Rheumatology Follow Up Patient Form: Fill & Download for Free

Data is very limited but the limited data we do have suggests there is not a drastic differenceThe only epidemiological survey I am aware of is from the COVID-19 Global Rheumatology Alliance .[1] Lupus and rheumatoid arthritis are often treated with immunosuppressive drugs,[2] which could make patients more vulnerable to COVID-19 infection. The Alliance was formed to track the prevalence of COVID-19 in this population with a secondary aim of seeing if any of the drugs currently used made an impact on infection rates (in addition to hydroxychloroquine, Tocilizumab (Actemra) is undergoing a Phase III clinical trial for severe COVID-19)[3]The Rheumatology Alliance is a survey, not a systematic study. The Alliance relies on the reports from 301 health care providers and self reports from patients. The survey so far has found 146 COVID-19 cases from 5454 patient reports.25% of these are on hydroxychloroquineAdditional data regarding patients on hydroxychloroquine from the first 110 patients:Of the 22 individuals on HCQ, 7 have resolved COVID19 infection, 12 have unresolved infection, 3 unknown. There was 1 death.— The COVID-19 Global Rheumatology Alliance (@rheum_covid) April 2, 2020What can we learn from this? Not much. To make sense of this number, we need to know how many of these people are on hydroxychloroquine. They haven’t broken this number down by disease type so we are very limited in what we can say, since the percentage of people taking hydroxychloroquine varies for different diseases. The Alliance did conclude:[4]We can say that this drug is likely not 100% effective in preventing or treating COVID, and that SLE [systemic lupus erythematosus] patients should not let their guard downBased on early data currently available in our registry, we are not able to report any evidence of a protective effect from hydroxychloroquine against COVID-19.A randomized, controlled trial would be the only way to study this to get a reliable answer to this question.— The COVID-19 Global Rheumatology Alliance (@rheum_covid) April 5, 2020contradicting a previous report that may have served as the basis for the claim:[5]Interestingly, through a follow-up survey, we found that none of our 80 SLE patients who took long-term oral HCQ had been confirmed to have SARS-CoV-2 infection or appeared to have related symptoms. In addition, among the 178 patients diagnosed with COVID-19 pneumonia in our hospital, none were receiving HCQ treatment before admission.Why the difference? Lupus is a rare disease (about 1 in 1000).[6] Positively ID COVID-19 was also fairly rare even in Wuhan (about 1 in 150).[7] While these numbers sound impressive, they are not that surprising. To find a connection, you need much larger numbers. While the survey above suggests a drastic difference does not exist, it is not able to detect moderate to small differences (for example a 20% decrease). In the end a clinical trial gives a much better answer to this question.Footnotes[1] The COVID-19 Global Rheumatology Alliance: collecting data in a pandemic[2] The risk of infections with biologic therapies for rheumatoid arthritis.[3] https://www.cancernetwork.com/news/fda-approves-phase-iii-clinical-trial-tocilizumab-covid-19-pneumonia[4] Trump's False Coronavirus Claim About Lupus Patients[5] Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial[6] Infection Is Leading Cause of Death in Lupus Patients in China...[7] Phase-adjusted estimation of the number of Coronavirus Disease 2019 cases in Wuhan, China

Adderall DescriptionA single-entity amphetamine product combining the neutral sulfate salts of dextroamphetamine and amphetamine, with the dextro isomer of amphetamine saccharate and d, l-amphetamine aspartate. kindly email juicetrip at Protonmail dot com to purchase Adderall with and without prescription, not out of context reliable sources and legit.EACH TABLET CONTAINS5 mg7.5 mg10 mg12.5 mg15 mg20 mg30 mgDextroamphetamineSaccharate1.25 mg1.875 mg2.5 mg3.125 mg3.75 mg5 mg7.5 mgAmphetamine Aspartate Monohydrate Equivalent1.25 mg*1.875 mg†2.5 mg‡3.125 mg§3.75 mg¶5 mg#7.5 mgÞDextroamphetamineSulfate, USP1.25 mg1.875 mg2.5 mg3.125 mg3.75 mg5 mg7.5 mgAmphetamineSulfate, USP1.25 mg1.875 mg2.5 mg3.125 mg3.75 mg5 mg7.5 mgTotal Amphetamine Base Equivalence3.13 mg4.7 mg6.3 mg7.8 mg9.4 mg12.6 mg18.8 mgInactive Ingredients: colloidal silicon dioxide, compressible sugar, corn starch, magnesium stearate, microcrystalline cellulose and saccharin sodium.Colors: Adderall ® 5 mg is a white to off-white tablet, which contains no color additives.Adderall ® 7.5 mg and 10 mg contain FD&C Blue #1 Aluminum Lake as a color additive.Adderall ® 12.5 mg, 15 mg, 20 mg and 30 mg contain FD&C Yellow #6 Aluminum Lake as a color additive.Adderall - Clinical PharmacologyPharmacodynamicsAmphetamines are non-catecholamine sympathomimetic amines with CNS stimulant activity. The mode of therapeutic action in Attention Deficit Hyperactivity Disorder (ADHD) is not known. Amphetamines are thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space.PharmacokineticsAdderall® tablets contain d-amphetamine and l-amphetamine salts in the ratio of 3:1. Following administration of a single dose 10 or 30 mg of Adderall® to healthy volunteers under fasted conditions, peak plasma concentrations occurred approximately 3 hours post-dose for both d-amphetamine and l-amphetamine. The mean elimination half-life (t1/2) for d-amphetamine was shorter than the t1/2 of the l-isomer (9.77 to 11 hours vs. 11.5 to 13.8 hours). The PK parameters (Cmax, AUC0-inf) of d-and l-amphetamine increased approximately three-fold from 10 mg to 30 mg indicating dose-proportional pharmacokinetics.The effect of food on the bioavailability of Adderall® has not been studied.Metabolism and ExcretionAmphetamine is reported to be oxidized at the 4 position of the benzene ring to form 4-hydroxyamphetamine, or on the side chain α or β carbons to form alpha-hydroxy-amphetamine or norephedrine, respectively. Norephedrine and 4-hydroxy-amphetamine are both active and each is subsequently oxidized to form 4-hydroxy-norephedrine. Alpha-hydroxy-amphetamine undergoes deamination to form phenylacetone, which ultimately forms benzoic acid and its glucuronide and the glycine conjugate hippuric acid. Although the enzymes involved in amphetamine metabolism have not been clearly defined, CYP2D6 is known to be involved with formation of 4-hydroxy-amphetamine. Since CYP2D6 is genetically polymorphic, population variations in amphetamine metabolism are a possibility.Amphetamine is known to inhibit monoamine oxidase, whereas the ability of amphetamine and its metabolites to inhibit various P450 isozymes and other enzymes has not been adequately elucidated. In vitro experiments with human microsomes indicate minor inhibition of CYP2D6 by amphetamine and minor inhibition of CYP1A2, 2D6, and 3A4 by one or more metabolites. However, due to the probability of auto-inhibition and the lack of information on the concentration of these metabolites relative to in vivoconcentrations, no predications regarding the potential for amphetamine or its metabolites to inhibit the metabolism of other drugs by CYP isozymes in vivo can be made.With normal urine pHs approximately half of an administered dose of amphetamine is recoverable in urine as derivatives of alpha-hydroxy-amphetamine and approximately another 30% to 40% of the dose is recoverable in urine as amphetamine itself. Since amphetamine has a pKa of 9.9, urinary recovery of amphetamine is highly dependent on pH and urine flow rates. Alkaline urine pHs result in less ionization and reduced renal elimination, and acidic pHs and high flow rates result in increased renal elimination with clearances greater than glomerular filtration rates, indicating the involvement of active secretion. Urinary recovery of amphetamine has been reported