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Comment by waboremo | Hacker News Reader

Adderall contains dextroamphetamine btw

I know this. But it also contains levoamphetamine.

But as far as I know there's no clinically proven benefit(happy to be proven wrong) to including levoamph, and it can cause more side effects. Which is why in most countries these days adderall is not really prescribed, and often isn't even in the pharmacopoeia.

Why adderall is still in use in the US is an interesting question I don't have the answer to.

> But as far as I know there's no clinically proven benefit

My impression of US pharma regulation and drug trials is that it would not have been approved if it did not show some benefit over the status quo. I don't know about adderall's clinical trials in particular, though.

I was a little unclear maybe. What I meant was that there's no clinically proven benefit of racemic amphetamine versus dextroamphetamine.

Racemic amphetamine is certainly an effective treatment, that's been well proven.

By “status quo,” I meant dextroamphetamine.

Oh I see, my bad!

I think I was still in the mindset of thinking adderall pre-existed dexedrine. So I guess I interpreted status quo as meaning amphetamine vs whatever else was available at the time.

Interesting little inversion of logic that can happen when two people have diametrically opposed ideas of the order of events.

Hah, no worries.

Adderall was originally formulated and marketed as a diet drug. It had already been approved before it was rebranded and remarketed for ADHD, and the criteria for approving a new on-label use is significant but not as rigorous as approving a new drug.

Drugs that are still under a patent have a company with the incentive to go through the expensive approval process while generic drugs lack that. So a wacky mix of amphetamines designed as a diet drug that are still under patent have more corporate backing for that approval process than plain old generic dextroamphetamine, which has been around forever. There’s a similar story with the use of esketamine versus ketamine to treat depression.

Ah, thanks for elaborating on the history.

Do you have relevant sources about most countries refusing to prescribe adderall in cases where they do not also ban the use of dextroamphetamine?

It seems to me Adderall is not even marketed in Europe. Can't find anything suggesting otherwise, but it's hard to find a source on something never happening.

Though I can tell you definitely at least that here in Norway, Adderall is not an approved drug(neither is dexedrine). The only approved amphetamine here is Vyvanse and its generic form Aduvanz.

Dexamphetamine is certainly prescribed in Europe, I know a fair few people with prescriptions for it.

I did some digging and apparently no amphetamine based drugs had been approved for ADHD in Europe back in 2011.(1) Back then the only ADHD med was methylphenidate (ritalin, concerta). This must have changed somewhere between 2012-2014 when dextroamphetamine(attentin) and lisdexamfetamine(elvanse) got approved for ADHD treatment as well. So today in majority of EU countries (possibly in all) it is possible to get 100% dextroamphetamine based ADHD medication. As far as I can tell it seems like levoamphetamine is not approved for medical use at all so that's why adderall isn't prescribed here.

1:https://www.reuters.com/article/us-shire-adhd-idUSTRE7BB0H42...

There is at least some evidence that levoamphetamine is more effective than dextroamphetamine for "hyperactivity and aggressiveness" associated with ADHD (https://jamanetwork.com/journals/jamapsychiatry/article-abst...), and other studies that have found that it has less of certain side effects than dextroamphetamine (though more of others).

A more cynical explanation is that where levoamphetamine and dextroamphetamine alone were not patentable, a new combination of the two (as Adderall is) was patentable, making it more profitable to research.

ADHD is a collection of symptoms that differ enough across individuals that it's almost certain some patients genuinely do respond better to different combinations of drugs.

Interesting research, thank you. Though worth pointing out this study is comparing pure l-amph with pure d-amph. I'm not aware of enantiomerically pure l-amph being used clinically, which is an interesting side note: why not?

Are you aware of studies comparing adderall specifically to d-amph? This has certainly piqued my curiosity.

This actually tracks in my experience. I did Vyvanse for a while but had markedly higher issues with aggression and agitation.

Switched back to Adderall and returned to having near zero issues in terms of problematic aggression. Sample size 1 in my case.

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