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.
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.
Are you aware of studies comparing adderall specifically to d-amph? This has certainly piqued my curiosity.
Switched back to Adderall and returned to having near zero issues in terms of problematic aggression. Sample size 1 in my case.
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.
Racemic amphetamine is certainly an effective treatment, that's been well proven.
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.
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.
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.
1:https://www.reuters.com/article/us-shire-adhd-idUSTRE7BB0H42...