Talk:Adderall/Archive 3

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Archive 1

Archive 2

Archive 3

Archive 4

Archive 5

Grossly Unverified Claims

This article's most bold and significant statement regarding the drug's benefits for mood and lifestyle has absolutely no supporting references: "Adderall is widely reported to increase alertness, increase libido, increase concentration and overall cognitive performance, and, in general, improve mood, while decreasing user fatigue."

In addition the effects listed have indication as to how longlasting they are i.e. they may be short lived, and produce a withdrawl effect worse then their benefits. Also, it uses overly broad and unscientific phrases such as 'widely reported' and 'in general' with no supporting data. This unbalanced view, focusing on possible drug advantages may lead to false conclusions being made on this drug's efficacy in favour of any pharmaceutical company promoting it. Such bias would appear unacceptable and therefore this article needs ammendment.

Thomas.b.mole (talk) 15:33, 18 February 2011 (UTC)

Claims of different activity of the racemic mixture of dextroamphetamine salts

I believe the claims that the following chemicals have different half-lifes is untrue and used for marketing purposes. Please add a proper citation if I am mistaken. Thanks!

1/4 dextroamphetamine saccharate
1/4 dextroamphetamine sulfate
1/4 (racemic dextro/levo-amphetamine) aspartate monohydrate
1/4 (racemic dextro/levo-amphetamine) sulfate

Jatlas (talk) 18:27, 28 August 2009 (UTC) Going to relocate this information to discussion since I believe it is untrue. Jatlas (talk) 18:11, 2 September 2009 (UTC)

These four salts are metabolized at different rates and possess diverse half lives^{[citation needed]}, therefore resulting in a less dramatic onset and termination of therapeutic action, as compared to single-salt amphetamine preparations.^{[citation needed]} The average elimination half-life in adults for dextroamphetamine and levoamphetamine is 10 hours and 13 hours respectively.^{[citation needed]}

I believe this is true information actually. I know it sounds like some marketing mumbo-jumbo but the different salts are contained in special beads. Some of the beads are designed to dissolve immediately, while others are time-released and dissolve in about 4 hours. I found a source to back this up: [[1]]. This is the basis of most extended-release drugs that need to maintain a therapeutic blood plasma concentration throughout the day, especially if the drugs half-life would not normally allow it to last an entire day.

A drug like amphetamine tends to produce undesirable effects/side effects when its blood plasma concentration is rapidly increased or decreased (especially the latter) and the formulation attempts to ensure smooth onset and smooth elimination of the effects. I'm going to go ahead and replace the information you removed because I think it really adds to the quality of the article and that source I linked proves what you took exception to or had skepticism about. -Novaprospekt (talk) 01:18, 28 March 2010 (UTC)

Influence exersized by drug companies on this entry

Does anybody else get the strange notion that this article has been written by a PR executive at a drug company? There is very little talk about the side effects of the drug, and all negative claims are vigorously fought back by quoting questionable research papers. This is phreaking amphetamine for heavens sake - a class A drug - it WILL mess up your head if you use it for any prolonged time period. —Preceding unsigned comment added by 212.71.90.143 (talk) 19:24, 3 September 2009 (UTC)

You're complaining about POV while being POV yourself? C6541 (T↔C) 20:06, 3 September 2009 (UTC)

I will say adderall messed my heart up bad. I was a kid when they placed me on it. Now my heart fluters and my blood pressure is unstable. My blood pressure on average is 160/100 and my pulse is 120 when i just walk up the stairs. This substance should be band because its no better than its illegal bother meth! —Preceding unsigned comment added by 99.188.105.105 (talk) 05:21, 7 September 2009 (UTC)

One, methamphetamine is not an illegal drug, it is a prescription drug. Two, this is not a forum for general discussion. C6541 (T↔C) 07:02, 7 September 2009 (UTC)

Citation needed for neutral viewpoint

Given that persons with ADHD are more likely to engage in risky or dangerous behavior, it has been suggested that stimulant medications for persons with ADHD may actually result in lower incidence of premature death.[37] --JaysonRL (talk) 06:50, 12 November 2009 (UTC)

Changes in Behavior

Extended content

My son has been taking adderall for years now. He is 14 and we are now seeing a drastic change in his behavior over the last few months. I have talked to him about school and other places where things might be going wrong and there doesn't appear to be any situational issues. This brings me to wondering if Adderall can act different in pre-pubescent children than in boys going through puberty?? Could the effects of the drug change?? He has become volatile, sometimes violent and otherwise disagreeable and difficult. He has high functioning autism and ADHD. His grades and behavior have nosedived. Help! —Preceding unsigned comment added by 67.253.4.255 (talk) 13:53, 1 April 2010 (UTC)

I feel very sorry for your case because I know exactly what he is going through. I am 28 years old. I first started taking Ritalin at age 10. My doses increased quite a bit through my teenage years. After high school, the stuff quit working, so I quit taking it. Later, I started taking Adderall. I currently take it at 5Mg doses three times a week. My dose is very low because I know very well what these drugs will do to the human mind. I won't go into details, but my head was very messed up after taking Ritalin for ten years. That's the reason why it stopped working. Currently, I am finally at the end of the recovery from it all. I'm not a medical expert, but I do recommend decreasing his dose dramatically from wherever it currently is. You might even consider taking him off for a long time to let his body return to normal. You won't find this in any official documents online, but these drugs mess with the body's hormones. Your son's body was already effected by the drug before he hit puberty. When his male hormones increased at puberty, his body started returning itself to normal. This causes big frustration for his mind because the medicine is a strong resistance to this normalizing process. He needs to feel normal again. Don't let him go through the torture that I have endured for the last twenty years. The drug is the problem. Trust a victim. --Baructt (talk) 16:53, 23 April 2010 (UTC)

What do you use to help w your recovery? and did you see a doctor for recovery? —Preceding unsigned comment added by 173.241.116.200 (talk) 00:54, 13 August 2010 (UTC)

In all honesty, you also need to take into account the fact that most humans go batshit insane during there transition from adolescent to teen to adult. I realize this message is insanely old, but for future reference. Take your kid off all his meds when he starts going through this phase. See what the meds were causing, and see what was just him transitioning into an adult. THEN put him back on or do whatever you wish to do.-Datahivemind (talk) 16:16, 1 November 2011 (UTC)

I have collapsed this discussion per talk page guidelines. Papillonderecherche (talk) 20:22, 27 March 2013 (UTC)

Availability outside the US

Could someone add information about the availability of Adderall outside the US? It's hard to track down this information. It isn't in the BNF or MIMS. Dexamfetamine sulphate is but not the combination described here. Njál (talk) 23:15, 5 June 2010 (UTC)

About this question: In a recent documentary shown on Arte (a french - german TV channel) called Les enfants et les psychotropes, Adderall was not mentioned at all. Most curious. The name Ritalin was mentioned many times. A big part of the filming had been done in the USA. Furthermore the film focused on a Boston hospital as the starting point of the expanding use of amfetamine treatment of children with Bipolar disorder or ADHD. But not a word about Adderall. The dialogues were translated, of course, and it is possible that the name of Adderall had been translated into Ritalin. --86.201.64.241 (talk) 15:38, 9 October 2010 (UTC)

Adderall, Effect on person with Charcot-Marie-Tooth disease

My daughter has been prescribed Adderall for ADHD. I am concerned about any negative effect that may be known for the use of this drug on females with Charcot-Marie-Tooth disease/Type II. Has the use of Adderall by this group been studied? If so, where may I find the information?Zoraidalyle (talk) 00:21, 17 June 2010 (UTC)

adderall XR 30 mg

Libido

Several people have mentioned that drugs of this type should increase libido, but the reference says only "Impotence, changes in libido" which makes it seem like it decreases. Anyone have a better citation for this? A13ean (talk) 03:27, 27 August 2010 (UTC)

It's an amphetamine. As such, its side effects go both ways, sometimes killing libido, and sometimes boosting it. —Preceding unsigned comment added by 67.169.50.167 (talk) 05:48, 7 April 2011 (UTC)

Brain's "preference" for Adderol isomers

There is a sentence in the article under "Mechanisms of action" that states: "Although it seems the human brain has a preference for dextroamphetamine over levoamphetamine...". I think should be changed since brains don't have a bias for drugs. Richard☺Decal (talk) 18:07, 16 October 2010 (UTC)

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That's...disconcerting.

From the opening paragraph: "It is thought to work by..." Well, that's disconcerting, you'd think we'd like to know how it works before stuffing our brains with it. 95.209.83.221 (talk) 12:15, 27 June 2011 (UTC)

Well take a look at every pharmaceutical page. Most psychoactive medications arent distributed by individuals with DIVINE KNOWLEDGE on the workings of the drug.-Datahivemind (talk) 16:18, 1 November 2011 (UTC)

Question about mg's

I just wanted to know what mg. they come in? I know they come in 20 and 30./// but what else? — Preceding unsigned comment added by 72.154.18.171 (talk) 04:28, 10 February 2012 (UTC)

Hello. Wikipedia is not a forum. Consult a doctor. 108.72.62.226 (talk) 16:02, 24 March 2012 (UTC)

No section on recreational use?