to range from 1% to 75%, depending on urinary pH, with the remaining fraction of the dose hepatically metabolized. Consequently, both hepatic and renal dysfunction have the potential to inhibit the elimination of amphetamine and result in prolonged exposures. In addition, drugs that affect urinary pH are known to alter the elimination of amphetamine, and any decrease in amphetamine’s metabolism that might occur due to drug interactions or genetic polymorphisms is more likely to be clinically significant when renal elimination is decreasedIndications and Usage for AdderallAdderall® (Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate Tablets (Mixed Salts of a Single Entity Amphetamine Product)) is indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) and Narcolepsy.Attention Deficit Hyperactivity Disorder (ADHD)A diagnosis of Attention Deficit Hyperactivity Disorder (ADHD; DSM-IV®) implies the presence of hyperactive-impulsive or inattentive symptoms that caused impairment and were present before age 7 years. The symptoms must cause clinically significant impairment, e.g., in social, academic, or occupational functioning, and be present in two or more settings, e.g., school (or work) and at home. The symptoms must not be better accounted for by another mental disorder. For the Inattentive Type, at least six of the following symptoms must have persisted for at least 6 months: lack of attention to details/careless mistakes; lack of sustained attention; poor listener; failure to follow through on tasks; poor organization; avoids tasks requiring sustained mental effort; loses things; easily distracted; forgetful. For the Hyperactive-Impulsive Type, at least six of the following symptoms must have persisted for at least 6 months: fidgeting/squirming; leaving seat; inappropriate running/climbing; difficulty with quiet activities; “on the go;” excessive talking; blurting answers; can't wait turn; intrusive. The Combined Type requires both inattentive and hyperactive-impulsive criteria to be met.Special Diagnostic ConsiderationsSpecific etiology of this syndrome is unknown, and there is no single diagnostic test. Adequate diagnosis requires the use not only of medical but of special psychological, educational, and social resources. Learning may or may not be impaired. The diagnosis must be based upon a complete history and evaluation of the child and not solely on the presence of the required number of DSM-IV® characteristics.Need for Comprehensive Treatment ProgramAdderall® (Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate Tablets (Mixed Salts of a Single Entity Amphetamine Product)) is indicated as an integral part of a total treatment program for ADHD that may include other measures (psychological, educational, social) for patients with this syndrome. Drug treatment may not be indicated for all children with this syndrome. Stimulants are not intended for use in the child who exhibits symptoms secondary to environmental factors and/or other primary psychiatric disorders, including psychosis. Appropriate educational placement is essential and psychosocial intervention is often helpful. When remedial measures alone are insufficient, the decision to prescribe stimulant medication will depend upon the physician's assessment of the chronicity and severity of the child's symptoms.Long-Term UseThe effectiveness of Adderall®(Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate Tablets (Mixed Salts of a Single Entity Amphetamine Product)) for long-term use has not been systematically evaluated in controlled trials. Therefore, the physician who elects to use Adderall® (Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate Tablets (Mixed Salts of a Single Entity Amphetamine Product)) for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient.ContraindicationsAdvanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, known hypersensitivity or idiosyncrasy to the sympathomimetic amines, glaucoma.Agitated states.Patients with a history of drug abuse.During or within 14 days following the administration of monoamine oxidase inhibitors (hypertensive crises may result).WarningsSerious Cardiovascular EventsSudden Death and Preexisting Structural Cardiac Abnormalities or Other Serious Heart ProblemsChildren and AdolescentsSudden death has been reported in association with CNS stimulant treatment at usual doses in children and adolescents with structural cardiac abnormalities or other serious heart problems.Although some structural heart problems alone may carry an increased risk of sudden death, stimulant products generally should not be used in children or adolescents with known structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or other serious cardiac problems that may place them at increased vulnerability to the sympathomimetic effects of a stimulant drugAdultsSudden deaths, stroke, and myocardial infarction have been reported in adults taking stimulant drugs at usual doses for ADHD. Although the role of stimulants in these adult cases is also unknown, adults have a greater likelihood than children of having serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, or other serious cardiac problems. Adults with such abnormalities should also generally not be treated with stimulant drugsHypertension and Other Cardiovascular ConditionsStimulant medications cause a modest increase in average blood pressure (about 2 to 4 mmHg) and average heart rate (about 3 to 6 bpm) and individuals may have larger increases. While the mean changes alone would not be expected to have short-term consequences, all patients should be monitored for larger changes in heart rate and blood pressure. Caution is indicated in treating patients whose underlying medical conditions might be compromised by increases in blood pressure or heart rate, e.g., those with preexisting hypertension, heart failure, recent myocardial infarction, or ventricular arrhythmiaAssessing Cardiovascular Status in Patients Being Treated With Stimulant MedicationsChildren, adolescents, or adults who are being considered for treatment with stimulant medications should have a careful history (including assessment for a family history of sudden death or ventricular arrhythmia) and physical exam to assess for the presence of cardiac disease, and should receive further cardiac evaluation if findings suggest such disease (e.g., electrocardiogram and echocardiogram). Patients who develop symptoms such as exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease during stimulant treatment should undergo a prompt cardiac evaluation.Psychiatric Adverse EventsPreexisting PsychosisAdministration of stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with preexisting psychotic disorder.Bipolar IllnessParticular care should be taken in using stimulants to treat ADHD patients with comorbid bipolar disorder because of concern for possible induction of mixed/manic episode in such patients. Prior to initiating treatment with a stimulant, patients with comorbid depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.Emergence of New Psychotic or Manic SymptomsTreatment emergent psychotic or manic symptoms, e.g., hallucinations, delusional thinking, or mania in children and adolescents without prior history of psychotic illness or mania can be caused by stimulants at usual doses. If such symptoms occur, consideration should be given to a possible causal role of the stimulant, and discontinuation of treatment may be appropriate. In a pooled analysis of multiple short-term, placebo-controlled studies, such symptoms occurred in about 0.1% (4 patients with events out of 3482 exposed to methylphenidate or amphetamine for several weeks at usual doses) of stimulant-treated patients compared to 0 in placebo-treated patients.AggressionAggressive behavior or hostility is often observed in children and adolescents with ADHD, and has been reported