Twisted_Chemist
Bluelighter
- Joined
- Mar 23, 2018
- Messages
- 44
The Complete Lay Guide To Dextro-/Levo-/Meth(L-,D-,) Amphetamines. Revision 1.1
Written By: Twisted_Chemist, PhD and Sssnake, PhD
I wrote this up because I keep seeing new amphetamine discussions popping up about different kinds of amphetamines (mostly prescribed ones) and many people are giving out incomplete or just wrong information. I have tried to write this so it is easy for anyone to get the basics, as well as some more advanced info for those who wish to do further research.
For common doses people take, see section 6.2 and 6.3. Know your limits.
Obligatory Note:
1. Introduction
2. Methamphetamine and Amphetamine Isomers and Their Differences
2.1 Racemic Amphetamine
(Amphetamine Sulfate, Amphetamine Aspartate Monohydrate):
2.1.1 Adderall (Mixed Amphetamine Salts)
2.2 Dextroamphetamine
Binding Sites (advanced):
2.3 Levoamphetamine
Binding Sites (advanced):
2.4 Racemic Methamphetamine
Binding Sites (advanced):
Levo-methamphetamine (l-methamphetamine):
Dextro-methamphetamine (d-methamphetamine):
---
3. Comparison of Amphetamines: Mechanistic Differences and Clinical Effects
3.1 Mechanistic Differences-
Levoamphetamine:
d-Methamphetamine:
3.2 CNS vs. Peripheral Action
CNS Action:
3.3 Prescription Uses and Clinical Considerations
---
4. Medical-Grade Methamphetamine vs. Street Methamphetamine
4.1 Purity and Composition
4.2 Pharmacological Differences
4.3 Health Risks
---
5. Other ADD/ADHD meds, prodrugs and related compounds.
5.1 Lisdexamfetamine (Vyvanse)
5.2 Methylphenidate (Ritalin, Concerta)
5.3 Modafinil (Provigil)
5.4 Atomoxetine (Strattera)
5.5 Phentermine
5.7 Dexmethylphenidate (Focalin)
6. Harm Reduction and Dosage Information (WIP)
6.1 Harm Reduction Strategies
6.2 Typical Prescribed Doses of Amphetamines and Related Drugs
Dextroamphetamine:
Lisdexamfetamine (Vyvanse):
Methamphetamine (Desoxyn):
Methylphenidate (Ritalin, Concerta):
Phentermine:
6.3 Doses Commonly Taken For Recreational Use
Dextroamphetamine and Methamphetamine:
Lisdexamfetamine:
Methylphenidate:
6.4 Summary of Harm Reduction for Amphetamines and Cathinones
---
I am still working on section 6, but for the most part, this guide is complete. I tried to keep it as basic as possible. If you see an error, something that should be added or anything else. Let me know.
Stay safe and Stay High
Written By: Twisted_Chemist, PhD and Sssnake, PhD
I wrote this up because I keep seeing new amphetamine discussions popping up about different kinds of amphetamines (mostly prescribed ones) and many people are giving out incomplete or just wrong information. I have tried to write this so it is easy for anyone to get the basics, as well as some more advanced info for those who wish to do further research.
For common doses people take, see section 6.2 and 6.3. Know your limits.
Obligatory Note:
I am not a medical doctor or healthcare provider. Nothing I say should be considered medical advice. Everything provided here is solely for research and education.
Both Amphetamine and Methamphetamine are highly addictive and have become endemic in most parts of the world. While generally safe when used by itself, mixing amphetamines with other drugs can be fatal.
Misuse of amphetamines can cause serious cardiovascular problems, including increased blood pressure and heart rate, stroke, and heart attack.
According to the FDA's reporting information, at therapeutic doses, there have been 17 cases of sudden death in people taking only amphetamines, and 35 reports of cardiovascular or stroke problems.
Those who died from sudden death were reported to have structural anomalies in their heart that were unknown to them.
Misuse of amphetamines can cause serious cardiovascular problems, including increased blood pressure and heart rate, stroke, and heart attack.
According to the FDA's reporting information, at therapeutic doses, there have been 17 cases of sudden death in people taking only amphetamines, and 35 reports of cardiovascular or stroke problems.
Those who died from sudden death were reported to have structural anomalies in their heart that were unknown to them.
1. Introduction
Amphetamines and methamphetamine are potent central nervous system (CNS) stimulants with both therapeutic and recreational uses. This guide provides an overview of the mechanisms of action, pharmacodynamics, and pharmacokinetics of these substances, emphasizing the differences between their isomeric forms, reported effects when used as prescribed, and the distinction between medical-grade methamphetamine and street methamphetamine.