How come this drug, which has high rates of abuse as it is amphetamine (one only need to look at several drug forums, studies, Erowid, etc.), has no section on its use as a recreational drug? Methamphetamine is almost completely devoted to its use as a recreational drug despite it too being used for ADHD (Desoxyn). I'm thinking I should add a section on its use as a stimulant for recreation. As it stands it smacks of a certain "its a perfectly legitimate drug with no problems" POV. C6541 (T↔C) 02:07, 20 April 2012 (UTC)

I added a small section regarding its recreational use. I hope to expand upon it later. C6541 (T↔C) 02:35, 20 April 2012 (UTC)

No Mention of Product Shortage in the market

Hi. I didn't notice any mention of the current, ongoing, and prolonged shortage of Adderall in the market. I'm in Atlanta and I have a friend with narcalepsy. I haven't seen her in a while, she's probably sleeping, but I went all over town one day with her and we couldn't find Aderall anywhere. 24.126.238.179 (talk) 13:56, 1 June 2012 (UTC)

I agree with the preceding post. I am attempting to add this section. Please correct/improve as you more experienced editors see fit. Papillonderecherche (talk) 20:51, 4 January 2013 (UTC)

Recent revert

I've recently reverted a couple edits by User:Skullballoons here. I don't believe that these edits are correct but I might be wrong. My understanding is that Adderall is a racemic mixure of dextro and levo ampetamine. Also, I'm pretty sure it is available in Canada. If I'm incorrect I'd appreciate it if the user would present sourcing that contradicts our current article (which I'm assuming the sources support having read them about a year ago - it's possible they've changed but I'm a bit too busy to scrutinize them at the moment). SÆdon ^talk 21:24, 21 June 2012 (UTC)

Adderall is not racemic, it's a mix of dextroamphetamine and racemic amphetamine coming out to 3/4 dextro and 1/4 levo. ~~However I have heard nothing about it being banned in Canada and there are no citations.~~ I'm assuming good faith, but it appears skullballoons is getting into a revert war. C6541 (T↔C) 23:07, 21 June 2012 (UTC)

Eh scratch that, amphetamine salts were indeed re-scheduled and placed to schedule I in Canada. C6541 (T↔C) 23:11, 21 June 2012 (UTC)

Saedon, you are correct; Adderall XR is still widely available in Canada. It was reclassified to a class 1 drug, but this does not mean the same thing as a schedule I drug in the USA. Class 1 drugs in Canada still may have recognized medical uses (such as Oxycodone, which also appears in this list) but criminal offences involving these drugs carry stronger penalties and jail times versus lower classes.DangerGrouse (talk) 23:28, 31 July 2012 (UTC)

Legality in Canada

Editor: 12.167.100.194 reverted the edit that I made, and indicated that Adderall is illegal in Canada. This is not the case; it is still legal. Under the new Safe Streets and Communities Act, Amphetamines and derivatives have been reclassified to schedule 1. This does NOT automatically make the substance illegal; it simply means there are harsher penalties for illegal activities such as trafficking and manufacture. Adderall still exists as an active medication in the Health Canada database. I will wait to see if there are any objections; otherwise I will go ahead and make the change. DangerGrouse (talk) 18:43, 18 November 2012 (UTC)

Too Technical technical to understand?

The too technical issue only exists in one section: "Mechanism of Action." An effective rewrite of that section would justify a removal of "too technical" tag in my opinion.

The rest of article from a clarity standpoint is fine. Ranger2000 (talk) 19:31, 28 November 2012 (UTC)

I'm not seeing how it's too technical, if anything it's a simplistic explanation of the MOA, that section could use more cites rather than a rewrite. But by all means be bold. C6541 (Talk ↔ Contribs) 19:49, 28 November 2012 (UTC)

The "Mechanism of Action" section could be simplified a little by reducing the styles for naming optically active forms from 3 to 1. The introduction of R and S is not needed; it's a convention used mainly by organic chemists because it is describes absolute chiral configuration. If d- and l- are used, they should be defined as meaning dextro- and levo-. They were not defined anywhere in the article. D- and L- are often used in the article, and should not be used to mean d- and l-. D- and L-, properly rendered in small caps, are a chemist's convention for relating absolute chiral configuration to glyceraldehyde. Drbillellis 01:06, 4 December 2012 (UTC) — Preceding unsigned comment added by Drbillellis (talk • contribs)

Amphetamine neurotoxicity

Why is there no mention in this article about amphetamine neurotoxictiy (relating to VMAT2)? Seems like it is important information. 80.98.57.37 (talk) 17:56, 25 December 2012 (UTC)

Neutrality

This is yet another drug-related article that is under-developed and full of weasel words and POV. A lot of it seems to be added bit-by-bit by people on the anti-ADD-medication bandwagon, and the page wasn't sufficiently policed to catch it all. I'll try to clean it up when I have the time, any help is greatly appreciated. Exercisephys (talk) 20:28, 19 May 2013 (UTC)

Agreed. — Preceding unsigned comment added by 121.72.168.141 (talk) 11:32, 5 June 2013 (UTC)

Title change from Adderall

I changed the title to be like other drug pages. Some editors raised questions, so I checked the policies. It seems consistent with the policy that I did it... Cantaloupe2 (talk) 00:22, 20 May 2013 (UTC)

discussion that I posted on Patraarchan47's user talk;

The guideline (there is no policy governing article names) is that the title of small molecule drugs should be named after International Nonproprietary Name (INN). As far as I am aware, no INN has been assigned to Adderal. "Amphetamine mixed salts" is not an INN. It is a generic but non-specific description of Adderal. A specific generic name for Adderal is "dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate and amphetamine sulfate" which is much too long for an article name. The guideline does allow the use of brand names where INN or generic name is not available. Hence I think the name of this article should be changed back to Adderal. Boghog (talk) 21:26, 25 May 2013 (UTC)

Since we already have separate articles on racemic amphetamine and optically pure dextroamphetamine, the scope of this article should be restricted to dextroamphetamine enriched amphetamine. So an alternative title for this article is dextroamphetamine enriched amphetamine. In my opinion, that title would be preferable to the present article title since it more precisely defines the scope of this article. Boghog (talk) 22:03, 25 May 2013 (UTC)

Personally, I think this article should either be retitled Adderall or greatly reduced in size and redirect to the amphetamine and dextroamphetamine pages. It seems highly redundant to have a 3rd page on both. Furthermore, as far as I know, there's nothing preventing new mixed-amphetamine drugs from entering the market; in that event, the title of this page would simply cause confusion. As already mentioned, the new name of this page is definitely NOT consistent with the policy, which says "Drugs—The International Nonproprietary Name (INN). Most biologics, including vaccines, do not have INN or other generic names, so the brand name is used instead." Seppi333 (talk) 17:41, 11 June 2013 (UTC)

As I stated above, I support changing the name back to Adderall. Regardless of what the article is called, I disagree that the contents of this article are redundant. Dextroamphetamine and amphetamine have significantly different pharmacological effects from each other and a fixed 3:1 mixture (as found in Adderall) would have effects that differ somewhat from either of the two ingredients. Furthermore Adderall and its generics are fairly widely prescribed. Boghog (talk) 21:03, 11 June 2013 (UTC)

That's a moot point if this page is merged with Obetrol. Besides, I don't see how what's written on this page wouldn't be a subset of the information contained on the 2 aforementioned articles. As you said, adderall is 75% dextroamphetamine and 25% levoamphetamine, which would make it 50% amphetamine and 50% dextroamphetamine. Insofar as I can tell (ie, after spending an hour trying to find a single research paper to say otherwise), while levo- and dextro-amphetamine are different compounds, the neuropsychopharmacological profiles relating to catecholamines are roughly the same (each has effects on TAAR1, VMAT2, MAO-?, DAT, NET, etc. with possibly different intensities). The research I've read just differentiates the two by their relative effects on dopamine vs norepi and behavioral modification in ADHD (which is simply reflective of the variance in dopamine/norepi). That said, there doesn't seem to be that much research on pure levoamphetamine.

In any event, there already is redundancy on these pages because I ended up deleting identical mis-citations on 2 of these pages and removing/adding identical information (literally, just copy/paste) on all 3 of these pages today. Seppi333 (talk) 01:58, 12 June 2013 (UTC)

As argued below, below, the original formulation of Obetrol contains a mixture of methamphetamine and amphetamine and hence is a different drug than Adderall. Therefore I believe Obetrol (or at least the section on the original formulation) should not be merged with Adderall.