in clinical trials and the postmarketing experience of some medications indicated for the treatment of ADHD. Although there is no systematic evidence that stimulants cause aggressive behavior or hostility, patients beginning treatment for ADHD should be monitored for the appearance of or worsening of aggressive behavior or hostility.Long-Term Suppression of GrowthCareful follow-up of weight and height in children ages 7 to 10 years who were randomized to either methylphenidate or non-medication treatment groups over 14 months, as well as in naturalistic subgroups of newly methylphenidate-treated and non-medication treated children over 36 months (to the ages of 10 to 13 years), suggests that consistently medicated children (i.e., treatment for 7 days per week throughout the year) have a temporary slowing in growth rate (on average, a total of about 2 cm less growth in height and 2.7 kg less growth in weight over 3 years), without evidence of growth rebound during this period of development. Published data are inadequate to determine whether chronic use of amphetamines may cause a similar suppression of growth, however, it is anticipated that they will likely have this effect as well. Therefore, growth should be monitored during treatment with stimulants, and patients who are not growing or gaining weight as expected may need to have their treatment interrupted.SeizuresThere is some clinical evidence that stimulants may lower the convulsive threshold in patients with prior history of seizure, in patients with prior EEG abnormalities in absence of seizures, and very rarely, in patients without a history of seizures and no prior EEG evidence of seizures. In the presence of seizures, the drug should be discontinued.Peripheral Vasculopathy, Including Raynaud’s PhenomenonStimulants, including Adderall®, used to treat ADHD are associated with peripheral vasculopathy, including Raynaud’s phenomenon. Signs and symptoms are usually intermittent and mild; however, very rare sequelae include digital ulceration and/or soft tissue breakdown. Effects of peripheral vasculopathy, including Raynaud’s phenomenon, were observed in postmarketing reports at different times and at therapeutic doses in all age groups throughout the course of treatment. Signs and symptoms generally improve after reduction in dose or discontinuation of drug. Careful observation for digital changes is necessary during treatment with ADHD stimulants. Further clinical evaluation (e.g., rheumatology referral) may be appropriate for certain patients.Serotonin SyndromeSerotonin syndrome, a potentially life-threatening reaction, may occur when amphetamines are used in combination with other drugs that affect the serotonergic neurotransmitter systems such as monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, and St. John’s Wort .Amphetamines and amphetamine derivatives are known to be metabolized, to some degree, by cytochrome P450 2D6 (CYP2D6) and display minor inhibition of CYP2D6 metabolism . The potential for a pharmacokinetic interaction exists with the coadministration of CYP2D6 inhibitors which may increase the risk with increased exposure to Adderall®. In these situations, consider an alternative non-serotonergic drug or an alternative drug that does not inhibit CYP2D6Serotonin syndrome symptoms may include mental status changes (e.g., agitation, hallucinations, delirium, and coma), autonomic instability (e.g., tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, hyperthermia), neuromuscular symptoms (e.g., tremor, rigidity, myoclonus, hyperreflexia, incoordination), seizures, and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea).Concomitant use of Adderall® with MAOI drugs is contraindicatedDiscontinue treatment with Adderall® and any concomitant serotonergic agents immediately if the above symptoms occur, and initiate supportive symptomatic treatment. If concomitant use of Adderall® with other serotonergic drugs or CYP2D6 inhibitors is clinically warranted, initiate Adderall® with lower doses, monitor patients for the emergence of serotonin syndrome during drug initiation or titration, and inform patients of the increased risk for serotonin syndrome.Visual DisturbanceDifficulties with accommodation and blurring of vision have been reported with stimulant treatment.PrecautionsGeneralThe least amount of amphetamine feasible should be prescribed or dispensed at one time in order to minimize the possibility of overdosage. Adderall® should be used with caution in patients who use other sympathomimetic drugs.TicsAmphetamines have been reported to exacerbate motor and phonic tics and Tourette’s syndrome. Therefore, clinical evaluation for tics and Tourette’s syndrome in children and their families should precede use of stimulant medications.Information for PatientsAmphetamines may impair the ability of the patient to engage in potentially hazardous activities such as operating machinery or vehicles; the patient should therefore be cautioned accordingly.Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with amphetamine or dextroamphetamine and should counsel them in its appropriate use. A patient Medication Guide is available for Adderall®.The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. The complete text of the Medication Guide is reprinted at the end of this document.Circulation Problems in Fingers and Toes [Peripheral Vasculopathy, Including Raynaud’s Phenomenon]Instruct patients beginning treatment with Adderall® about the risk of peripheral vasculopathy, including Raynaud’s phenomenon, and associated signs and symptoms: fingers or toes may feel numb, cool, painful, and/or may change color from pale, to blue, to red.Instruct patients to report to their physician any new numbness, pain, skin color change, or sensitivity to temperature in fingers or toes.Instruct patients to call their physician immediately with any signs of unexplained wounds appearing on fingers or toes while taking Adderall®.Further clinical evaluation (e.g., rheumatology referral) may be appropriate for certain patients.Drug InteractionsAcidifying AgentsGastrointestinal acidifying agents (guanethidine, reserpine, glutamic acid HCl, ascorbic acid, fruit juices, etc.) lower absorption of amphetamines.Urinary Acidifying Agents(ammonium chloride, sodium acid phosphate, etc.) increase the concentration of the ionized species of the amphetamine molecule, thereby increasing urinary excretion. Both groups of agents lower blood levels and efficacy of amphetamines.Adrenergic BlockersAdrenergic blockers are inhibited by amphetamines.Alkalinizing AgentsGastrointestinal alkalinizing agents (sodium bicarbonate, etc.) increase absorption of amphetamines. Coadministration of Adderall® and gastrointestinal alkalizing agents, such as antacids, should be avoided. Urinary alkalinizing agents (acetazolamide, some thiazides) increase the concentration of the non-ionized species of the amphetamine molecule, thereby decreasing urinary excretion. Both groups of agents increase blood levels and therefore potentiate the actions of amphetamines.Antidepressants, TricyclicAmphetamines may enhance the activity of tricyclic or sympathomimetic agents; d-amphetamine with desipramine or protriptyline and possibly other tricyclics cause striking and sustained increases in the concentration of d-amphetamine in the brain; cardiovascular effects can be potentiated.CYP2D6 InhibitorsThe concomitant use of Adderall® and CYP2D6 inhibitors may increase the exposure of Adderall®compared to the use of the drug alone and increase the risk of serotonin syndrome. Initiate with lower doses and monitor patients for signs and symptoms of serotonin syndrome particularly during Adderall® initiation and after a dosage increase. If serotonin syndrome occurs, discontinue Adderall® and the CYP2D6 inhibitor . Examples of CYP2D6 Inhibitors include paroxetine and fluoxetine (also serotonergic