Amphetamines were first synthesized in 1887 by Romanian chemist Lazăr Edeleanu, but their stimulant properties were not recognized until the 1920s when American chemist Gordon Alles rediscovered them. Amphetamine, marketed as Benzedrine, was introduced in the 1930s for the treatment of nasal congestion and asthma. During World War II, amphetamines were widely used by military personnel to combat fatigue and improve alertness. Post-war, amphetamines became popular as a treatment for a variety of conditions, including depression, obesity, and attention deficit hyperactivity disorder (ADHD). However, their potential for abuse and addiction became apparent in the 1960s, leading to increased regulation and control. Despite this, amphetamines continue to be used therapeutically under strict medical supervision, primarily for ADHD and narcolepsy, while also being widely abused for their stimulant effects.
Amphetamines were first synthesized in 1887 by Romanian chemist Lazăr Edeleanu, but their stimulant properties were not recognized until the 1920s when American chemist Gordon Alles rediscovered them. Amphetamine, marketed as Benzedrine, was introduced in the 1930s for the treatment of nasal congestion and asthma. During World War II, amphetamines were widely used by military personnel to combat fatigue and improve alertness. Post-war, amphetamines became popular as a treatment for a variety of conditions, including depression, obesity, and attention deficit hyperactivity disorder (ADHD). However, their potential for abuse and addiction became apparent in the 1960s, leading to increased regulation and control. Despite this, amphetamines continue to be used therapeutically under strict medical supervision, primarily for ADHD and narcolepsy, while also being widely abused for their stimulant effects.
2. Methamphetamine and Amphetamine Isomers and Their Differences
2.1 Racemic Amphetamine
(Amphetamine Sulfate, Amphetamine Aspartate Monohydrate):
Racemic amphetamine is a 1:1 mixture of dextroamphetamine and levoamphetamine. The combination provides a balanced effect, with dextroamphetamine contributing more to CNS stimulation and levoamphetamine affecting peripheral systems. The therapeutic use of racemic amphetamine, such as in the treatment of ADHD and narcolepsy, benefits from this combination as it provides both cognitive enhancement and peripheral stimulation, such as improved physical energy levels and respiratory function.
Reported Effects When Used as Directed:
- Increased focus and attention span
- Improved wakefulness and reduction of excessive daytime sleepiness
- Mild elevation in mood
- Potential cardiovascular effects such as increased heart rate and blood pressure
Reported Effects When Used as Directed:
- Increased focus and attention span
- Improved wakefulness and reduction of excessive daytime sleepiness
- Mild elevation in mood
- Potential cardiovascular effects such as increased heart rate and blood pressure
2.1.1 Adderall (Mixed Amphetamine Salts)
Adderall is a widely prescribed medication for ADHD and narcolepsy. It is a mixture of several amphetamine salts, providing a balanced and sustained effect on both cognitive and physical energy levels. The medication contains a combination of four salts that together equal 75% dextroamphetamine and 25% levoamphetamine.
Salts Included in Adderall:
Dextroamphetamine Saccharate: A salt form of dextroamphetamine, contributing to the potent CNS stimulant effects.
Amphetamine Aspartate Monohydrate: A racemic mixture that provides both dextro- and levoamphetamine, offering a balance of effects.
Dextroamphetamine Sulfate: Another form of dextroamphetamine, enhancing the overall psychostimulant properties.
Amphetamine Sulfate: A racemic mixture, similar to the aspartate salt, providing both CNS and peripheral effects.
Reported Effects When Used as Directed:
Significant improvement in attention, focus, and hyperactivity symptoms in ADHD patients
Increased wakefulness and reduced sleep attacks in narcolepsy
Enhanced cognitive performance in tasks requiring sustained attention
Possible side effects including insomnia, loss of appetite, and dry mouth
Bioavailability (Same for both Dextroamphetamine and Levoamphetamine):
Oral: 90-95%.
Intranasal: 70-80%
Smoked: research suggests up 100%
Intravenous: ~100%
Rectal: 90-95%
Onset of action is 45 mins oral and 30 minutes intranasal. For best intranasal results, snort with sterile water. Amphetamines are water soluble at a ratio of 1.74 mg/mL
Note for IV Use: Do not crush up a pill and inject it, it's just not worth the risk of losing your limbs or your life.
Salts Included in Adderall:
Dextroamphetamine Saccharate: A salt form of dextroamphetamine, contributing to the potent CNS stimulant effects.
Amphetamine Aspartate Monohydrate: A racemic mixture that provides both dextro- and levoamphetamine, offering a balance of effects.
Dextroamphetamine Sulfate: Another form of dextroamphetamine, enhancing the overall psychostimulant properties.
Amphetamine Sulfate: A racemic mixture, similar to the aspartate salt, providing both CNS and peripheral effects.
Reported Effects When Used as Directed:
Significant improvement in attention, focus, and hyperactivity symptoms in ADHD patients
Increased wakefulness and reduced sleep attacks in narcolepsy
Enhanced cognitive performance in tasks requiring sustained attention
Possible side effects including insomnia, loss of appetite, and dry mouth
Bioavailability (Same for both Dextroamphetamine and Levoamphetamine):
Oral: 90-95%.