Roughly the same is not exactly the same. The two enantiomers do have somewhat different pharmacokinetics and pharmacodynamics. Redundancy can be reduced as you have already done through copyedit. As the topics partially overlap, some redundancy between the articles cannot be avoided, but this is not necessarily a bad thing. Finally the particular formulation of mixed salts contained in Adderall is widely prescribed and this is reason alone to have a separate article on Adderall. Boghog (talk) 06:14, 12 June 2013 (UTC)

I really can't find an authoritative source on the differences in pharmacodynamics. IMO, pharmacokinetic differences aren't relevant enough to merit having separate pages on the enantiomers. I'd frankly rather see the pages on levo, dextro, and amph merged instead than this one pared down and linked to them. The information on dextro and levo could just as well be mentioned in sections in the amph page. I just think it's a bit excessive to have this many pages on the same topic. In any event, I'm well aware of how widely adderall is prescribed in the US compared to other psychostimulants; I've even contributed to that number for over a decade. Seppi333 (talk) 02:30, 15 June 2013 (UTC)

Amphetamine salts

I'm on the fence on this one. Let's say I say "sodium salts". It would be a general page of various salts of sodium, as opposed to say.. a product of combination of salts marketed as "combo" as accepted in industry. So, "amphetamine salts" while "amphetamine salts combo" specifically refers to single entity pharmaceutical product. Cantaloupe2 (talk) 23:08, 19 May 2013 (UTC)

Adding comment to this...

update, I checked the policies and I am doing this right for them most part. One difficult is that proper INN would be the list of all four components and the US non-proprietary name would be "Mixed salts of a single-entity amphetamine product" per FDA hosted PDF document Either ways, it would be too long. "Amphetamine combos" is what it pops up under generic name on pharmacy sites and I'm inclined to keep it as what it is now if other editors are ok with it. Cantaloupe2 (talk) 00:13, 20 May 2013 (UTC)

I agree with the move in principle of the naming conventions but I disagree with the particular target. "Combo" is a colloquial abbreviation and is commonly used in short hand pharmacology but it is not titular (to use a very casual version of the word). I would suggest instead Mixed amphetamine salts, or probably most concisely Racemic amphetamine salts as my understanding is that all combinations under the purview of this article will be racemic (and those which aren't are not within its scope as far as I can tell). Alternatively, since "racemic" implies salts anyway, Racemic amphetamine might be even better. Additionally, if we're going by the bottle sitting in front of me, it's only Amphetamine salts. Regardless, I think we should drop "combo." Sædon ^talk 08:58, 20 May 2013 (UTC)

I agree. "Combo" is too informal for a serious encyclopedia. "Racemic" seems unnecessarily technical, and maybe not entirely correct. Mixed amphetamine salts might be a winner even though slightly vague. It's nonproprietary and correct, at least. Is there a way to word it that suggests that it's a very specific drug? What do doctors write on prescriptions? —Ben Kovitz (talk) 14:38, 20 May 2013 (UTC)

At least in the states, the prescriptions I've seen just say "amphetamine salts." Exercisephys (talk) 15:26, 20 May 2013 (UTC)

It is used in official labeling by some. See this. How about "amphetamine mixed salts (medication}" or "amphetamines mixture (medication)" much like Lithium_(medication)? Since INN for this would be unusually long, I'm not sure how it is best done..Cantaloupe2 (talk) 21:57, 21 May 2013 (UTC)

"amphetamine mixed salts (medication)" is definitely the better of those two options. Exercisephys (talk) 22:09, 21 May 2013 (UTC)

I do not think "amphetamine mixed salts" is a good name since it is imprecise. dextroamphetamine and amphetamine would be better or perhaps "amphetamine and dextroamphetamine mixed salts". Adderall ~~and Biphetamine are brand names~~ is a brand name of this specific combination of amphetamine and dextroamphetamine. Furthermore the current lead is incorrect since it doesn't mention dextroamphetamine. Boghog (talk) 06:35, 24 May 2013 (UTC)

Additionally, Amphetamine mixed salts does not seem to be grammatically correct (I read it as "Amphetamine, mixed salts"). Should it not instead be Mixed amphetamine salts? However, if we want to use the prescription label it should just be Amphetamine salts - though non-specific, it is likely the most true to reliable sources. Sædon ^talk 09:51, 24 May 2013 (UTC)

A consideration that was given in titling is to place amphetamine as the first word so it helps user searching it by bringing it up in suggestions. Cantaloupe2 (talk) 19:47, 24 May 2013 (UTC)

I think you are not understanding that "isomers of amphetamine" is inclusive of l-amphetamine and d-amphetamine. You also misunderstood what Biphetamine is. Biphetamine is d,l-amphetamine sulfate in 50/50. Adderall involves three different salts and enantiomeric ratios are different. Cantaloupe2 (talk) 19:47, 24 May 2013 (UTC)

What kind of isomer? Stereoisomer or regioisomer? The lead needs to be more precise. Biphetamine is a side issue and in any case is a discontinued drug that is no longer available. Boghog (talk) 20:10, 24 May 2013 (UTC)

Also "amphetamine and dextroamphetamine mixed salts" needs to be included as a synonym in the lead because it is frequently referred to as that. Boghog (talk) 20:19, 24 May 2013 (UTC)

Where are you getting that drugs that are no longer commercially available become a side issue in pharmacology project? Can you cite policies? Cantaloupe2 (talk) 22:42, 24 May 2013 (UTC)

In the context of this immediate discussion, it is a side issue. I never stated that discontinued drugs are unimportant within the pharmacology project. Quite to the contrary, discontinued and failed drugs can teach us a lot and are appropriate subjects of Wikipedia articles. Once a drug, always a drug. Boghog (talk) 23:48, 24 May 2013 (UTC)

Racemic mixtures of amphetamine such as Biphetamine fall within the scope of the amphetamine article, not this one. Optically pure amphetamines fall within the scope of the dextroamphetamine and levoamphetamine articles, and again, not this article. The scope of this article is amphetamine that has been enriched with dextroamphetamine (1 < d/l ratio < 0.5). By far, the most commonly available form is Aderall and Aderall generics all of which have a 3:1 d/l ratio. Are there any commercially available forms of dextroamphetamine enriched amphetamine (present or past) that have an enantiomeric ratio that differ from this? Boghog (talk) 21:55, 25 May 2013 (UTC)

Google searches on "adderall" no longer find this page. Seppi333 (talk) 08:36, 16 June 2013 (UTC)

The Google search results (or lack thereof) is a very strong reason to change the name back to Adderall. Making it more difficult for the general public to find this article is bad thing. Furthermore, there is ample precedence for having separate Wikipedia articles for widely prescribed brands of drugs (e.g., Advil, NyQuil, Sudafed, Tylenol, etc.) in addition to the articles on the corresponding generic equivalents. Adderall certainly qualifies as a widely prescribed drug. Boghog (talk) 09:11, 16 June 2013 (UTC)

History section

The history section here is a little iffy, depending on how we define the term "amphetamine salts combo." It may only mean the specific formula used in Adderall and its generics; current medical literature assumes this is the case. However, the current history section contradicts this, presenting other combinations of amphetamine salts as "amphetamine salts combos" as well. If the history section stays, the combo section of the drug info box may have to go. Exercisephys (talk) 01:30, 20 May 2013 (UTC)

This might highlight the need for an article about Adderall specifically, and keep this one a general, perhaps more technical, discussion. The truth is, given recent controversy surrounding Adderall specifically, removing the Adderall article serves the makers of the product rather than the WIkipedia reader, imo. petrarchan47 t c 02:28, 20 May 2013 (UTC)

I don't think that it's worth worrying about what effect we're having, positive or negative, on the manufacturers of Adderall. The fact of the matter is that Adderall is a brand name version of amphetamine salts, which is a pharmaceutical. That's how it's seen in the medical and pharmaceutical communities these days. If you buy generic amphetamine salts in a pharmacy it has a composition identical to Adderall and is labeled "amphetamine salts" (or "amphetamine salts combo"). Exercisephys (talk) 02:52, 20 May 2013 (UTC)

...I just saw the comment about policy from Canteloupe. Prozac redirects to Fluoxetine, with sections for Adverse effects, subsections: Discontinuation syndrome, Suicide, Violence, Interactions; and "Other brand names" are dealt with at the end. The "Popular culture" is entirely about Prozac, specifically. It doesn't seem to be a problem, the article reads well. It might be a good example to follow here. petrarchan47 t c 02:49, 20 May 2013 (UTC)

Sounds good. That information at the beginning of the History section is interesting and notable though, we should move it to the amphetamine article if we're going to remove it. Exercisephys (talk) 02:53, 20 May 2013 (UTC)

I was just about to do this move, but it turns out the History section of the amphetamine article needs significant cleaning up too. It has a whole paragraph about methamphetamine. I'll get to it tomorrow morning if no one else beats me to it. Exercisephys (talk) 02:57, 20 May 2013 (UTC)

Now I am wondering even more about whether this could be a POV fork. The Prozac article, as I mentioned, is very general except for the "In popular culture", which was 100% about Prozac specifically. But when I changed the title to reflect this information ("Prozac in popular culture"), my suspicion that information is being obfuscated (the antithesis of encyclopedic) was only strengthened in this revert. Any thoughts? petrarchan47 t c 01:35, 21 May 2013 (UTC)

I don't know what the scientifically accepted definition would be, but that's the general direction. The aim of wiki is to go for globally relevant contents and not just in the context of anglophone culture. I expect region specific legal definition varies form scientific definition. I'm looking to get rid of the wording "single entity" once I find something else to replace it with. It appears arbitrarily defined for legal definition sake by the US government. Adderall and its predecessor are the ones I have any fundamental knowledge for me to start research from so that's where I am starting. I can't tell for sure if there are any other formulas containing multiple isomers and/or salts of amphetamine derivatives.. and even if there is, how far can we extend as "derivative" ? It doesn't have to represent one very specific standardized preparation though. Cantaloupe2 (talk) 06:39, 20 May 2013 (UTC)