drugs), quinidine, ritonavir.Serotonergic DrugsThe concomitant use of Adderall® and serotonergic drugs increases the risk of serotonin syndrome. Initiate with lower doses and monitor patients for signs and symptoms of serotonin syndrome, particularly during Adderall® initiation or dosage increase. If serotonin syndrome occurs, discontinue Adderall® and the concomitant serotonergic drug(s) . Examples of serotonergic drugs include selective serotonin reuptake inhibitors (SSRI), serotonin norepinephrine reuptake inhibitors (SNRI), triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, St. John’s Wort.MAO InhibitorsMAOI antidepressants, as well as a metabolite of furazolidone, slow amphetamine metabolism. This slowing potentiates amphetamines, increasing their effect on the release of norepinephrine and other monoamines from adrenergic nerve endings; this can cause headaches and other signs of hypertensive crisis. A variety of neurological toxic effects and malignant hyperpyrexia can occur, sometimes with fatal results.AntihistaminesAmphetamines may counteract the sedative effect of antihistamines.AntihypertensivesAmphetamines may antagonize the hypotensive effects of antihypertensives.ChlorpromazineChlorpromazine blocks dopamine and norepinephrine receptors, thus inhibiting the central stimulant effects of amphetamines, and can be used to treat amphetamine poisoning.EthosuximideAmphetamines may delay intestinal absorption of ethosuximide.HaloperidolHaloperidol blocks dopamine receptors, thus inhibiting the central stimulant effects of amphetamines.Lithium CarbonateThe anorectic and stimulatory effects of amphetamines may be inhibited by lithium carbonate.MeperidineAmphetamines potentiate the analgesic effect of meperidine.Methenamine TherapyUrinary excretion of amphetamines is increased, and efficacy is reduced, by acidifying agents used in methenamine therapy.NorepinephrineAmphetamines enhance the adrenergic effect of norepinephrine.PhenobarbitalAmphetamines may delay intestinal absorption of phenobarbital; coadministration of phenobarbital may produce a synergistic anticonvulsant action.PhenytoinAmphetamines may delay intestinal absorption of phenytoin; coadministration of phenytoin may produce a synergistic anticonvulsant action.PropoxypheneIn cases of propoxyphene overdosage, amphetamine CNS stimulation is potentiated and fatal convulsions can occur.Proton Pump InhibitorsPPIs act on proton pumps by blocking acid production, thereby reducing gastric acidity. When Adderall XR® (20 mg single-dose) was administered concomitantly with the proton pump inhibitor, omeprazole (40 mg once daily for 14 days), the median Tmax of d-amphetamine was decreased by 1.25 hours (from 4 to 2.75 hours), and the median Tmax of l-amphetamine was decreased by 2.5 hours (from 5.5 to 3 hours), compared to Adderall XR® administered alone. The AUC and Cmax of each moiety were unaffected. Therefore, coadministration of Adderall® and proton pump inhibitors should be monitored for changes in clinical effect.Veratrum AlkaloidsAmphetamines inhibit the hypotensive effect of veratrum alkaloids.Drug/Laboratory Test InteractionsAmphetamines can cause a significant elevation in plasma corticosteroid levels. This increase is greatest in the evening. Amphetamines may interfere with urinary steroid determinationsCarcinogenesis/Mutagenesis and Impairment of FertilityNo evidence of carcinogenicity was found in studies in which d,l-amphetamine (enantiomer ratio of 1:1) was administered to mice and rats in the diet for 2 years at doses of up to 30 mg/kg/day in male mice, 19 mg/kg/day in female mice, and 5 mg/kg/day in male and female rats. These doses are approximately 2.4, 1.5, and 0.8 times, respectively, the maximum recommended human dose of 30 mg/day [child] on a mg/m2body surface area basis.Amphetamine, in the enantiomer ratio present in Adderall® (immediate-release)(d- to l- ratio of 3:1), was not clastogenic in the mouse bone marrow micronucleus test in vivo and was negative when tested in the E. coli component of the Ames test in vitro. d, l-Amphetamine (1:1 enantiomer ratio) has been reported to produce a positive response in the mouse bone marrow micronucleus test, an equivocal response in the Ames test, and negative responses in the in vitrosister chromatid exchange and chromosomal aberration assays.Amphetamine, in the enantiomer ratio present in Adderall® (immediate-release)(d- to l- ratio of 3:1), did not adversely affect fertility or early embryonic development in the rat at doses of up to 20 mg/kg/day (approximately 5 times the maximum recommended human dose of 30 mg/day on a mg/m2 body surface area basis).PregnancyTeratogenic EffectsPregnancy Category CAmphetamine, in the enantiomer ratio present in Adderall® (d- to l- ratio of 3:1), had no apparent effects on embryofetal morphological development or survival when orally administered to pregnant rats and rabbits throughout the period of organogenesis at doses of up to 6 and 16 mg/kg/day, respectively. These doses are approximately 1.5 and 8 times, respectively, the maximum recommended human dose of 30 mg/day [child] on a mg/m2 body surface area basis. Fetal malformations and death have been reported in mice following parenteral administration of d-amphetamine doses of 50 mg/kg/day (approximately 6 times that of a human dose of 30 mg/day [child] on a mg/m2basis) or greater to pregnant animals. Administration of these doses was also associated with severe maternal toxicity.A number of studies in rodents indicate that prenatal or early postnatal exposure to amphetamine (d- or d,l-), at doses similar to those used clinically, can result in long-term neurochemical and behavioral alterations. Reported behavioral effects include learning and memory deficits, altered locomotor activity, and changes in sexual function.There are no adequate and well-controlled studies in pregnant women. There has been one report of severe congenital bony deformity, tracheo-esophageal fistula, and anal atresia (vater association) in a baby born to a woman who took dextroamphetamine sulfate with lovastatin during the first trimester of pregnancy. Amphetamines should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.Nonteratogenic EffectsInfants born to mothers dependent on amphetamines have an increased risk of premature delivery and low birth weight. Also, these infants may experience symptoms of withdrawal as demonstrated by dysphoria, including agitation, and significant lassitude.Usage in Nursing MothersAmphetamines are excreted in human milk. Mothers taking amphetamines should be advised to refrain from nursing.Pediatric UseLong-term effects of amphetamines in children have not been well established. Amphetamines are not recommended for use in children under 3 years of age with Attention Deficit Hyperactivity Disorder described under INDICATION AND USAGEGeriatric UseAdderall® has not been studied in the geriatric population.Adverse ReactionsCardiovascularPalpitations, tachycardia, elevation of blood pressure, sudden death, myocardial infarction. There have been isolated reports of cardiomyopathy associated with chronic amphetamine use.Central Nervous SystemPsychotic episodes at recommended doses, overstimulation, restlessness, irritability, euphoria, dyskinesia, dysphoria, depression, tremor, tics, aggression, anger, logorrhea, dermatillomania.Eye DisordersVision blurred, mydriasis.GastrointestinalDryness of the mouth, unpleasant taste, diarrhea, constipation, other gastrointestinal disturbances. Anorexia and weight loss may occur as undesirable effects.AllergicUrticaria, rash, hypersensitivity reactions including angioedema and anaphylaxis. Serious skin rashes, including Stevens-Johnson syndrome and toxic epidermal necrolysis have been reported.EndocrineImpotence, changes in libido, frequent or prolonged erections.SkinAlopecia.MusculoskeletaDrug Abuse and