Intranasal: 70-80%
Smoked: research suggests up 100%
Intravenous: ~100%
Rectal: 90-95%
Onset of action is 45 mins oral and 30 minutes intranasal. For best intranasal results, snort with sterile water. Amphetamines are water soluble at a ratio of 1.74 mg/mL
Note for IV Use: Do not crush up a pill and inject it, it's just not worth the risk of losing your limbs or your life.
2.2 Dextroamphetamine
Dextroamphetamine, the more active enantiomer of amphetamine, has a higher affinity for CNS receptors, particularly the dopamine and norepinephrine transporters. This results in stronger cognitive effects, such as enhanced concentration, alertness, and mental clarity. Dextroamphetamine is commonly prescribed for ADHD and narcolepsy and is found in medications like Adderall and Dexedrine.
Reported Effects When Used as Directed:
- Significant improvement in attention, focus, and hyperactivity symptoms in ADHD patients
- Increased wakefulness and reduced sleep attacks in narcolepsy
- Enhanced cognitive performance in tasks requiring sustained attention
- Possible side effects including insomnia, loss of appetite, and dry mouth
Reported Effects When Used as Directed:
- Significant improvement in attention, focus, and hyperactivity symptoms in ADHD patients
- Increased wakefulness and reduced sleep attacks in narcolepsy
- Enhanced cognitive performance in tasks requiring sustained attention
- Possible side effects including insomnia, loss of appetite, and dry mouth
Binding Sites (advanced):
The strong binding to dopamine transporters (DAT) makes dextroamphetamine particularly potent in enhancing cognitive function and mood, which is why it is more commonly used in the treatment of ADHD and narcolepsy.
Dextroamphetamine also has a high affinity for the norepinephrine transporter (NET), leading to increased levels of norepinephrine in the brain. This contributes to its effects on alertness, attention, and physical energy.
It has moderate affinity for the serotonin transporter (SERT), leading to slight increases in serotonin levels. However, this effect is relatively minor compared to its action on DAT and NET. The modest impact on serotonin levels may contribute slightly to mood elevation but is not the primary mechanism of action for dextroamphetamine.
The action on adrenergic receptors in the CNS enhances its overall stimulant effects, while peripheral effects are relatively mild.
Dextroamphetamine primarily acts on the CNS, making it more effective for cognitive enhancement, attention, and mood elevation. It has a stronger effect on dopamine and norepinephrine levels in the brain compared to that of Levoamphetamine.
Dextroamphetamine also has a high affinity for the norepinephrine transporter (NET), leading to increased levels of norepinephrine in the brain. This contributes to its effects on alertness, attention, and physical energy.
It has moderate affinity for the serotonin transporter (SERT), leading to slight increases in serotonin levels. However, this effect is relatively minor compared to its action on DAT and NET. The modest impact on serotonin levels may contribute slightly to mood elevation but is not the primary mechanism of action for dextroamphetamine.
The action on adrenergic receptors in the CNS enhances its overall stimulant effects, while peripheral effects are relatively mild.
Dextroamphetamine primarily acts on the CNS, making it more effective for cognitive enhancement, attention, and mood elevation. It has a stronger effect on dopamine and norepinephrine levels in the brain compared to that of Levoamphetamine.
2.3 Levoamphetamine
Levoamphetamine, though less potent in CNS effects compared to dextroamphetamine, has a stronger impact on peripheral adrenergic systems. It acts more on the cardiovascular and respiratory systems, making it less effective as a sole treatment for CNS-related conditions but useful when combined with dextroamphetamine to provide a broader range of effects.
Reported Effects When Used as Directed:
- Mild CNS stimulation, less intense than dextroamphetamine
- More pronounced peripheral effects, such as increased heart rate and bronchodilation
- Contributes to the overall therapeutic effects of racemic amphetamine by balancing CNS and peripheral stimulation
Reported Effects When Used as Directed:
- Mild CNS stimulation, less intense than dextroamphetamine
- More pronounced peripheral effects, such as increased heart rate and bronchodilation
- Contributes to the overall therapeutic effects of racemic amphetamine by balancing CNS and peripheral stimulation
Binding Sites (advanced):
Due to its lower affinity for DAT, levoamphetamine is less effective at increasing dopamine levels in the brain, leading to milder stimulant effects. It contributes more to physical stimulation and peripheral effects rather than cognitive enhancement.
The moderate affinity for NET by levoamphetamine leads to stronger peripheral effects such as increased heart rate and blood pressure, which are more pronounced than its CNS effects. This is why levoamphetamine is often associated with physical stimulation rather than cognitive enhancement. The low affinity for SERT means that levoamphetamine does not significantly influence mood or emotional states through serotonin pathways.
Levoamphetamine has a more pronounced effect on peripheral adrenergic receptors, leading to increased heart rate, blood pressure, and other physical symptoms associated with adrenergic stimulation.