Since the two enantiomers of amphetamine are both pharmacologically active but with somewhat different effects, the exact ratio of enantiomers that the drug contains is significant. The enantiomeric ratio is not just a legal distinction. It also has pharmacological consequences. Boghog (talk) 22:02, 24 May 2013 (UTC)

Aderal is a stereochemically enriched mixture of amphetamine salts with a specific enantiomeric excess (the "drug substance", FDA definition) formulated in a specific way (to produce a "drug product") that was developed by the drug sponsor. Furthermore Aderal is an approved drug. Generic competitors that wish to obtain marketing approval under a Abbreviated New Drug Application must use the same drug substance (since both enantiomers are active with some what different effects, the generic must contain the same enantiomeric excess as contained in Aderal) and show bioequivalence with the original formulation. Hence this specific stereochemically enriched mixture was not defined by the US government, but rather the drug sponsor. Boghog (talk) 20:47, 24 May 2013 (UTC)

The non-proprietary name that the FDA has assigned to Adderall, Mixed Salts of a Single Entity Amphetamine Product, is very instructive. More specifically, the name contains the word "product". Furthermore according to FDA definitions, a drug product is a specific formulation of a drug substance. This implies that Adderall generics, at least in the US, must have an identical formulation to Adderall. Boghog (talk) 23:03, 24 May 2013 (UTC)

Correction to what I wrote above. There are at least two formulations of Adderall deveoped by Rexar/Richwood/Shire, so there obviously can be more than one formulation of Adderall generics. Boghog (talk) 22:38, 25 May 2013 (UTC)

"Pharmacology" vs. "Mechanisms of Action"

Can anyone tell me how these two sections differ? This article has both of them, as does amphetamine, but the distinction seems really dubious. Exercisephys (talk) 03:16, 23 May 2013 (UTC)

I am planning on combining them at one point. It's still a work in progress. It was a HUGE mess before I started working on it. I've put a few hours into this and still not done. I've been scrutinizing every bit and whenever I come across something that looks opinionated, I go back to sources and validate if the references indeed support that stance. Unfortunately, it is badly contaminated with interpretive and personal value claims by various editors who worked on this article. I'm using the article Aspirin as guidance. It is a good article in pharmacology project.

Obetrol Merge

The following discussion is closed. Please do not modify it. Subsequent comments should be made in a new section. A summary of the conclusions reached follows.

The result of this discussion was no consensus to merge. Boghog (talk) 12:54, 16 June 2013 (UTC)

I support this merge as long as we make sure to do a redirect and merge all relevant and notable information. Exercisephys (talk) 13:45, 25 May 2013 (UTC)

The original composition of Obetrol contained an active ingredient, methamphetamine that is not contained in Addrell. A later form was identical to Addrell. Because the original form differs from Addrell, I am leaning against merger, however parts of the Obetrol article could be moved into this article. Boghog (talk) 22:23, 25 May 2013 (UTC)

First, it Adderall, not Addrell. Second, we need to build consensus on including it, as it does contain amphetamine salts. The question is if inclusion of methamphetamine (which is also one of amphetamines) excludes it. Cantaloupe2 (talk) 09:35, 29 May 2013 (UTC)

Methamphetamine is a chemically and pharmacologically distinct from amphetamine. In short, it is not the same drug. Hence the original formulation of Obetrol is not within the scope of this article. Boghog (talk) 10:33, 29 May 2013 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Intro confusing

This is confusing:

Amphetamine mixed salts, also known as amphetamine and dextroamphetamine mixed salts, amphetamine salt combo, amphetamine salts and under the brand name Adderall, is a pharmaceutical drug consisting of a mixture of salts and enantiomers[1] of the stimulant amphetamine. As of 2013, there is a single accepted formulation, which contains a 3:1 ratio of dextroamphetamine (the dextrorotary or "right-handed" enantiomer) to levoamphetamine (the levorotary or "left-handed" enantiomer)

First, it's hard to read. I guess the phrase "of the stimulant amphetamine" is meant to modify the noun enantiomers and also the noun salts? We cannot be sure. I would edit it, but I dont know: salts of, and enantiomers[1] of, the stimulant amphetamine. I am going to at least put "also known as..." in parenthesis to divide it from the definition.

But after getting through, I still have the following questions: It is a "a mixture of salts and enantiomers[1] of the stimulant amphetamine." It is salts + enantiomers... pretty clear. But there is "a single accepted formulation, which contains a 3:1 ratio of dextroamphetamine (the dextrorotary or "right-handed" enantiomer) to levoamphetamine (the levorotary or "left-handed" enantiomer)" Um, now it is made of dextroamphetamine + levoamphetamine. Okay, how exactly is that the same thing as salts + enantiomers? Or are you saying it is salts + enantiomers, where the enantiomers are then made of dextroamphetamine + levoamphetamine? Or maybe the levoamphetamine is the salts part and the dectroamphetamine is the enantiomers part? Finally, all other sites I visit say adderall is a simple combo of amphetamine plus dextroamphetamine. How do I reconcile that with the above? Are they wrong, or is that somehow equivalent to what we are writing? 108.65.1.41 (talk) 05:43, 27 May 2013 (UTC)me

A previous version read:

Amphetamine mixed salts (also known as amphetamine and dextroamphetamine mixed salts or amphetamine salt combo or amphetamine salts and under the brand name Adderall) is a pharmaceutical drug containing of one or more salts of amphetamine that is enriched in the "right-handed" dextroamphetamine form of amphetamine. The most commonly available form (including Adderall and Adderall generics) has a 3:1 ratio of dextroamphetamine [right-handed] to levoamphetamine [left-handed].

Racemic amphetamine is a 1:1 mixture of dextroamphetamine and levoamphetamine. Aderall in turn is a 1:1 mixture of amphetamine and dextroamphetamine. Hence Aderall is one part dextroamphetamine and one part levoamphetamine from the amphetamine portion of the medication and 2 parts dextroamphetamine from the dextroamphetamine portion of the medication. The net result is that Adderall contains three parts dextroamphetamine to one part levoamphetamine. Furthermore the amphetamine and dextroamphetamine contained in Adderall are in the form of salts instead of the free base. Boghog (talk) 06:24, 27 May 2013 (UTC)

A simpler alternative is simply to say the drug is a combination of amphetamine and dextroamphetamine:

Amphetamine mixed salts, also known as amphetamine and dextroamphetamine mixed salts or amphetamine salt combo or amphetamine salts and under the brand name Adderall, is a pharmaceutical drug consisting of a mixture of salts of racemic amphetamine and optically pure dextroamphetamine.

Boghog (talk) 10:40, 27 May 2013 (UTC)

Per your suggestion, the lead has been edited to first simply state that "amphetamine mixed salts" are a "mixture of amphetamine and dextroamphetamine salts" and then later specify the ratio of the stereoisomers. I hope the lead is now clearer and at the same time retains accuracy. Boghog (talk) 19:41, 27 May 2013 (UTC)

Popular misconceptions about stimulant medications and ADHD.

I added my previous statement clearing up the misconception that stimulant drugs affect individuals with ADHD differently than someone who does not have ADHD. "Contrary to popular misconception, the effects of stimulant drugs (including amphetamine salts) on individuals with ADHD is not "paradoxical" as the same increase in focus and motivation, as well as the same suppression of motor activity is seen in individuals who do not have ADHD. This leads to the conclusion that the presence of ADHD does not change the pharmacological action of stimulant medications in anyway."

I feel very passionately about this subject and I hope this can now be put to rest.

This is definitely an improvement, but per WP:MEDRS, secondary sources are needed to back up medical claims. This secondary source looks relevant, but I do not have access to the full text to be certain. Boghog (talk) 10:13, 2 June 2013 (UTC)

Whoops, I improperly formated the ref tags the first time. Thanks for fixing that for me. SwampFox556 (talk) 5:26, 2 June 2013 (UTC)

Removed claim about prevalence of abuse

I went through this cited reference. Here are two sentences from the source " The authors investigated illicit use of stimulant medications at a midwestern university." "Findings revealed that 17% of 179 surveyed men and 11% of 202 women reported illicit use of prescribed stimulant medication. "

The original prose I removed read "Amphetamine salts is widely used as a cognitive enhancer at universities." This is slippery slope synthesis. The source analyzed stimulants abuse at a university. The source doesn't advance the position "widely used at" multiple "universities" and a case study can't be extrapolated to make it generally applicable. Furthermore, this is regarding all stimulants, which is inclusive of methylphenidate and others. So, it is not specific enough to this article. Cantaloupe2 (talk) 09:53, 29 May 2013 (UTC)

Claim that Bupropion synergises with Amphetamine.

I am questioning this due the pharmacodynamic actions of Bupropion, as well as the pharmacodynamic actions of Amphetamine. The article states "Both bupropion and amphetamine have noradrenergic and dopaminergic activity. Possible augmentation/potentiation of effects. Bupropion has pro-convulsant properties that may be enhanced or cumulatively potentiated by amphetamine."

