FDA ( Food and Drug Administration ) has approved Adderall XR ( mixed salts of a single-entity amphetamine product ) as a once-daily treatment for adolescents aged 13 to 17 with attention deficit hyperactivity disorder ( ADHD ).

Since October 2001, Adderall XR has been approved in the U.S. for treatment in children aged 6 to 12 years and since August 2004 in adults 18 years and older.

ADHD affects approximately 3 to 7 percent of all school-age children, or approximately two million U.S. children, and is considered the most commonly diagnosed psychiatric disorder in children and adolescents.
ADHD is a neurological brain disorder that manifests as a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable age and maturity.
ADHD can have a profound effect on a child's quality of life and can be serious enough to interfere beyond academics, leading to problems maintaining friendships, difficulties focusing on sports or other after-school activities, and challenges in relating well with other family members.
Untreated ADHD has long-term adverse effects on academic performance, vocational success and social-emotional development.
Evidence also suggests that many with untreated ADHD may be at risk for other problems, such as drug abuse, anti-social behavior and poor self-esteem. As they age, up to 65 percent of adolescents with ADHD may still exhibit symptoms into adulthood.

The FDA based its approval on data that Shire provided in a supplement to its New Drug Application ( sNDA ).
These data included the results of a pharmacokinetic study and a placebo-controlled, fixed-dose clinical trial of a range of doses of once-daily Adderall XR in adolescents with ADHD.

In a randomized, double-blind, placebo-controlled clinical trial, Adderall XR was proven to be significantly more effective than placebo in the treatment of ADHD symptoms in adolescents.
Adderall XR was generally safe and well tolerated with adverse events similar to those seen in other populations.
The most common adverse events were loss of appetite, insomnia, abdominal pain, and weight loss. The results of this study show that Adderall XR produces a positive clinical response in adolescents diagnosed with ADHD.
The study showed Adderall XR at doses between 10 mg and 40 mg daily were statistically significantly superior to placebo ( p<0.0001 ) on the ADHD-RS-IV ( investigator-rated with the parent and adolescent ).
Furthermore, 63 percent of investigators considered their subjects' ADHD symptoms to be much improved or very much improved with Adderall XR compared to 27 percent for placebo ( p<0.0001 ).

The effectiveness of Adderall XR for long-term use has not been systematically evaluated in controlled trials. As with other psychostimulants indicated for ADHD, there is a potential for exacerbating motor and phonic tics and Tourette's syndrome. A side effect seen with the amphetamine class is psychosis. Caution also should be exercised in patients with a history of psychosis.

Abuse of amphetamines may lead to dependence. Misuse of amphetamine may cause sudden death and serious cardiovascular adverse events.
Adderall XR generally should not be used in children or adults with structural cardiac abnormalities.
Adderall XR is contraindicated in patients with symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism and glaucoma, known hypersensitivity to this class of compounds, agitated states, history of drug abuse, or current or recent use of MAO inhibitors.

Source: Shire Pharmaceuticals, 2005


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