DependenceAdderall® (Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate Tablets (Mixed Salts of a Single Entity Amphetamine Product)) is a Schedule II controlled substance.Amphetamines have been extensively abused. Tolerance, extreme psychological dependence, and severe social disability have occurred. There are reports of patients who have increased the dosage to levels many times higher than recommended. Abrupt cessation following prolonged high dosage administration results in extreme fatigue and mental depression; changes are also noted on the sleep EEG. Manifestations of chronic intoxication with amphetamines include severe dermatoses, marked insomnia, irritability, hyperactivity, and personality changes. The most severe manifestation of chronic intoxication is psychosis, often clinically indistinguishable from schizophrenia.OverdosageIndividual patient response to amphetamines varies widely. Toxic symptoms may occur idiosyncratically at low doses.SymptomsManifestations of acute overdosage with amphetamines include restlessness, tremor, hyperreflexia, rapid respiration, confusion, assaultiveness, hallucinations, panic states, hyperpyrexia and rhabdomyolysis.Fatigue and depression usually follow the central stimulation.Cardiovascular effects include arrhythmias, hypertension or hypotension and circulatory collapse.Gastrointestinal symptoms include nausea, vomiting, diarrhea, and abdominal cramps. Fatal poisoning is usually preceded by convulsions and coma.TreatmentConsult with a Certified Poison Control Center for up to date guidance and advice. Management of acute amphetamine intoxication is largely symptomatic and includes gastric lavage, administration of activated charcoal, administration of a cathartic and sedation. Experience with hemodialysis or peritoneal dialysis is inadequate to permit recommendation in this regard. Acidification of the urine increases amphetamine excretion, but is believed to increase risk of acute renal failure if myoglobinuria is present. If acute, severe hypertension complicates amphetamine overdosage, administration of intravenous phentolamine has been suggested. However, a gradual drop in blood pressure will usually result when sufficient sedation has been achieved. Chlorpromazine antagonizes the central stimulant effects of amphetamines and can be used to treat amphetamine intoxication.Adderall Dosage and AdministrationRegardless of indication, amphetamines should be administered at the lowest effective dosage, and dosage should be individually adjusted according to the therapeutic needs and response of the patient. Late evening doses should be avoided because of the resulting insomnia.Attention Deficit Hyperactivity DisorderNot recommended for children under 3 years of age. In children from 3 to 5 years of age, start with 2.5 mg daily; daily dosage may be raised in increments of 2.5 mg at weekly intervals until optimal response is obtained.In children 6 years of age and older, start with 5 mg once or twice daily; daily dosage may be raised in increments of 5 mg at weekly intervals until optimal response is obtained. Only in rare cases will it be necessary to exceed a total of 40 mg per day. Give first dose on awakening; additional doses (1 or 2) at intervals of 4 to 6 hours.Where possible, drug administration should be interrupted occasionally to determine if there is a recurrence of behavioral symptoms sufficient to require continued therapy.NarcolepsyUsual dose 5 mg to 60 mg per day in divided doses, depending on the individual patient response.Narcolepsy seldom occurs in children under 12 years of age; however, when it does, dextroamphetamine sulfate may be used. The suggested initial dose for patients aged 6 to 12 is 5 mg daily; daily dose may be raised in increments of 5 mg at weekly intervals until optimal response is obtained. In patients 12 years of age and older, start with 10 mg daily; daily dosage may be raised in increments of 10 mg at weekly intervals until optimal response is obtained. If bothersome adverse reactions appear (e.g., insomnia or anorexia), dosage should be reduced. Give first dose on awakening; additional doses (1 or 2) at intervals of 4 to 6 hours.How is Adderall SuppliedAdderall® (Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate Tablets (Mixed Salts of a Single Entity Amphetamine Product)) is supplied as follows:5 mg: White to off-white, round, flat-faced beveled edge tablet with four partial bisects debossed with 5 on one side and debossed with dp on the other side. They are available in bottles of 100 tablets (NDC 57844-105-01).7.5 mg: Blue, oval, biconvex tablet with two partial bisects debossed with 7.5 on one side and one full bisect and two partial bisects debossed with d | p on the other side. They are available in bottles of 100 tablets (NDC 57844-117-01).10 mg: Blue, round, biconvex tablet with one full bisect and two partial bisects debossed with 1 | 0 on one side and debossed with dp on the other side. They are available in bottles of 100 tablets (NDC 57844-110-01).12.5 mg: Peach, round, flat-faced beveled edge tablet debossed with 12.5 on one side and one full bisect and two partial bisects debossed with d | p on the other side. They are available in bottles of 100 tablets (NDC 57844-112-01).15 mg: Peach, oval, biconvex tablet with two partial bisects debossed with 15 on one side and one full bisect and two partial bisects debossed with d | p on the other side. They are available in bottles of 100 tablets (NDC 57844-115-01).20 mg: Peach, round, biconvex tablet with one full bisect and two partial bisects debossed with 2 | 0 on one side and debossed with dp on the other side. They are available in bottles of 100 tablets (NDC 57844-120-01).30 mg: Peach, round, flat-faced beveled edge tablet with one full bisect and 2 partial bisects debossed with 3 | 0 on one side and dp on the other side. They are available in bottles of 100 tablets (NDC 57844-130-01).Store at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature].Dispense in a tight, light-resistant container as defined in the USP, with a child-resistant closure (as required).KEEP THIS AND ALL MEDICATIONS OUT OF THE REACH OF CHILDREN.All brand names listed are the registered trademarks of their respective owners and are not trademarks of Teva Pharmaceuticals USA.Distributed by:Teva Pharmaceuticals USA, Inc.Parsippany, NJ 07054Rev. I 3/2020MEDICATION GUIDEAdderall® (ADD-ur-all) (CII)(Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate Tablets (Mixed Salts of a Single Entity Amphetamine Product))Read the Medication Guide that comes with Adderall® before you or your child starts taking it and each time you get a refill. There may be new information. This Medication Guide does not take the place of talking to your doctor about you or your child’s treatment with Adderall®.What is the most important information I should know about Adderall®?The following have been reported with use of Adderall® and other stimulant medicines.1. Heart-Related Problems:• sudden death in patients who have heart problems or heart defects• stroke and heart attack in adults• increased blood pressure and heart rateTell your doctor if you or your child have any heart problems, heart defects, high blood pressure, or a family history of these problems.Your doctor should check you or your child carefully for heart problems before starting Adderall®.Your doctor should check your or your child’s blood pressure and heart rate regularly during treatment with Adderall®.Call your doctor right away if you or your child have any signs of heart problems such as chest pain, shortness of breath, or fainting while taking Adderall®.2. Mental (Psychiatric) Problems:All Patients• new or worse behavior and thought problems• new or worse bipolar illness• new or worse aggressive behavior or hostilityChildren and Teenagers• new psychotic symptoms (such as hearing voices, believing things that are not