It has a greater impact on the periphery nervous system then it's right handed cousin, leading to physical stimulation such as increased heart rate and blood pressure. Its CNS effects are weaker, making it less effective for cognitive and attention-related issues.
The moderate affinity for NET by levoamphetamine leads to stronger peripheral effects such as increased heart rate and blood pressure, which are more pronounced than its CNS effects. This is why levoamphetamine is often associated with physical stimulation rather than cognitive enhancement. The low affinity for SERT means that levoamphetamine does not significantly influence mood or emotional states through serotonin pathways.
Levoamphetamine has a more pronounced effect on peripheral adrenergic receptors, leading to increased heart rate, blood pressure, and other physical symptoms associated with adrenergic stimulation.
It has a greater impact on the periphery nervous system then it's right handed cousin, leading to physical stimulation such as increased heart rate and blood pressure. Its CNS effects are weaker, making it less effective for cognitive and attention-related issues.
2.4 Racemic Methamphetamine
Just like it's parent drug, racemic methamphetamine is made up of a 1:1 ratio of both dextro- and Levo- methamphetamine. Methamphetamine is a substituted amphetamine.
Methamphetamine, particularly its d-isomer, is more potent than amphetamine due to its higher lipophilicity, which allows for faster CNS penetration and a more prolonged effect. Methamphetamine is prescribed less frequently due to its high potential for abuse but can be effective in treating severe ADHD and obesity. It is available in a prescription form under the brand name Desoxyn.
Reported Effects When Used as Directed:
- Strong CNS stimulation, leading to increased concentration, alertness, and wakefulness
- Enhanced mood and energy levels, often described as a "motivational boost"
- Potential side effects include increased blood pressure, anxiety, and potential for dependence
- Used under strict medical supervision due to its high potential for abuse and neurotoxicity
Bioavailability:
Oral: approximately 62% to 79%. This slightly lower bioavailability compared to dextroamphetamine is due to differences in metabolism and absorption.
Intranasal: 70-80% (best when administered in a solution of water)
Intravenous (IV): 100%
Inhalation (smoked): 90%
Rectal: 80%
On set of action varies by route of administration. IV, Snorted and Smoked are the fastest.
Methamphetamine, particularly its d-isomer, is more potent than amphetamine due to its higher lipophilicity, which allows for faster CNS penetration and a more prolonged effect. Methamphetamine is prescribed less frequently due to its high potential for abuse but can be effective in treating severe ADHD and obesity. It is available in a prescription form under the brand name Desoxyn.
Reported Effects When Used as Directed:
- Strong CNS stimulation, leading to increased concentration, alertness, and wakefulness
- Enhanced mood and energy levels, often described as a "motivational boost"
- Potential side effects include increased blood pressure, anxiety, and potential for dependence
- Used under strict medical supervision due to its high potential for abuse and neurotoxicity
Bioavailability:
Oral: approximately 62% to 79%. This slightly lower bioavailability compared to dextroamphetamine is due to differences in metabolism and absorption.
Intranasal: 70-80% (best when administered in a solution of water)
Intravenous (IV): 100%
Inhalation (smoked): 90%
Rectal: 80%
On set of action varies by route of administration. IV, Snorted and Smoked are the fastest.
Binding Sites (advanced):
Levo-methamphetamine (l-methamphetamine):
It is the "left-handed" isomer of methamphetamine.
L-methamphetamine has weaker effects on the central nervous system (CNS) compared to d-methamphetamine. It primarily acts as a vasoconstrictor and bronchodilator, affecting the peripheral nervous system (PNS) rather than the brain. It has minimal euphoric or psychoactive effects.
Due to its peripheral actions, l-methamphetamine is often found in over-the-counter nasal decongestants in some countries (e.g., Vicks VapoInhaler). It helps clear nasal congestion by constricting blood vessels in the nasal passages.
It is not considered to be very recreational.
L-methamphetamine has weaker effects on the central nervous system (CNS) compared to d-methamphetamine. It primarily acts as a vasoconstrictor and bronchodilator, affecting the peripheral nervous system (PNS) rather than the brain. It has minimal euphoric or psychoactive effects.
Due to its peripheral actions, l-methamphetamine is often found in over-the-counter nasal decongestants in some countries (e.g., Vicks VapoInhaler). It helps clear nasal congestion by constricting blood vessels in the nasal passages.
It is not considered to be very recreational.
Dextro-methamphetamine (d-methamphetamine):
It is the "right-handed" isomer of methamphetamine.
D-methamphetamine is significantly more potent in the CNS and is primarily responsible for the stimulant and euphoric effects associated with methamphetamine use. It has a strong effect on increasing the release of dopamine, norepinephrine, and to a lesser extent, serotonin in the brain, leading to increased alertness, energy, and mood elevation. It also has a high potential for abuse and dependence.