I know it says "Possible augmentation/potentiation" however, I'm questioning whether or not this is correct. According to the Wikipedia article on Bupropion - Bupropion exerts its reuptake inhibiting mechanism of action by binding to the Monoamine transporters, thus blocking them. Since a lot of Amphetamines stimulating effects are due to the fact that it reverses Monoamine transporters, I'm almost certain that Bupropion would dull effects felt from Amphetamine due to the fact that the transporters wouldn't outflow their respective neurotransmitters.

I am 95% certain this is the case and I was planning on adding that in the article, however, I don't know of any study that confirms this which is what stopped me. I am going to plan on looking, but since both of these are stated on Wikipedia, would I even have to? What I mean by that is, since we know Bupropion for sure exerts its action by binding to transporters, and we know for sure that medications that bind to Monoamine transporters stop both inflow and outflow of neurotransmitters, it seems pretty obvious to me that Bupropion would result in decreased effects felt by amphetamine and therefore wouldn't result in "potentiated pro-convulsive effects" but would rather be unaffected or even possibly lessened, due to the Bupropion.

Alternatively, does anyone know for sure if I am incorrect? SwampFox556 (talk) 08:31, 5 June 2013 (UTC)

We require verifiability through MEDRS in some cases and sometimes plain 'ol RS. Not absolute correctness. If multiple reliable sources disagree, we simply list them both and summarize and leave it at that. For something like this, it is expected to have supporting evidence in MEDRS rather than popular press. So, if cited references do not support this or they are not MEDRS, purge it. Cantaloupe2 (talk) 13:05, 5 June 2013 (UTC)

The pharmacological interaction between Bupropion and Amphetamine is mediated by the CYP2D6 liver enzyme and another unknown mechanism related to lowered seizure threshold. Bupropion is a strong inhibitor of CYP2D6 and amphetamine compounds are metabolized on CYP2D6 to weaker sympathomimetic compounds. As a result, hepatic metabolism of amphetamines along that pathway essentially ceases with concurrent bupropion usage. It has nothing to do with their neuropsychopharmacological profiles related to catecholamines. Seppi333 (talk) 16:45, 11 June 2013 (UTC)

Requested move

The following discussion is an archived discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review. No further edits should be made to this section.

The result of the move request was: no consensus. -- tariqabjotu 02:35, 29 June 2013 (UTC)

Amphetamine mixed salts (medication) → Adderall –

Background – The original name for this article was Adderall. It was changed for the reasons listed above.
Convention – The normal convention is to name drug articles after the International Nonproprietary Name (INN) or other generic name, however brand names can be used in cases where a generic name is not available. Adderall is a complex mixture of salts with a specific 3:1 ratio of dextroamphetamine to levoamphetamine. Hence there is no generally accepted international name for this drug. The US non-proprietary name is "Mixed salts of a single-entity amphetamine product" per FDA hosted PDF document which is a somewhat circular definition since "product" implicitly refers to a specific mixture of salts found in Adderall.
Precision – The current title "amphetamine mixed salts" is imprecise since it does not specify the specific enantiomeric ratio of amphetamine contained in this drug.
Precedence – There is ample precedence for having separate Wikipedia articles for widely prescribed brands of drugs (e.g., Advil, NyQuil, Sudafed, Tylenol, etc.) in addition to the articles on the corresponding generic equivalents. Adderall certainly qualifies as a widely prescribed drug.
Search engines – as Seppi333 (talk · contribs) has pointed out above, Google searches on "adderall" no longer find this page making it much more difficult for the general public to find this article.
Solution – All of these problems would be solved by changing the name back to Adderall. Boghog (talk) 11:31, 16 June 2013 (UTC)

Not a big fan of having article name by the brand name. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:27, 16 June 2013 (UTC)

My reaction is exactly the same as that of Doc James. As long as Adderall is a redirect to this page, I'm not bothered by the generic name, and feel as though it's a little more encyclopedic. But it's certainly not a fighting issue for me. Maybe the search engine issue could be fixed by moving the Adderall name earlier in the lead sentence. --Tryptofish (talk) 17:55, 16 June 2013 (UTC)

I highly doubt the placement of the drug name within the article will have any bearing on search engine page ranking. Amphetamine is literally in the title of this page, but google searches on amphetamine only produce the article on amphetamine, not this one. Seppi333 (talk) 19:50, 16 June 2013 (UTC)

Oppose move following the arguments of Doc James. Agree also with BarrelProof's comment below (would prefer Amphetamine mixed salts – which is already a redirect or maybe better Amphetamine (mixed salts)). The argument that the enantiomeric ratio and specific salts are not given, is a little bit over the top. BTW, Google doesn't find Methylphenidate as well if searched for Ritalin – which is also a redirect. If somebody wants to find the article, Adderall in the search-field of WP will do the job. Maybe I just opened Pandora's box; f.i., Tylenol is stupid and should be merged into Paracetamol, IMHO. We have many articles on APIs containing sections on brands – why making exceptions for a few? Alfie ↑↓© 23:35, 16 June 2013 (UTC)

The search-engine argument is less about finding the article in wikipedia and more about finding the wikipedia article when using google or other-search-engines to find information on adderall. Adderall doesn't have a generic name like methylphenidate, so an argument comparing this to Ritalin/methylphenidate is pretty moot. The fact that we have yet to determine a feasible generic name is a testament to that. More importantly, wikipedia already has a pre-established naming convention for cases like this (mentioned in the bullets, but just to copy/paste the relevant line from the linked page here): Drugs—The International Nonproprietary Name (INN). Most biologics, including vaccines, do not have INN or other generic names, so the brand name is used instead. Seppi333 (talk) 00:00, 17 June 2013 (UTC)

My argument is based solely on the enantiomeric ratio and not on the counter ion (i.e., salt). Both enantiomers are pharmacologically active but have somewhat different pharmacological effects. Hence the specific 3:1 enantiomeric ratio contained in Adderall has pharmacological consequences. In addition Adderall is not the same drug as racemic amphetamine nor dextroamphetamine. Furthermore a drug containing a 3:1 ratio of enantiomers will have slightly different effects than a hypothetical drug containing a 4:1 or 2:1 ratio. This article is specifically about a drug containing a 3:1 ratio. The current "amphetamine mixed salts" title is incredibly vague since it does not even specify that it is enantiomerically enriched. Per WP:TITLE, "the ideal article title resembles titles for similar articles, precisely identifies the subject, and is short, natural, and recognizable". The current title fails all of the bolded criteria.
Drug articles should normally be named after the INN, but in this case, there is no INN. The only available generic name for this drug contains the word "product" which according to FDA definitions means a specific formulation of a drug. Hence it is implicit in the generic name that the formulations (including the specific 3:1 ratio enantiomeric ratio) of generic amphetamine mixed salts must be identical Adderall. Per WP:COMMONNAME, why not avoid all the confusion and just name this article Adderall? Like it or not, that is what most people call it. Boghog (talk) 18:36, 19 June 2013 (UTC)

Comment – The current name contains what seems to be an unnecessary parenthetical disambiguation. As far as I know, there is no other article about "Amphetamine mixed salts" that might lead to confusion with this article. My understanding (per WP:NATURAL) is that parenthetical disambiguation should only be used when necessary. —BarrelProof (talk) 20:00, 16 June 2013 (UTC)
Support per nom. Definite WP:COMMONNAME. I can't see anyone besides a pharmaceutical expert actually searching for the current title. --BDD (talk) 18:15, 24 June 2013 (UTC)

The above discussion is preserved as an archive of a requested move. Please do not modify it. Subsequent comments should be made in a new section on this talk page or in a move review. No further edits should be made to this section.

Abuse & performance-enhancing section

I've removed statements that I could not verify or were based on primary sources contradicted by secondary sources, and added citations where they were needed. I've added a good secondary source and removed the box flagging this section. I had to put in a link to the Wikipedia section on the UN Convention because the UN primary source had strangely difficult-to-link-to documents in it: I verified that this section of Wikipedia was right about MA salts, though. There were 3 sections to cover a small amount of issues and content, so I collapsed them into one. Hildabast (talk) 21:53, 20 June 2013 (UTC)

Use, prolonged use and withdrawal

I've removed an unreferenced statement about withdrawal, and included information from a secondary source on withdrawal. However, the prolonged use info that is there really needs quite a bit of work - I think it would be more useful if this addressed pharmaceutical use with normal doses separately from illicit use of MA. But I didn't have time to do the work on this. Hildabast (talk) 22:17, 20 June 2013 (UTC)

I added secondary sources on treatment and additional source of information on use, but only briefly summarized the results. Hildabast (talk) 22:44, 20 June 2013 (UTC)

Section on performance-enhancing

The following discussion is closed. Please do not modify it. Subsequent comments should be made in a new section. A summary of the conclusions reached follows.

This content dispute was resolved with the inclusion of better sources.