true, are suspicious) or new manic symptomsTell your doctor about any mental problems you or your child have, or about a family history of suicide, bipolar illness, or depression.Call your doctor right away if you or your child have any new or worsening mental symptoms or problems while taking Adderall®, especially seeing or hearing things that are not real, believing things that are not real, or are suspicious.3. Circulation Problems in Fingers and Toes [Peripheral Vasculopathy, Including Raynaud’s Phenomenon]:Fingers or toes may feel numb, cool, painfulFingers or toes may change color from pale, to blue, to redTell your doctor if you have or your child has numbness, pain, skin color change, or sensitivity to temperature in your fingers or toes.Call your doctor right away if you have or your child has any signs of unexplained wounds appearing on fingers or toes while taking Adderall®.What is Adderall®?Adderall® is a central nervous system stimulant prescription medicine. It is used for the treatment of Attention-Deficit Hyperactivity Disorder (ADHD). Adderall® may help increase attention and decrease impulsiveness and hyperactivity in patients with ADHD.Adderall® should be used as a part of a total treatment program for ADHD that may include counseling or other therapies.Adderall® is also used in the treatment of a sleep disorder called narcolepsy.Adderall® is a federally controlled substance (CII) because it can be abused or lead to dependence. Keep Adderall® in a safe place to prevent misuse and abuse. Selling or giving away Adderall® may harm others, and is against the law.Tell your doctor if you or your child have (or have a family history of) ever abused or been dependent on alcohol, prescription medicines or street drugs.Who should not take Adderall®?Adderall® should not be taken if you or your child:have heart disease or hardening of the arterieshave moderate to severe high blood pressurehave hyperthyroidismhave an eye problem called glaucomaare very anxious, tense, or agitatedhave a history of drug abuseare taking or have taken within the past 14 days an anti-depression medicine called a monoamine oxidase inhibitor or MAOI.are sensitive to, allergic to, or had a reaction to other stimulant medicinesAdderall® is not recommended for use in children less than 3 years old.Adderall® may not be right for you or your child. Before starting Adderall® tell your or your child’s doctor about all health conditions (or a family history of) including:heart problems, heart defects, high blood pressuremental problems including psychosis, mania, bipolar illness, or depressiontics or Tourette’s syndromeliver or kidney problemscirculation problems in fingers and toesthyroid problemsseizures or have had an abnormal brain wave test (EEG)Tell your doctor if you or your child are pregnant, planning to become pregnant, or breastfeeding.Can Adderall® be taken with other medicines?Tell your doctor about all of the medicines that you or your child take including prescription and nonprescription medicines, vitamins, and herbal supplements. Adderall® and some medicines may interact with each other and cause serious side effects. Sometimes the doses of other medicines will need to be adjusted while taking Adderall®.Your doctor will decide whether Adderall® can be taken with other medicines.Especially tell your doctor if you or your child take:anti-depression medicines including MAOIsblood pressure medicinesseizure medicinesblood thinner medicinescold or allergy medicines that contain decongestantsstomach acid medicinesKnow the medicines that you or your child take. Keep a list of your medicines with you to show your doctor and pharmacist.Do not start any new medicine while taking Adderall® without talking to your doctor first.How should Adderall® be taken?Take Adderall® exactly as prescribed. Your doctor may adjust the dose until it is right for you or your child.Adderall® tablets are usually taken two to three times a day. The first dose is usually taken when you first wake in the morning. One or two more doses may be taken during the day, 4 to 6 hours apart.Adderall® can be taken with or without food.From time to time, your doctor may stop Adderall® treatment for a while to check ADHD symptoms.Your doctor may do regular checks of the blood, heart, and blood pressure while taking Adderall®. Children should have their height and weight checked often while taking Adderall®. Adderall® treatment may be stopped if a problem is found during these check-ups.If you or your child take too much Adderall®or overdose, call your doctor or poison control center right away, or get emergency treatment.What are possible side effects of Adderall®?See “What is the most important information I should know about Adderall®?” for information on reported heart and mental problems.Other serious side effects include:slowing of growth (height and weight) in childrenseizures, mainly in patients with a history of seizureseyesight changes or blurred visionserotonin syndrome. A potentially life-threatening problem called serotonin syndrome can happen when medicines such as Adderall® are taken with certain other medicines. Symptoms of serotonin syndrome may include:agitation, hallucinations, coma or other changes in mental statusproblems controlling your movements or muscle twitchingfast heartbeathigh or low blood pressuresweating or fevernausea or vomitingdiarrheamuscle stiffness or tightnessCommon side effects include:stomach achedecreased appetitenervousnessAdderall® may affect your or your child’s ability to drive or do other dangerous activities.Talk to your doctor if you or your child have side effects that are bothersome or do not go away.This is not a complete list of possible side effects. Ask your doctor or pharmacist for more information.How should I store Adderall®?Store Adderall® in a safe place at room temperature, 20° to 25°C (68° to 77°F).Keep Adderall® and all medicines out of the reach of children.General information about Adderall®Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use Adderall® for a condition for which it was not prescribed. Do not give Adderall®to other people, even if they have the same condition. It may harm them and it is against the law. This Medication Guide summarizes the most important information about Adderall®. If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for information about Adderall® that was written for healthcare professionals.What are the ingredients in Adderall®?Active Ingredient: dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate and amphetamine sulfate.Inactive Ingredients: colloidal silicon dioxide, compressible sugar, corn starch, magnesium stearate, microcrystalline cellulose and saccharin sodium. The 5 mg is a white to off-white tablet, which contains no color additives. The 7.5 mg and 10 mg also contain FD&C Blue #1 Aluminum Lake as a color additive. The 12.5 mg, 15 mg, 20 mg and 30 mg also contain FD&C Yellow #6 Aluminum Lake as a color additive.This Medication Guide has been approved by the U.S. Food and Drug Administration.Distributed by:Teva Pharmaceuticals USA, Inc.Parsippany, NJ 07054Rev. H 3/2020Package/Label Display PanelAdderall® 5 mg CII 100s Label TextNDC 57844-105-01CIIAdderall®(Dextroamphetamine Saccharate,Amphetamine Aspartate,Dextroamphetamine Sulfate andAmphetamine Sulfate Tablets)(Mixed Salts of a Single EntityAmphetamine Product)5 mgPHARMACIST: DISPENSE THEACCOMPANYING MEDICATIONGUIDE TO EACH PATIENT.Rx only100 TABLETSTEVAPackage/Label Display PanelAdderall® 7.5 mg CII 100s Label TextNDC 57844-117-01CIIAdderall®(Dextroamphetamine Saccharate,Amphetamine Aspartate,Dextroamphetamine Sulfate andAmphetamine Sulfate Tablets)(Mixed Salts of a Single EntityAmphetamine Product)7.5 mgPHARMACIST: DISPENSE THEACCOMPANYING MEDICATIONGUIDE TO EACH PATIENT.Rx only100 TABLETSTEVAPackage/Label Display PanelAdderall® 10 mg CII 100s Label TextNDC 