D-methamphetamine has a high binding affinity for the dopamine transporter (DAT). It reverses the action of DAT, leading to an increased release of dopamine into the synaptic cleft. This results in the potent stimulant and euphoric effects commonly associated with methamphetamine use.
D-methamphetamine also has a high affinity for the norepinephrine transporter (NET), increasing norepinephrine levels in the brain. This contributes to heightened alertness, increased heart rate, and elevated blood pressure.
It has a moderate affinity for the serotonin transporter (SERT), increasing serotonin levels in the synaptic cleft. This may contributes to mood elevation and the empathogenic effects sometimes associated with its use, but is not the primary mechanism of action.
It also binds to adrenergic receptors both centrally and peripherally, leading to increased blood pressure, heart rate, and other sympathetic nervous system responses.
Overall D-methamphetamine primarily affects the CNS due to its high affinity for DAT, NET, and to a lesser extent, SERT. This results in its strong psychoactive and stimulant effects.
D-methamphetamine is significantly more potent in the CNS and is primarily responsible for the stimulant and euphoric effects associated with methamphetamine use. It has a strong effect on increasing the release of dopamine, norepinephrine, and to a lesser extent, serotonin in the brain, leading to increased alertness, energy, and mood elevation. It also has a high potential for abuse and dependence.
D-methamphetamine has a high binding affinity for the dopamine transporter (DAT). It reverses the action of DAT, leading to an increased release of dopamine into the synaptic cleft. This results in the potent stimulant and euphoric effects commonly associated with methamphetamine use.
D-methamphetamine also has a high affinity for the norepinephrine transporter (NET), increasing norepinephrine levels in the brain. This contributes to heightened alertness, increased heart rate, and elevated blood pressure.
It has a moderate affinity for the serotonin transporter (SERT), increasing serotonin levels in the synaptic cleft. This may contributes to mood elevation and the empathogenic effects sometimes associated with its use, but is not the primary mechanism of action.
It also binds to adrenergic receptors both centrally and peripherally, leading to increased blood pressure, heart rate, and other sympathetic nervous system responses.
Overall D-methamphetamine primarily affects the CNS due to its high affinity for DAT, NET, and to a lesser extent, SERT. This results in its strong psychoactive and stimulant effects.
---
3. Comparison of Amphetamines: Mechanistic Differences and Clinical Effects
3.1 Mechanistic Differences-
Dextroamphetamine: Highly selective for CNS targets, leading to pronounced cognitive and mood-enhancing effects. It has a high affinity for the dopamine transporter (DAT) and norepinephrine transporter (NET), facilitating increased neurotransmitter release and reuptake inhibition
Levoamphetamine:
Exhibits stronger peripheral effects due to its action on adrenergic receptors in the cardiovascular and respiratory systems. It has a lower affinity for CNS transporters compared to dextroamphetamine, leading to less pronounced effects on mood and cognition.
d-Methamphetamine:
Methamphetamine is unique in its rapid CNS penetration due to its high lipophilicity. It acts similarly to dextroamphetamine but with greater potency, leading to more intense and prolonged effects. Methamphetamine's stronger action on VMAT2 (vesicular monoamine transporter 2) results in higher dopamine release, which contributes to its stronger euphoric effects and higher abuse potential.
3.2 CNS vs. Peripheral Action
CNS Action:
Dextroamphetamine and d-methamphetamine are more focused on CNS effects, which include improved attention, increased cognitive function, and elevated mood. Methamphetamine’s effects are more intense and long-lasting due to its pharmacokinetic properties.
Peripheral Action: Levoamphetamine has more significant effects on peripheral adrenergic systems, influencing heart rate, blood pressure, and respiratory function. This makes it more suitable for applications where peripheral stimulation is desired, though its CNS effects are less pronounced.
Peripheral Action: Levoamphetamine has more significant effects on peripheral adrenergic systems, influencing heart rate, blood pressure, and respiratory function. This makes it more suitable for applications where peripheral stimulation is desired, though its CNS effects are less pronounced.
3.3 Prescription Uses and Clinical Considerations
Dextroamphetamine:
Primarily used for ADHD and narcolepsy. Its cognitive-enhancing effects make it a preferred choice for managing attention deficits and sleep disorders.
Racemic Amphetamine:
Used in ADHD and narcolepsy, offering a balanced approach with both CNS and peripheral stimulation. It is beneficial for patients who may need both cognitive and physical activation.
Methamphetamine (Medical Grade):
Used in severe cases of ADHD and obesity where other treatments have failed. Due to its high abuse potential, it is prescribed under strict medical supervision and in limited dosages.
Primarily used for ADHD and narcolepsy. Its cognitive-enhancing effects make it a preferred choice for managing attention deficits and sleep disorders.
Racemic Amphetamine:
Used in ADHD and narcolepsy, offering a balanced approach with both CNS and peripheral stimulation. It is beneficial for patients who may need both cognitive and physical activation.