I've undone the addition of a section on performance-enhancing, that discussed effectiveness in a rather promotional way and used references that included a report on the Internet Wayback Machine. Adderall is not prescribed for enhancing the performance of students in tests. Hildabast (talk) 02:15, 25 June 2013 (UTC)

How a drug is prescribed and how it is used are two distinct things that aren't necessarily at odds. Frankly, I think it's neutral; however, if you have an issue with the verbiage, I encourage you to edit it if you think it contains POV. I have a major issue with you outright deleting the entire section though, as it is relevant and is at odds with wp:censor.Seppi333 (talk) 05:07, 25 June 2013 (UTC)

I've tried to distinguish chronicled statements of fact ("used by" students, athletes etc) from medical claims requiring reliable medical sources. One of the sources supporting such claims is from 2013 and hasn't been formally catalogued yet by the NLM (PMID 23754970). Much of the paper regards research conducted by the authors themselves (the reason why I tagged the need for a better source [2]). I propose to highlight general concepts that formed the basis of the researchers' work, rather than their interpretation of their own research. I hope this may help address an issue of undue weight.81.157.7.7 (talk) 09:27, 25 June 2013 (UTC)

PMID 23754970 is likely not in the NLM catalogue because it's been published in the past month. It has passed peer review though. Per WP:MEDRS, I quote "Reliable primary sources may occasionally be used with care as an adjunct to the secondary literature, but there remains potential for misuse. For that reason, edits that rely on primary sources should only describe the conclusions of the source, and should describe these findings clearly so the edit can be checked by editors with no specialist knowledge." Before your edit, the article text paraphrased, nearly verbatim, the abstract of that paper. A lot of what you edited to recast the results of these studies is at odds with this policy and wp:npov. What you deleted w.r.t. athletic performance is at odds with wp:censor. Hence, I'm reverting most, but not all, of your changes on ~~the~~ those grounds ~~of vandalism~~. Seppi333 (talk) 10:32, 25 June 2013 (UTC)

I agree with the arguments of Seppi333, this is censorship, a clear breach of wp:npov. Woodywoodpeckerthe3rd (talk) 10:48, 25 June 2013 (UTC)

My edits certainly weren't "vandalism". See WP:NOTVANDAL. 81.157.7.7 (talk) 10:54, 25 June 2013 (UTC)

This edit reinstates medical claims based on primary sources (PMID 7392905; PMID 5051458) and on dated secondary source from 1959 (PMID

13653995) and 1963 (PMID 13989424), none of which satisfy WP:MEDRS. Furthermore the content based on PMID 23754970 (a possible reliable medical source) is decontextualized. 81.157.7.7 (talk) 11:11, 25 June 2013 (UTC)

This is a controlled substance, and its misuse and illicit is a serious issue. This is not like off-label-use of a prescription drug, which this argument seems to be implying. A good faith edit to remove a one-sided detailing of contravention of a DEA-relevant substance is not vandalism. What's more, it's implying that one of the effects of using a drug at the dosage levels prescribed for ADHD is an increase in strength and performance - that is, if these references were even about Adderall, which they are not. This page is about amphetamine/dextroamphetamine, which is not what these additions are about. Deleting inappropriate misleading one-sided content that does not accurately represent the legal situation of a controlled substance is a good faith edit, not vandalism. Hildabast (talk) 11:31, 25 June 2013 (UTC)

Our feelings about right and wrong really shouldn't be used to justify our edits - as an encyclopedia, we need to represent reliable sources neutrally. In this case, WP:MEDRS applies, and the consensus in such sources is very cautionary -- e.g. PMID 23097484 -- with great emphasis placed on the risks (rather than the limited evidence of short-term benefits) of use for performance enhancement. Our article should reflect that perspective. If a high-quality recent peer-reviewed publication (e.g. systematic review or similar) were to demonstrate a change in consensus, WP should reflect that. -- Scray (talk) 12:00, 25 June 2013 (UTC)

The current edited version is good (current is a single sentence that puts it in perspective). Hildabast (talk) 12:04, 25 June 2013 (UTC)

I'm not sure what is particularly one-sided about the papers, so I'd appreciate some elaboration. These are pretty clear-cut summaries of those papers, in line with the policy on primary sources on wp:medrs (see bolded section above). Just being at odds with a policy of the US government is not sufficient grounds for removal of information; that argument alone is pretty moot since adderall is outright banned in several countries and that's certainly not justification for deleting the entire article. That said, deletion of this information still falls under wp:censor unless there is a specific WP policy at which it is at odds. I'd ask that you copy and paste the text here as I did above so that I know exactly what you are referring to instead of, for example, the entire wp:medrs page. Seppi333 (talk) 12:16, 25 June 2013 (UTC)

I'm quite happy to explain this later today. It wasn't a US government point (I'm not even American) - I should have referenced UN. Selective use of papers is not neutral - but I need some time to show why. Not ignoring - just have to go to work now. Hildabast (talk) 12:21, 25 June 2013 (UTC)

Before I run off, here's the beginning of a relevant passage from MEDRS: Individual primary sources should not be cited or juxtaposed so as to "debunk" or contradict the conclusions of reliable secondary sources. -- Scray (talk) 12:24, 25 June 2013 (UTC)

In regard to PMID 23097484, the US FDA already did a safety review of adhd stimulants with three peer reviewed studies (on http://www.fda.gov/Drugs/DrugSafety/ucm277770.htm and http://www.fda.gov/Drugs/DrugSafety/ucm279858.htm), with very large sample sizes, indicating that there are no cardiovascular risks associated with adhd stimulant use at therapeutic doses. These studies are cited in the article itself in the Adverse effects (Chronic) section. Moreover, after a quick read of PMID 23097484, I noticed the paper is not confined to therapeutic doses as the FDA studies are. Since the the posology is supratherapeutic in this paper and the posology in the associated papers from the 1950's and 1960's is in the therapeutic range, that paper is not as relevant in this context (exercise in the therapeutic dose range) as those FDA studies. The results of the FDA studies and that paper together would seem to suggest that high dose amphetamine use, not surprisingly, is risky when combined with exercise.

With all that in mind, I don't see the safety implications of those papers as being an issue. Nonetheless, I will refrain from editing that section any further until we have finished discussing these changes. Seppi333 (talk) 12:55, 25 June 2013 (UTC)

I have no comment on the merits here, but the pace is approaching the threshold where full protection might be necessary. The number of reverts by some is excessive. WP:BRD is the order of the day. Dennis Brown | 2¢ | © | WER 17:17, 25 June 2013 (UTC)

Agree with Scray we cannot be using primary sources to refute secondary ones. I have made a few formatting adjustments and fixed some broken text.Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:33, 25 June 2013 (UTC)

(Partially in response to Dennis Brown's comment) I'd like to commend the restraint of Seppi333 (talk · contribs) and Woodywoodpeckerthe3rd (talk · contribs) following my arrival/revert/comments. I feared that the edit war might continue, but things seem to have calmed down. -- Scray (talk) 20:43, 25 June 2013 (UTC)

This took a while to write and cite, but it more or less summarizes my thoughts on this topic. TL;DR: I'm completely willing to concede my position and not add the related material if I'm directed to a relevant WP policy that clearly indicates that material like this should not be added or the claimed contradictory secondary sources on this material are provided in this discussion (as of now, I know of no such sources or policies).

Over the past couple hours, I thought about the concerns raised and had an idea to re-cast the information under different headings that would less likely to promote abuse, but still be faithfully represent the information in those studies.

On athletic performance material:

I actually did all the original copyediting of the material/citations on physiological effects (w.r.t. PMID 7392905, PMID 5051458, PMID 13653995) with the intention of explaining to people who already use Adderall licitly about why they probably have experienced greater athletic capacity on it. At the time I wrote it, the performance-enhancing heading (in the amph article) just seemed to be the most logical first choice because it already existed and the studies are about increased (“enhanced”) athletic performance. In my case, I’ve been using Adderall for about fourteen years and have trained for and run four marathons while using it; the effects documented in these studies are quite noticeable but sporadic in their presentation and it wasn’t until I actively began researching amphetamines that I learned about why this happened (to be clear, this sentence is just an explanation on why I have these intentions, it’s not a ridiculous attempt to use personal experiences to support these studies – that would be against the policy on this page. Statisticians also don’t draw conclusions from a sample size of one ;) ).

With that said, provided that this material doesn’t clearly violate a particular WP policy requiring its exclusion, I frankly do not care how this material on athletic performance is framed (ex: performance-enhancing uses, physical side-effects, reasons why some people abuse this drug) so long as it’s faithfully represented in the article in its original state. That said, it’s been mentioned that this material is at odds with something in WP:MEDRS and possibly a secondary source, but at present I don’t know the specific contention point in MEDRS or about any non-primary sources that say anything concrete about the effects amphetamines have on physical performance. I’d like to know about any secondary sources on this topic for personal reasons though, so please enlighten me if you know of any. In any event, I don’t see why the age of these studies would inherently invalidate the conclusions; as any current experimental researcher probably knows, there’s much less proclivity of research safety panels to approve research involving human experimentation now compared to fifty or sixty years ago due to higher safety standards. Since it was only recently that studies (the FDA ones I mentioned above) demonstrated psychostimulants don’t increase cardiovascular disease risk at therapeutic doses, I’m not surprised by the fact that there are no recent papers on this. The specific MEDRS policy on this issue, WP: MEDDATE, to me, doesn’t seem to suggest exclusion of these papers given these circumstances, as there is no more-recent and relevant material which I know of to invalidate or supplant it.