57844-110-01CIIAdderall®(Dextroamphetamine Saccharate,Amphetamine Aspartate,Dextroamphetamine Sulfate andAmphetamine Sulfate Tablets)(Mixed Salts of a Single EntityAmphetamine Product)10 mgPHARMACIST: DISPENSE THEACCOMPANYING MEDICATIONGUIDE TO EACH PATIENT.Rx only100 TABLETSTEVAPackage/Label Display PanelAdderall® 12.5 mg CII 100s Label TextNDC 57844-112-01CIIAdderall®(Dextroamphetamine Saccharate,Amphetamine Aspartate,Dextroamphetamine Sulfate andAmphetamine Sulfate Tablets)(Mixed Salts of a Single EntityAmphetamine Product)12.5 mgPHARMACIST: DISPENSE THEACCOMPANYING MEDICATIONGUIDE TO EACH PATIENT.Rx only100 TABLETSTEVAPackage/Label Display PanelAdderall® 15 mg CII 100s Label TextNDC 57844-115-01CIIAdderall®(Dextroamphetamine Saccharate,Amphetamine Aspartate,Dextroamphetamine Sulfate andAmphetamine Sulfate Tablets)(Mixed Salts of a Single EntityAmphetamine Product)15 mgPHARMACIST: DISPENSE THEACCOMPANYING MEDICATIONGUIDE TO EACH PATIENT.Rx only100 TABLETSTEVAPackage/Label Display PanelAdderall® 20 mg CII 100s Label TextNDC 57844-120-01CIIAdderall®(Dextroamphetamine Saccharate,Amphetamine Aspartate,Dextroamphetamine Sulfate andAmphetamine Sulfate Tablets)(Mixed Salts of a Single EntityAmphetamine Product)20 mgPHARMACIST: DISPENSE THEACCOMPANYING MEDICATIONGUIDE TO EACH PATIENT.Rx only100 TABLETSTEVAPackage/Label Display PanelAdderall® 30 mg CII 100s Label TextNDC 57844-130-01CIIAdderall®(Dextroamphetamine Saccharate,Amphetamine Aspartate,Dextroamphetamine Sulfate andAmphetamine Sulfate Tablets)(Mixed Salts of a Single EntityAmphetamine Product)30 mgPHARMACIST: DISPENSE THEACCOMPANYING MEDICATIONGUIDE TO EACH PATIENT.Rx only100 TABLETSTEVAAdderalldextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate tabletProduct InformationProduct TypeHUMAN PRESCRIPTION DRUG LABELItem Code (Source)NDC:57844-105Route of AdministrationORALDEA ScheduleCIIActive Ingredient/Active MoietyIngredient NameBasis of StrengthStrengthDEXTROAMPHETAMINE SACCHARATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SACCHARATE1.25 mgAMPHETAMINE ASPARTATE MONOHYDRATE(AMPHETAMINE)AMPHETAMINE ASPARTATE MONOHYDRATE1.25 mgDEXTROAMPHETAMINE SULFATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SULFATE1.25 mgAMPHETAMINE SULFATE(AMPHETAMINE)AMPHETAMINE SULFATE1.25 mgInactive IngredientsIngredient NameStrengthSILICON DIOXIDESUCROSEMALTODEXTRINSTARCH, CORNMAGNESIUM STEARATECELLULOSE, MICROCRYSTALLINESACCHARIN SODIUMProduct CharacteristicsColorWHITE (white to off-white)Score4 piecesShapeROUNDSize7mmFlavorImprint Code5;dpContainsPackaging#Item CodePackage Description1NDC:57844-105-01100 TABLET in 1 BOTTLEMarketing InformationMarketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End DateANDAANDA04042211/13/2014Adderalldextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate tabletProduct InformationProduct TypeHUMAN PRESCRIPTION DRUG LABELItem Code (Source)NDC:57844-117Route of AdministrationORALDEA ScheduleCIIActive Ingredient/Active MoietyIngredient NameBasis of StrengthStrengthDEXTROAMPHETAMINE SACCHARATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SACCHARATE1.875 mgAMPHETAMINE ASPARTATE MONOHYDRATE(AMPHETAMINE)AMPHETAMINE ASPARTATE MONOHYDRATE1.875 mgDEXTROAMPHETAMINE SULFATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SULFATE1.875 mgAMPHETAMINE SULFATE(AMPHETAMINE)AMPHETAMINE SULFATE1.875 mgInactive IngredientsIngredient NameStrengthSILICON DIOXIDESUCROSEMALTODEXTRINSTARCH, CORNMAGNESIUM STEARATECELLULOSE, MICROCRYSTALLINESACCHARIN SODIUMFD&C BLUE NO. 1 ALUMINUM LAKEProduct CharacteristicsColorBLUEScore4 piecesShapeOVALSize10mmFlavorImprint Code7;5;d;pContainsPackaging#Item CodePackage Description1NDC:57844-117-01100 TABLET in 1 BOTTLEMarketing InformationMarketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End DateANDAANDA04042203/03/2015Adderalldextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate tabletProduct InformationProduct TypeHUMAN PRESCRIPTION DRUG LABELItem Code (Source)NDC:57844-110Route of AdministrationORALDEA ScheduleCIIActive Ingredient/Active MoietyIngredient NameBasis of StrengthStrengthDEXTROAMPHETAMINE SACCHARATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SACCHARATE2.5 mgAMPHETAMINE ASPARTATE MONOHYDRATE(AMPHETAMINE)AMPHETAMINE ASPARTATE MONOHYDRATE2.5 mgDEXTROAMPHETAMINE SULFATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SULFATE2.5 mgAMPHETAMINE SULFATE(AMPHETAMINE)AMPHETAMINE SULFATE2.5 mgInactive IngredientsIngredient NameStrengthSILICON DIOXIDESUCROSEMALTODEXTRINSTARCH, CORNMAGNESIUM STEARATECELLULOSE, MICROCRYSTALLINESACCHARIN SODIUMFD&C BLUE NO. 1 ALUMINUM LAKEProduct CharacteristicsColorBLUEScore4 piecesShapeROUNDSize9mmFlavorImprint Code1;0;dpContainsPackaging#Item CodePackage Description1NDC:57844-110-01100 TABLET in 1 BOTTLEMarketing InformationMarketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End DateANDAANDA04042202/03/2014Adderalldextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate tabletProduct InformationProduct TypeHUMAN PRESCRIPTION DRUG LABELItem Code (Source)NDC:57844-112Route of AdministrationORALDEA ScheduleCIIActive Ingredient/Active MoietyIngredient NameBasis of StrengthStrengthDEXTROAMPHETAMINE SACCHARATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SACCHARATE3.125 mgAMPHETAMINE ASPARTATE MONOHYDRATE(AMPHETAMINE)AMPHETAMINE ASPARTATE MONOHYDRATE3.125 mgDEXTROAMPHETAMINE SULFATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SULFATE3.125 mgAMPHETAMINE SULFATE(AMPHETAMINE)AMPHETAMINE SULFATE3.125 mgInactive IngredientsIngredient NameStrengthSILICON DIOXIDESUCROSEMALTODEXTRINSTARCH, CORNMAGNESIUM STEARATECELLULOSE, MICROCRYSTALLINESACCHARIN SODIUMFD&C YELLOW NO. 6Product CharacteristicsColorORANGE (peach)Score4 piecesShapeROUNDSize7mmFlavorImprint Code12;5;d;pContainsPackaging#Item CodePackage Description1NDC:57844-112-01100 TABLET in 1 BOTTLEMarketing InformationMarketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End DateANDAANDA04042206/18/2014Adderalldextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate tabletProduct InformationProduct TypeHUMAN PRESCRIPTION DRUG LABELItem Code (Source)NDC:57844-115Route of AdministrationORALDEA ScheduleCIIActive Ingredient/Active MoietyIngredient NameBasis of StrengthStrengthDEXTROAMPHETAMINE SACCHARATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SACCHARATE3.75 mgAMPHETAMINE ASPARTATE MONOHYDRATE(AMPHETAMINE)AMPHETAMINE ASPARTATE MONOHYDRATE3.75 mgDEXTROAMPHETAMINE SULFATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SULFATE3.75 mgAMPHETAMINE SULFATE(AMPHETAMINE)AMPHETAMINE SULFATE3.75 mgInactive IngredientsIngredient NameStrengthSILICON DIOXIDESUCROSEMALTODEXTRINSTARCH, CORNMAGNESIUM STEARATECELLULOSE, MICROCRYSTALLINESACCHARIN SODIUMFD&C YELLOW NO. 6Product CharacteristicsColorORANGE (peach)Score4 piecesShapeOVALSize10mmFlavorImprint Code15;d;pContainsPackaging#Item CodePackage Description1NDC:57844-115-01100 TABLET in 1 BOTTLEMarketing InformationMarketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End DateANDAANDA04042206/30/2014Adderalldextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate tabletProduct InformationProduct TypeHUMAN PRESCRIPTION DRUG LABELItem Code (Source)NDC:57844-120Route of AdministrationORALDEA ScheduleCIIActive Ingredient/Active MoietyIngredient NameBasis of StrengthStrengthDEXTROAMPHETAMINE SACCHARATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SACCHARATE5 mgAMPHETAMINE ASPARTATE MONOHYDRATE(AMPHETAMINE)AMPHETAMINE ASPARTATE MONOHYDRATE5 mgDEXTROAMPHETAMINE SULFATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SULFATE5 mgAMPHETAMINE SULFATE(AMPHETAMINE)AMPHETAMINE SULFATE5 mgInactive IngredientsIngredient NameStrengthSILICON DIOXIDESUCROSEMALTODEXTRINSTARCH, CORNMAGNESIUM STEARATECELLULOSE, MICROCRYSTALLINESACCHARIN SODIUMFD&C YELLOW NO. 6Product CharacteristicsColorORANGE (peach)Score4 piecesShapeROUNDSize9mmFlavorImprint Code2;0;dpContainsPackaging#Item CodePackage Description1NDC:57844-120-01100 TABLET in 1 BOTTLEMarketing InformationMarketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End DateANDAANDA04042202/11/2014Adderalldextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate tabletProduct InformationProduct TypeHUMAN PRESCRIPTION DRUG LABELItem Code (Source)NDC:57844-130Route of AdministrationORALDEA ScheduleCIIActive Ingredient/Active MoietyIngredient NameBasis of StrengthStrengthDEXTROAMPHETAMINE SACCHARATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SACCHARATE7.5 mgAMPHETAMINE ASPARTATE MONOHYDRATE(AMPHETAMINE)AMPHETAMINE ASPARTATE MONOHYDRATE7.5 mgDEXTROAMPHETAMINE SULFATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SULFATE7.5 mgAMPHETAMINE SULFATE(AMPHETAMINE)AMPHETAMINE SULFATE7.5 mgInactive IngredientsIngredient NameStrengthSILICON DIOXIDESUCROSEMALTODEXTRINSTARCH, CORNMAGNESIUM STEARATECELLULOSE, MICROCRYSTALLINESACCHARIN SODIUMFD&C YELLOW NO. 6Product CharacteristicsColorORANGE (peach)Score4 piecesShapeROUNDSize10mmFlavorImprint Code3;0;dpContainsPackaging#Item CodePackage Description1NDC:57844-130-01100 TABLET in 1 BOTTLE