Methamphetamine (Medical Grade):
Used in severe cases of ADHD and obesity where other treatments have failed. Due to its high abuse potential, it is prescribed under strict medical supervision and in limited dosages.
---
4. Medical-Grade Methamphetamine vs. Street Methamphetamine
4.1 Purity and Composition
Medical-grade methamphetamine, such as Desoxyn, is manufactured under strict pharmaceutical standards, ensuring a high level of purity and precise dosing. It contains only the d-isomer of methamphetamine, which is responsible for its therapeutic effects.
Street methamphetamine, on the other hand, is typically produced in illicit laboratories with poor quality control. It often contains a mixture of d- and l-isomers, along with numerous impurities and toxic byproducts resulting from the unregulated manufacturing process. These impurities can include dangerous chemicals such as battery acid, ammonia, and various solvents.
Street methamphetamine, on the other hand, is typically produced in illicit laboratories with poor quality control. It often contains a mixture of d- and l-isomers, along with numerous impurities and toxic byproducts resulting from the unregulated manufacturing process. These impurities can include dangerous chemicals such as battery acid, ammonia, and various solvents.
4.2 Pharmacological Differences
The presence of impurities and the l-isomer in street methamphetamine can lead to different and often more dangerous effects compared to the medical-grade version. The l-isomer has more pronounced peripheral effects and less CNS activity, which can lead to increased cardiovascular strain without the cognitive benefits seen with the d-isomer.
4.3 Health Risks
Street methamphetamine is associated with a higher risk of acute and chronic health issues, including cardiovascular problems, neurotoxicity, and addiction. The presence of toxic impurities can also cause severe health complications, such as kidney and liver damage, respiratory issues, and increased risk of infections from injection use.
Medical-grade methamphetamine, when used as directed, has a more predictable safety profile. However, due to its high potential for abuse, it is prescribed with caution, and patients are closely monitored to prevent misuse.
Medical-grade methamphetamine, when used as directed, has a more predictable safety profile. However, due to its high potential for abuse, it is prescribed with caution, and patients are closely monitored to prevent misuse.
---
5. Other ADD/ADHD meds, prodrugs and related compounds.
In addition to the traditional amphetamines, there are other substances that are prodrugs for amphetamines or have similar modes of action that are used for the same reason.
5.1 Lisdexamfetamine (Vyvanse)
Lisdexamfetamine is a long acting prodrug of dextroamphetamine, meaning it is metabolized in the body to produce the active dextroamphetamine. This conversion occurs gradually, providing a longer-lasting effect with a lower potential for abuse compared to immediate-release amphetamines. Lisdexamfetamine is completely converted to dextroamphetamine in circulation. Due to the complex nature of prodrugs, this does not mean dosing is 1:1.
Clarification: Since the conversion of lisdexamfetamine to dextroamphetamine leads to a slower, more sustained release of the active drug. This results in more stable and prolonged blood concentration of dextroamphetamine at lower levels.
Uses:
- ADHD treatment, offering extended duration of action, making it suitable for once-daily dosing
- Approved for the treatment of binge eating disorder in adults
Side Effects:
- Common side effects include insomnia, decreased appetite, dry mouth, and anxiety
- Lower risk of abuse due to its prodrug nature, but it can still lead to dependence with prolonged use
Clarification: Since the conversion of lisdexamfetamine to dextroamphetamine leads to a slower, more sustained release of the active drug. This results in more stable and prolonged blood concentration of dextroamphetamine at lower levels.
Uses:
- ADHD treatment, offering extended duration of action, making it suitable for once-daily dosing
- Approved for the treatment of binge eating disorder in adults
Side Effects:
- Common side effects include insomnia, decreased appetite, dry mouth, and anxiety
- Lower risk of abuse due to its prodrug nature, but it can still lead to dependence with prolonged use
5.2 Methylphenidate (Ritalin, Concerta)
Methylphenidate is structurally different from amphetamines but functions similarly by blocking the reuptake of dopamine and norepinephrine, leading to increased concentrations of these neurotransmitters in the brain. It is a commonly prescribed stimulant for ADHD and narcolepsy.
Uses:
- Widely used for ADHD management, particularly in children and adolescents
- Also prescribed for narcolepsy and, in some cases, for depression and cognitive enhancement in elderly patients
Side Effects:
- Insomnia, appetite loss, increased heart rate, and anxiety
- Potential for abuse, particularly with immediate-release formulations
Uses:
- Widely used for ADHD management, particularly in children and adolescents
- Also prescribed for narcolepsy and, in some cases, for depression and cognitive enhancement in elderly patients
Side Effects:
- Insomnia, appetite loss, increased heart rate, and anxiety
- Potential for abuse, particularly with immediate-release formulations
5.3 Modafinil (Provigil)
Modafinil is a wakefulness-promoting agent that, while not an amphetamine, is often used in similar contexts to treat sleep disorders. It is believed to work by modulating dopamine levels and possibly affecting other neurotransmitter systems. It has been study for the treatment of ADHD.