On cognition-related material:

As for the material on cognition enhancement (PMID 23754970), in spite of the fact that there are several papers showing definitive nootropic effects, at the time I added it I thought it would be better to add material on this effect it with a paper that explicitly said something along the lines of “amphetamines do some good in this respect, but there’s capacity for bad that may mitigate these benefits” so as not to overtly promote abusing it. This topic doesn’t seem to me to have caused as much of a contention issue w.r.t. NPOV because of that, but I’m open to conceding and reframing it given a reasonable argument to the contrary or a policy issue. I think the IP account has an issue with how this paper is framed though, so I’d appreciate some feedback on what he/she would like to see improved.

On an associated edit I was about to make before this issue was contested:

While this is also being discussed, I’d appreciate some guidance on whether or not to include, and if so, how to frame, material about the effects amphetamine has on nociception, specifically increased pain tolerance (some examples I know of are PMID 6468501 for amph and PMID 19741505 for meth, though obviously the meth reference isn’t relevant in this article – this amph paper isn’t necessarily the one I’d cite for this purpose either though). Due to the fact that this kind of study involves causing pain to measure tolerance, there isn’t even a chance that a relevant paper on humans exists. That said, there is a potential neurobiological explanation for this since is a study (in this case, a human study, PMID 22386378) which asserts amphetamine causes efflux of endogenous morphine (endorphin) in the brain (in mesocortical/mesolimbic pathways - specific structures are mentioned in the abstract) and μ-opioid receptors in the CNS are the relevant sites for producing analgesia (see opioid#Morphine-centric chart). Ideally, I figured adding it to a section on physical side effects with a list of relevant effects would be innocuous enough. After all, I don’t see people abusing amph for the sake of increasing pain tolerance when an NSAID will suffice. In any event, any feedback on this would be appreciated. Seppi333 (talk) 21:08, 25 June 2013 (UTC)

Edit: Here is a secondary source w.r.t. athletic performance. PMC1991074 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1991074/pdf/brmedj02951-0048a.pdf) Seppi333 (talk) 03:14, 26 June 2013 (UTC)

A secondary source from 1959 is a lot more than 5 years old - it's not possible for it to be up-to-date and it predates the existence of Adderall. Hildabast (talk) 04:07, 26 June 2013 (UTC)

(edit conflict)Given the pace of biomedical research, sources older than 5 years are generally discouraged - that applies to many of the references you cited, especially ones from the 1950s-1980s. Animal studies are also not considered WP:MEDRS, but they can be used where they specifically support a biological basis for a concept strongly supported by WP:MEDRS. So, the question is where recent high-quality secondary sources come down. In going through this literature, the consensus seems to be represented by this statement (specifically in the context of performance enhancement): "All stimulants structurally related to amphetamine can cause catecholamine-mediated cardiotoxicity. Increased catecholamine levels can lead to vasoconstriction, vasospasm, tachycardia and hypertension and it is as a result of these responses that oxygen supply to the heart is compromised and hypertrophy, fibrosis and necrosis can result. Clearly, such conditions develop over time, as a consequence of chronic exposure to amphetamines and the repercussions may include myocardial infarction, aortic dissection and sudden cardiac death." (from PMID 23097484). This consensus is reflected in USA and UK regulations that severely restrict prescription of these drugs.

Please note also that it is particularly unhelpful that you've personalized this discussion as above. Such comments add nothing of value; on the contrary, we must absolutely avoid appearing to provide medical advice (which you've explicitly requested immediately above), so don't expect anyone here to offer it (and our discussion now has a further constraint). -- Scray (talk) 04:19, 26 June 2013 (UTC)

I apologise that this isn't as carefully formulated as I'd like, and I've probably missed one or two key pieces of literature in the big pile I've got here now. But it's already horrendously long, so I'm just stopping, and formatting it in now. I'll principally explain in detail why I undid those 2 original paragraphs on performance enhancing use. I didn't undo or edit any of the other changes that were being made at that time. I don’t want to get in a long debate either - this is not a major area of interest of mine. But I think I should explain in more detail what I was only able to summarise at that time. I did not have time to do the careful selection of words and research papers that would have been necessary, knew it would be some time until I could. I won’t go into the evidence on use in people with ADHD relative to these issues too much, as the latest systematic review is already in this article and the same essential message has been coming for a while, eg from AHRQ, from NICE and from DERP.

The first 2 sentences include a variety of claims of effectiveness for study & test-taking, with 1 reference involved. That reference linked to a newspaper report in the Internet Wayback Machine, that had been published in the Milwaukee Journal Sentinel from 2006: I checked if it reported research on effectiveness that I could look up, but it did not. It was based on people’s beliefs about its effectiveness, but that’s not proof of effectiveness based on blinded placebo comparisons, for example. Even if there had been research reported there, it was considerably longer than 5 years ago.

An unsupported claim that could imply that children with ADHD’s scholastic achievements may not be “legitimate” or apparent encouragement to others to anticipate improved scholastic/academic performance (especially since it would be illegal to supply it someone for this purpose in parts of the world), shouldn’t stand on public health grounds in something so widely read every day. People may have read it as only applying to people without ADHD, but not necessarily. I didn’t think this should be discussed without reliable sources, without discussing harm, and without discussion of the illegality of supplying it for that purpose in many jurisdictions.

The systematic reviews in the article already show that no major impact on scholastic performance is to be expected for most children with ADHD using Adderall. The references that have been contributed already point to the lack of conclusive evidence of benefit for people without ADHD. (Absent though is discussion of its effect in people with narcolepsy but I can’t speak to that, because I haven’t looked at that.)

The next sentence was supported by a source from the literature, but the conclusion of that 2013 review – “little or no benefit” – was not included. Although negative effects that may in effect ‘cancel out’ any positive effects were raised, the net conclusion wasn’t, and that's the critical. Then it was followed by a primary source from 1963 – long before the 2013 review - claiming benefit in some tests but not others. This 1963 study suffers from similar extreme flaws to the 1959 paper which was cited later, so I’ll comment on those together (including the fact that they precede the existence of Adderall, which is the subject of the page). A study flawed by such bias as either of these doesn’t modify the results of better research that comes later, and a selective citing of individual sources doesn’t help – especially when the conclusions of review articles are not being discussed.

The second para, about sport/exercise, does not raise adverse effects either, and no uncertainty about whether or not amphetamines – and Adderall in particular are in fact effective in improving athletic performance. The first 3 references support the existence of use, but not effectiveness. A very detailed list of positive effects, with dosage details, is supported by 3 primary studies and no reliable review. I haven’t assessed the quality or reliability of 2, but did look at the third out of historical interest because it predates the modern era of drug evaluation. Some of these people were given packets of drugs to take in cycles (no washout period), they evaluated their own outcomes, there wasn’t a control group, they had packages that they controlled, they were advised in one instance not to take anything if it rained – those are some of the kinds of things that make a source unreliable.

The paragraph ended with an hypothesis based on physiology, partly supported by a primary source involving only 8 men, and partly by a Medscape reference, the provenance of which I couldn’t find (it may be there, but by then I had run out of time to look too closely). That amphetamines are on the World Anti-Doping Agency’s prohibited list – along with their uncertainty as to whether it does in fact improve performance – wasn’t addressed. The concerns that it might increase injury when people ignore pain isn’t raised, along with the other general adverse effects, including the risk of addiction specifically in sport, and lack of good evidence of overall performance improvement.

Additional issues beside safety of the drug use itself, were other performance-related issues that are not enhancing, but which are critical if non-medicinal use of this medication is going to be addressed – such as the FDA caution about driving, hazardous activity and using heavy machinery while taking the drug. The studies on this are very equivocal – hence the caution, not a warning – any discussion of effect on performance shouldn’t leave this issue out. (Amended formatting) Hildabast (talk) 04:40, 26 June 2013 (UTC)

Hildabast, thanks for your thorough research. I don't understand the topic well enough to comment on the content, but I'm glad you've improved the sourcing and accuracy. I do have some concerns about your approach in this statement: "An unsupported claim that could imply that children with ADHD’s scholastic achievements may not be 'legitimate' or apparent encouragement to others to anticipate improved scholastic/academic performance (especially since it would be illegal to supply it someone for this purpose in parts of the world), shouldn’t stand on public health grounds in something so widely read every day. People may have read it as only applying to people without ADHD, but not necessarily."

I don't think we should censor articles based on how other people might interpret them, or whether they might be seen as advocating something that's illegal somewhere in the world. That's problematic, and arguably impossible. In general, public health errs if it tries to manipulate discussion for the sake of virtuous ends. See: http://www.forbes.com/sites/trevorbutterworth/2013/05/27/top-science-journal-rebukes-harvards-top-nutritionist/. I'm much more sympathetic to the argument that claims were biased or poorly sourced. However, poorly-sourced claims can simply be removed on that basis. As for claims that are biased because they present an incomplete picture, I don't believe (though I am still learning Wikipedia policies) that removing them is the appropriate Wikipedia:NPOV response. Instead, countervailing information should be added.