I'm am not an expert on health insurance , but I believe the following logical deduction, based on some real facts, can give an explanation.Health insurance coverage is very less in India. I think less than 15 percent. Let's take an ideal example for comparison, like USA, whose healthcare is heavily dependent on private insurance .USA has possibly more than 80 percent people covered with insurance. So when companies have more people covered, the relative percentage of claims is far less and hence they can afford to include opd fees also. Also, USA system is generally well tabulated, organized and may be at times more ethical, since it is more tightly regulated by authorities (though many might argue otherwise). The opd fees request can be monitored properly and a proper claim can be easily separated from an improper claim. They also have codes for various diseases . Doctors actually spent more time in sending forms to insurance companies then actually seeing patients. Secretaries become more important than patients. Obviously, charges increase, insurance premiums increase etc etc.It is very costly for insurance companies to cover opd's in India for many reasons which are opposite to what happens in a developed country.No proper organisation to document things in opd, no proper disease coding system , huge maintenance costs being unaffordable, unless there is wider and adequate coverage or costs generally go up. As it is, most people still don't understand in investing in health insurance and even if they do, the premiums are still quite high for them. Most middle class people are hardly left with anything at end of month after emi’s etc. They might have an insurance, but most often, it is grossly inadequate.Most developed countries (USA is mostly exception), have robust government funded primary health care services. As you have would have realised by now, insurance companies are in for profits and having them involved for minor things is not good for populatiion in general. So they have properly funded government healthcare, which at least funds partial (if not all) costs of primary health care and patient might take help of insurance as an add on (to get early acess, for getting some non listed services, for cosmetic or dental procedures etc) . Some countries are extreme (in a very good way), everything is government funded , like in UK - though besides the point and it's many issues, I think NHS (UK) is one of the best health system in world. Now access to healthcare is a basic right in India too and government technically provides free healthcare to everybody. I have worked in government hospitals in India all my training life. I know and public knows how miserable they are. That's why most of us affording types rely on private health insurance. That is why private clinics and hospitals are in every nook and corner of the country, which should have never happened as per visionaries.As I have already mentioned before (I like repeating stuff, drives point better ;), insurance coverage in India is very less and also most people are not covered adequately. Most government insurance companies have a claim settlement ratio of above 100 percent. That basically means if 100 people claim insurance, all will actually get money back, which is quite unviable for a country with such low insurance coverage. This is not financially viable for good private insurance companies. They are not in for charity, they are offering services for profits. Private companies and even government companies just cannot afford opd fees as of yet.For the same above reasons, these companies (even government ones) do not cover some sinister diseases like rheumatoid arthritis RA or inflammatory diseases (lupus, ankylosing spondylitis etc) which are life long. They do cover cancer, because most people want cancer cover, the fear factor is quite high. Also in cancer, patient either gets cured or dies in many cases. So it is not as costly as RA patient , who usually will require lifelong treatment and at least RA doesn't kill directly.Phew, there are some more factors (poor sanitation, poor water causing more diseases, those who get cover make easy claims, tendency of doctors to put higher imappropriate claims as they always feel underpaid etc ), but the above are really the main ones.I am kind of modi sympathizer (with many crticisms too :), but basically when he is trying to bash doctors and try to bring a modicare insurance plan, it's absolutely farce (unless he has better plans ahead). Insurance based healthcare never works in a poor economy and bankrupts people, as how much ever large cover you buy, you will always have to pay some more charges, things will be costly and cover runs out for people with complex illnesses. Insurance companies will always try to reject claims and people, including insured ones, fear accessing healthcare because of so many problems. Fear of price in such a setup makes people acess healthcare too late and that complicates diseases further. Also, prices only increase as insurance company tries to underpay doctors and doctors try to escalate prices to get more out of companies (classic USA healthcare roblem). Thus people, even from upper middle class give up at some point, especially in chronic diseases or end up chosing far inferior services.I think I read somewhere, that second most common cause of bankruptcy in USA is due to healthcare expenses. In India I think (if I am right) it's sixth most common cause. If we continue to push towards insurance based health service rather than improvement or more funding in government based health service , we might actually surpass USA in something (if you haven't got it, the sarcasm was totally intended). We are already not doing well in healthcare department. Atleast in USA, economy is stronger, unemployment is less, there are lot of social benefits. We have none of that and we are a country with more than 50 percent of population classifiable as poor. Imagine what's going to happen in future with further encouragement of insurance based healthcare ? Scary na ? Let's hope Modiji does something to improve government healthcare, which I believe should help millions to become less poor.So basically, till any Indian government thinks about increasing our GDP expenditure on healthcare ( which is basically one of the lowest in the world) and gets serious about providing universal adequate quality basic healthcare, get adequate insurance cover, but have contingency money too (for those uncovered diseases, opd expenses etc).Enough of my rambling. I have given much more than you asked for.Best wishesNileshArthritis and Rheumatology India (Let’s simplify arthritis)Please do like and share our facebook pageArthritis and Rheumatology India (Let’s simplify arthritis) - Facebook page