a generic form of the extended-release drug beginning in April 2009.[11][78]

التركيبات التجارية

Chemically, Adderall is a mixture of four amphetamine salts; specifically, it is composed of equal parts (by mass) of amphetamine aspartate monohydrate, amphetamine sulfate, dextroamphetamine sulfate, and dextroamphetamine saccharate.[36] This drug mixture has slightly stronger CNS effects than racemic amphetamine due to the higher proportion of dextroamphetamine.[27][30] Adderall is produced as both an immediate-release (IR) and extended-release (XR) formulation.[11][16][46] اعتبارا من ديسمبر 2013, ten different companies produced generic Adderall IR, while Teva Pharmaceutical Industries, Actavis, and Barr Pharmaceuticals manufactured generic Adderall XR.[11] اعتبارا من 2013, Shire plc, the company that held the original patent for Adderall and Adderall XR, still manufactured brand name Adderall XR, but not Adderall IR.[11]

مقارنة بتركيبات أخرى

Adderall is one of several formulations of pharmaceutical amphetamine, including singular or mixed enantiomers and as an enantiomer prodrug. The table below compares these medications (based on U.S.-approved forms):

قاعدة الأمفيتامين في أدوية الأمفيتامين المسوقة
الدواء التركيبة الكتلة المولية
[note 4] 		قاعدة الأمفيتامين
[note 5] 		قاعدة الأمفيتامين
في الجرعات المتساوية 		الجرعات
بمحتوى قاعدي
متساوي
[note 6]
(جم/مول) (النسبة المئوية) (جرعة 30 مجم)
الإجمالي القاعدة الإجمالي الدكسترو- اللـِڤو- الدكسترو- اللـِڤو-
كبريتات الدكستروأمفيتامين[80][81] (C9H13N)2•H2SO4
368.49
270.41
73.38%
73.38%
—
22.0 مج
—
30.0 مج
كبريتات الأمفيتامين[82] (C9H13N)2•H2SO4
368.49
270.41
73.38%
36.69%
36.69%
11.0 مجم
11.0 مجم
30.0 مجم
أديرال
62.57%
47.49%
15.08%
14.2 مجم
4.5 مجم
35.2 مجم
25% كبريتات الدكستروأمفيتامين[80][81] (C9H13N)2•H2SO4
368.49
270.41
73.38%
73.38%
—
25% كبريتات الأمفيتامين [82] (C9H13N)2•H2SO4
368.49
270.41
73.38%
36.69%
36.69%
25% سكريدات الدكستروأمفيتامين[83] (C9H13N)2•C6H10O8
480.55
270.41
56.27%
56.27%
—
25% مونوهيدرات أسپارتات الأمفيتامين [84] (C9H13N)•C4H7NO4•H2O
286.32
135.21
47.22%
23.61%
23.61%
ديميسيلات الليزديكسامفيتامين[85] C15H25N3O•(CH4O3S)2
455.49
135.21
29.68%
29.68%
—
8.9 mg
—
74.2 mg
معلق الأمفيتامين القاعدي[86] C9H13N
135.21
135.21
100%
76.19%
23.81%
22.9 مجم
7.1 مجم
22.0 مجم

المجتمع والثقافة

الوضع القانوني

  • In Canada, amphetamines are in Schedule I of the Controlled Drugs and Substances Act, and can only be obtained by prescription.[87]
  • In Japan, the use, production, and import of any medicine containing amphetamines is prohibited.[88]
  • In South Korea, amphetamines are prohibited.[89]
  • In Taiwan, amphetamines including Adderall are Schedule 2 drugs with a minimum five-year prison term for possession.[90] On the contrary, Ritalin can be legally prescribed as a form of treatment of ADHD.[91]
  • In Thailand, amphetamines are classified as Type 1 Narcotics.[92]
  • In the United Kingdom, amphetamines are regarded as Class B drugs. The maximum penalty for unauthorized possession is five years in prison and an unlimited fine. The maximum penalty for illegal supply is 14 years in prison and an unlimited fine.[93]
  • In the United States, amphetamine is a Schedule II prescription drug, classified as a central nervous system (CNS) stimulant.[8]
  • Internationally, amphetamine is in Schedule II of the Convention on Psychotropic Substances.[94][95]