Uses:
- Primary treatment for narcolepsy, shift work sleep disorder, and obstructive sleep apnea-related daytime sleepiness
- Off-label use includes cognitive enhancement and treatment of ADHD
Side Effects:
- Headache, nausea, nervousness, and dizziness
- Lower potential for abuse compared to traditional stimulants, though it can still lead to dependency in some cases
Uses:
- Primary treatment for narcolepsy, shift work sleep disorder, and obstructive sleep apnea-related daytime sleepiness
- Off-label use includes cognitive enhancement and treatment of ADHD
Side Effects:
- Headache, nausea, nervousness, and dizziness
- Lower potential for abuse compared to traditional stimulants, though it can still lead to dependency in some cases
5.4 Atomoxetine (Strattera)
Atomoxetine is a selective norepinephrine reuptake inhibitor (NRI) that is used as a non-stimulant option for ADHD treatment. It does not carry the same abuse potential as traditional stimulants, making it a safer option for some patients.
Uses:
- ADHD treatment, particularly in patients where stimulant medications are contraindicated or ineffective
- Can be used in both children and adults
Side Effects:
- Common side effects include fatigue, gastrointestinal upset, and decreased appetite
- Less effective for immediate symptom relief compared to stimulants, but beneficial for long-term management
Uses:
- ADHD treatment, particularly in patients where stimulant medications are contraindicated or ineffective
- Can be used in both children and adults
Side Effects:
- Common side effects include fatigue, gastrointestinal upset, and decreased appetite
- Less effective for immediate symptom relief compared to stimulants, but beneficial for long-term management
5.5 Phentermine
Phentermine is an appetite suppressant that acts similarly to amphetamines by stimulating the release of norepinephrine in the hypothalamus, which reduces hunger signals.
Uses:
- Short-term treatment of obesity in conjunction with diet and exercise
- Often used in combination with other weight-loss medications for enhanced effect
Side Effects:
- Increased heart rate, dry mouth, insomnia, and potential for addiction
- Not recommended for long-term use due to cardiovascular risks
Uses:
- Short-term treatment of obesity in conjunction with diet and exercise
- Often used in combination with other weight-loss medications for enhanced effect
Side Effects:
- Increased heart rate, dry mouth, insomnia, and potential for addiction
- Not recommended for long-term use due to cardiovascular risks
5.7 Dexmethylphenidate (Focalin)
Dexmethylphenidate is the dextrorotatory isomer of methylphenidate, offering similar effects but with potentially lower required doses. It is used primarily in the treatment of ADHD.
Uses:
- ADHD treatment, often preferred in cases where methylphenidate is effective but a more potent formulation is needed
Side Effects:
- Similar to methylphenidate, including insomnia, decreased appetite, and increased heart rate
- Potential for abuse, though somewhat mitigated by its formulation
Uses:
- ADHD treatment, often preferred in cases where methylphenidate is effective but a more potent formulation is needed
Side Effects:
- Similar to methylphenidate, including insomnia, decreased appetite, and increased heart rate
- Potential for abuse, though somewhat mitigated by its formulation
6. Harm Reduction and Dosage Information (WIP)
Amphetamines and related stimulant drugs are widely used both in medical settings and recreationally. While they can be effective therapeutic agents, they also carry significant risks, especially when misused. This section provides information on harm reduction strategies, typical prescribed doses, and the dosages commonly taken by those who abuse these drugs.
6.1 Harm Reduction Strategies
Harm reduction approaches aim to minimize the negative health, social, and legal impacts associated with drug use. For amphetamines and substituted cathinones, these strategies include:
Dose Reduction: Users who are dependent or regularly use high doses might consider gradually reducing their intake to minimize withdrawal symptoms and adverse effects.
If you suspect someone is experiencing an amphetamine overdose, it is crucial to seek emergency medical assistance immediately. While waiting for medical help:
Ensure the person is in a safe position: Place them on their side in the recovery position to prevent aspiration if they vomit.
Monitor vital signs: Keep track of their breathing, pulse, and consciousness.
Do not leave them alone: Stay with the person until medical help arrives.
Education on the signs of amphetamine overdose—such as chest pain, severe agitation, seizures, and loss of consciousness and other may help save a life.
Dose Reduction: Users who are dependent or regularly use high doses might consider gradually reducing their intake to minimize withdrawal symptoms and adverse effects.
If you suspect someone is experiencing an amphetamine overdose, it is crucial to seek emergency medical assistance immediately. While waiting for medical help:
Ensure the person is in a safe position: Place them on their side in the recovery position to prevent aspiration if they vomit.
Monitor vital signs: Keep track of their breathing, pulse, and consciousness.
Do not leave them alone: Stay with the person until medical help arrives.
Education on the signs of amphetamine overdose—such as chest pain, severe agitation, seizures, and loss of consciousness and other may help save a life.