Finally, I'm not sure that whether or not a drug is a controlled substance should affect its article. Laws change over time, aren't the same in different areas, and aren't an authority on truth or knowledge external to themselves. Or at least, encyclopedias tend to take that view. Proxyma (talk) 20:16, 8 August 2013 (UTC)

There was a question about the issue of being out-of-date and considering old trials, which was moved according to the history but I can't find it sorry. So I'm commenting here. Most systematic reviews are out-of-date by that time, but yes, you still generally assess old trials (although you can have a time limit related to issues such as, when the intervention became available or a seminal point of change in the intervention etc). But gathering up a few examples of primary studies in an unsystematic way is a risky way to go about reviewing drug effectiveness. In terms of early trials, it's unusual firstly for their to be a drug trial before 1962 (see figure 2 here), and then secondly, it's highly unusual for their to be a drug trial in particular with adequate methodology before the end of the 1950s - although it does of course happen (and things were done that an ethics committee would never allow these days, so they can remain the only study). I wanted to look at it carefully, because high quality early trials are of great historical interest, in trying to establish how trial methodology developed. So that's why I looked at one, but didn't look beyond abstract of the other two. Hildabast (talk) 12:34, 26 June 2013 (UTC)

After reading the responses, I’m going to concede the cognition related edit to Hildabast’s argument on that particular issue. Your argument was pretty well thought out. This discussion has really only been about two sentences in that section though, so I appreciate your thoroughness even if the piece-by-piece explanation on the edits wasn’t necessary. Moreover, I actually think it’s a good idea to include information on the non-medicinal negative performance related issues you mentioned. It’s relevant to amphetamines and consequently should be included in the article. I think the only thing you said that I disagree with is that research on amph is less relevant just because a brand-name amphetamine wasn’t developed by the time a study came out. Just seems a bit non-sequitur to me. That said, I would raise an issue in regard to the quality of the performance-related sources, but that issue is moot from the fact that this discussion is only going to settle on reviews of literature/secondary sources from the past five years.

I skimmed the PMC3405448 review you mentioned and noticed it had higher rejection rates than the FDA review along a noted issue with low statistical power (for comparison, the fda review has high power from a very large sample size) with roughly the same sample age-drug pairing, although the PMC paper clearly has more heterogeneity in its statistical design with multiple clusters and different age-drug combinations between clusters. One of the main statistical justifications for meta-analysis is to increase power, so it's concerning that there is an issue with low power in that paper. Moreover, the heterogeneity in that analysis may greatly complicate inference depending on how it is handled. At minimum, heterogeneity increases the number of potential sources of error in a statistical design. Barring a clinically relevant difference between the two studies, it's pretty concerning that the PMC paper has lower power and higher rejection rates than the FDA review. I only skimmed the paper, so there may be a relevant difference between the two studies that I've missed though - It may be worth seeing if comments on these papers say anything about this. All else equal (it never is), the higher power in the FDA review should would put an upper bound the effect sizes of those in the PMC paper due to its lower power, so if these are the same roughly the same population samples (i.e. no clinically relevant differences in drug-age pairing and sampling methods), this would seem to suggest the PMC paper has problems with its statistical analysis.

Scray, your response read like a diatribe and I’m frankly astounded that the tone of your discussion has become so hostile over an explanation of why I’m interested in these edits. It is also particularly unhelpful to include unwarranted hostility and wrongful accusations in a discussion. Really though, how did you read a request for a secondary source on performance enhancing effects of amph as a request for medical advice? That’s an absurd straw man fallacy. I also didn’t cite any animal studies in the contended edits. I brought it up on a topic you didn’t even comment on. I completely agree with the text you cited from the paper on abuse, provided the discussion is on amphetamine use at supratherapeutic doses, which this discussion is absolutely not about. Again, that paper isn’t relevant to this discussion because the paper is on abuse. Different population samples results in different population inference. I already mentioned that paper is above the therapeutic range after I read it, although anyone reading the title of the review could have gathered that much; you ignored my comment. I also mentioned the FDA review, which is at therapeutic doses and consequently is relevant. You ignored this too. The hostile and accusatory blob of text you just wrote didn’t add anything useful to this discussion.

Turning to the performance related edits, all of the current (i.e. from the past 5 years) literature I’ve seen relating to amphetamines involves just drug classes to which it belongs, not amph itself. As I mentioned before, I don’t expect new primary sources on amph and performance for various reasons; however, performance effects of larger classes of drugs which include amph does seem to be an active area of research. Material on this will have to suffice if date matters that much. However, if date matters that much, I’d also point out that PMID 15310585 is a review from 2004 so we also have a meddate issue with this paper as well. A newer review/secondary source, PMID 23456493, from this year (May 2013) is relevant and indicates that DNRI’s actually do improve performance though. One relevant quote: (don’t have the desire to format a block quote - sorry)

“After administration of bupropion, a dopamine/noradrenaline reuptake inhibitor, subjects cycled significantly faster on a preloaded 30-min time trial in the heat. The initial decrease in power output was much smaller in the bupropion condition (Fig. 3a, b). This ergogenic effect was apparent without any change in the subjective feelings of exertion and heat stress [41, 53]. We [42] showed that administration of a dopamine reuptake inhibitor, methylphenidate, significantly improved performance on a preloaded 30-min cycling time trial in the heat ([7 min or 16 % performance improvement). During the time trial subjects were able to maintain a higher output and sustain higher metabolic heat production through an increased drive and motivation [42].”

If there’s more than one relevant review on this within the past 5 years, I think it would be reasonable to include all associated reviews as citations in an edit on this topic. Thoughts? Seppi333 (talk) 12:57, 26 June 2013 (UTC)

Seppi333, I feel/felt no hostility. In the context of this discussion, listing a series of concerns is usual - I think it's overly negative to call that a diatribe. About medical advice, this concern was in the context of your description of personal use followed by a question about physical performance: "I’d like to know about any secondary sources on this topic for personal reasons though, so please enlighten me if you know of any." Re-reading that, it still reads like a request of personal interest on a medicine-related topic in the explicit context of personal use of a drug (i.e., medical advice). That's why I said what I did. Regarding animal studies, I'm not going to go back through all of your citations now, but there were animal studies among them. Please don't read hostility in my tone because there is none there - just a few things that needed to be addressed, including concerns that we stay on the right side of WP policy. Perhaps it's better if I step away from this altogether and let others weigh in. -- Scray (talk) 17:42, 26 June 2013 (UTC)

Fair enough. "Personal reasons" are related to my dissertation topic (I'm an applied statistician) - I didn't and still don't feel like elaborating. That said, I'm not some imbecile that seeks online medical advice, so I'd appreciate it if this issue isn't raised again. In any event, I've been travelling all day, so I'll follow up on the issues I raised, correct my typos, and read the paper more thoroughly tomorrow. In line with consensus so far, I'll also delete all associated cognition-related edits from both articles at that time as well. Regards, Seppi333 (talk) 03:47, 27 June 2013 (UTC)

This material is from a graduate level textbook (cited below) in neuropsychopharmacology from 2009 (i.e. satisfies WP:MEDDATE) - if you have evidence it's wrong, I'd strongly suggest contacting the authors, as a quick google search reveals that some graduate programs currently use text as the sole or primary reference in classes on the topic.

Therapeutic (relatively low) doses of psychostimulants, such as methylphenidate and amphetamine, improve performance on working memory tasks both in individuals with ADHD and in normal subjects.

Positron emission tomography (PET) demonstrates that methylphenidate decreases regional cerebral blood flow in the doroslateral prefrontal cortex and posterior parietal cortex while improving

performance of a spacial working memory task. This suggests that cortical networks that normally process spatial working memory become more efficient in response to the drug. Both methylphenidate

and amphetamines act by triggering the release of dopamine, norepinephrine, and serotonin, actions mediated via the plasma membrane transporters of these neurotransmitters and via the shared

vesicular monoamine transporter (Chapter 6). Based on animal studies with micro-iontophoretic application of selective D1 dopamine receptor agonists (such as the partial agonist SKF38393

or the full agonist SKF81297) and antagonist (such as SCH23390), and clinical evidence in humans with ADHD, it is now believed that dopamine and norepinephrine, but not serotonin, produce the

beneficial effects of stimulants on working memory. At abused (relatively high) doses, stimulants can interfere with working memory and cognitive control, as will be discussed below. It is

important to recognize, however, that stimulants act not only on working memory function, but also on general levels of arousal and, within the nucleus accumbens, improve the saliency of tasks.

Thus, stimulants improve performance on effortful but tedious tasks, probably acting at different sites in the brain through indirect stimulation of dopamine and norepinephrine receptors.

Source: Robert Malenka, Eric Nestler, Steven Hyman. Molecular neuropharmacology : A Foundation for Clinical Neuroscience 2nd ed. New York: McGraw-Hill Medical, 2009. Print. Chapter 13: Higher Cognitive Function and Behavioral Control. Page 318. ISBN 978-0-07-148127-4

Hence, I'm adding the relevant information (paraphrasing above) on the nootropic properties of amphetamines in the general population back to the article. Seppi333 (talk) 20:58, 24 July 2013 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.