النقص

In February 2023, news organizations began reporting on shortages of Adderall in the United States that have lasted for over five months.[96][97] The Food and Drug Administration first reported the shortage in October 2022.[98] In May 2023, seven months into the shortage, the Food and Drug Administration commissioner Robert Califf stated that "a number of generic drugs are in shortage at any given time because there's not enough profit". He points out that Adderall is a special case because it is a controlled substance and the amount available for prescription is controlled by the Drug Enforcement Administration. He also faults a "tremendous increase in prescribing" due to virtual prescribing and general overprescribing and overdiagnosing, adding that "if only the people that needed these drugs got them, there probably wouldn't be a [stimulant medication] shortage".[99][100] The shortage has continued into 2024.[101][102][103] It has led to the creation and expansion of businesses that outsource the search for Adderall. One company charges $50 per U.S. customer to hire workers in the Philippines or another country to make phone calls to all the pharmacies located near the customer and check whether they have any Adderall. Celebrity endorsements have contributed to the increased demand for Adderall.[104]

الهوامش

  1. ^ Salts of racemic amphetamine and dextroamphetamine are mixed in a (1:1) ratio to produce this drug. Because the racemate is composed of equal parts dextroamphetamine and levoamphetamine, this drug can also be described as a mixture of the D and (L)-enantiomers of amphetamine in a (3:1) ratio, although none of the components of the mixture are levoamphetamine salts.[1][2]
  2. ^ The trade name Adderall is used primarily throughout this article because the four-salt composition of the drug makes its nonproprietary name (dextroamphetamine sulfate 25%, dextroamphetamine saccharate 25%, amphetamine sulfate 25%, and amphetamine aspartate 25%) is excessively lengthy.[11] Mydayis is a relatively new trade name that is not commonly used to refer generally to the mixture.[10]
  3. ^ The human dopamine transporter contains a high affinity extracellular zinc binding site which, upon zinc binding, inhibits dopamine reuptake and amplifies amphetamine-induced dopamine efflux in vitro.[49][50][51] The human serotonin transporter and norepinephrine transporter do not contain zinc binding sites.[51]
  4. ^ من أجل التوحيد، حُسبت الكتل المولية باستخدام حاسبة الوزن الجزيئي[79] وكانت في حدود 0.01 جم/مول من القيم الصيدلانية المنشورة.
  5. ^ النسبة المئوية لقاعدة الأمفيتامين = الكتلة الموليةالقاعدية / الكتلة الموليةالإجمالية . النسبة المئوية لقاعدة الأمفيتامين في الأديرال = مجموع النسب المئوية للمكونات / 4.
  6. ^ dose = (1 / النسبة المئوية لقاعدة الأمفيتامين) &المرات؛ عامل القياس = (الكتلة المولية الإجمالية / الكتلة الموليةالقاعدية) &المرات؛ عامل القياس. تم قياس القيم في هذا العمود على أساس جرعة 30 مجم من كبريتات الدكستروأمفيتامين. نظرًا للاختلافات الدوائية بين هذه الأدوية (على سبيل المثال، الاختلافات في الإطلاق، والامتصاص، والتحويل، والتركيز، والتأثيرات المختلفة للنظائر المتماثلة، ونصف العمر، وما إلى ذلك)، لا ينبغي اعتبار القيم المدرجة جرعات متساوية الفعالية.
مفتاح الصورة

المصادر

  1. ^ [15][16][17][18][19][20][21][22][23][24][25]
  2. ^ [26][27][28][29][30][31][32][33]

المراجع

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