6.2 Typical Prescribed Doses of Amphetamines and Related Drugs
Prescribed doses of amphetamines and related stimulants vary depending on the specific condition being treated, the patient's age, weight, and tolerance level, as well as the formulation of the drug (immediate-release vs. extended-release). Below are the typical starting doses for some common amphetamines:
Dextroamphetamine:
ADHD in Children and Adolescents: Starting dose is typically 5 mg once or twice daily, with adjustments made based on response and tolerance. Maximum daily dose generally does not exceed 40 mg.
ADHD in Adults: Starting dose is usually 10 mg daily, with gradual increases. Maximum daily dose is typically around 60 mg.
Narcolepsy: Starting dose is 5 mg daily, with increases as needed. Doses of up to 60 mg per day may be used
ADHD in Adults: Starting dose is usually 10 mg daily, with gradual increases. Maximum daily dose is typically around 60 mg.
Narcolepsy: Starting dose is 5 mg daily, with increases as needed. Doses of up to 60 mg per day may be used
Lisdexamfetamine (Vyvanse):
ADHD: Starting dose is 30 mg once daily, with possible increases in increments of 10-20 mg. Maximum dose is 70 mg daily.
Binge Eating Disorder: Typically starts at 30 mg daily, titrated to a maximum of 70 mg daily based on patient response.
Binge Eating Disorder: Typically starts at 30 mg daily, titrated to a maximum of 70 mg daily based on patient response.
Methamphetamine (Desoxyn):
ADHD dosing: Initial dose is 5 mg daily, with increases as needed. Maximum doses are generally not recommended to exceed 25 mg per day due to the high potential for abuse and adverse effects.
Obesity: 5 mg before each meal, though this is rarely prescribed due to concerns about safety and dependency.
Obesity: 5 mg before each meal, though this is rarely prescribed due to concerns about safety and dependency.
Methylphenidate (Ritalin, Concerta):
Starting dose for immediate-release formulations is 5 mg twice daily, with adjustments made based on response. Extended-release formulations are usually started at 18-36 mg once daily, with a maximum dose of 72 mg daily.
Phentermine:
Obesity: Typically prescribed at doses of 15-37.5 mg once daily before breakfast or 1-2 hours after breakfast. Used short-term (a few weeks) as part of a weight loss program.
6.3 Doses Commonly Taken For Recreational Use
When amphetamines and related substances are abused, doses often exceed prescribed amounts significantly, leading to a higher risk of adverse effects, including overdose. The following are common recreational doses. These doses are averages and based on self-reported data
Dextroamphetamine and Methamphetamine:
Recreational Dose: Doses often range from 20 mg to 100 mg or more in a single session. Chronic users may consume even higher doses, upwards of 200 mg per day or more.
Common first dose for Dextroamphetamine: 30-40 MG
Duration: About 4-6 hours for, with peak effects last 1-2 hours
Common first dose for Methamphetamine: 15-20 MG (Oral) 5-10 MG (Snorted/smoked) 2-3mg for IV.
Duration: Up to 24 hours, with peak effects lasting up to 6 hours depending on route of administration. Smoked, IV and snorted lasting the least amount of time, with IV only lasting about an hour.
Binge Use: Users may take multiple doses over a short period, leading to extremely high cumulative doses (e.g., 500 mg or more within a day), which greatly increases the risk of severe side effects, including paranoia, aggression, and cardiovascular complications.
Common first dose for Dextroamphetamine: 30-40 MG
Duration: About 4-6 hours for, with peak effects last 1-2 hours
Common first dose for Methamphetamine: 15-20 MG (Oral) 5-10 MG (Snorted/smoked) 2-3mg for IV.
Duration: Up to 24 hours, with peak effects lasting up to 6 hours depending on route of administration. Smoked, IV and snorted lasting the least amount of time, with IV only lasting about an hour.
Binge Use: Users may take multiple doses over a short period, leading to extremely high cumulative doses (e.g., 500 mg or more within a day), which greatly increases the risk of severe side effects, including paranoia, aggression, and cardiovascular complications.
Lisdexamfetamine:
Recreational Dose: Some users report crushing and ingesting large amounts to cause more of the drug to be converted in the body at once for a faster effect. Doses can reach 100 mg or more, far exceeding safe levels. Most people do not get the effect they were hoping for.
Common first does: 60-80 mg
Duration: 12-13 hours, most user report little to no peak like effects.
Common first does: 60-80 mg
Duration: 12-13 hours, most user report little to no peak like effects.
Methylphenidate:
Recreational Dose: Doses can range from 20 mg to 100 mg or more, especially when taken in rapid succession. Users may crush and snort the medication to intensify its effects, increasing the risk of respiratory and cardiovascular issues.
Common first dose: 15-40 mg (snorted), 40-60 mg (oral)
Duration: 3-4 hours with peak lasting 1-1.5 hours.
Common first dose: 15-40 mg (snorted), 40-60 mg (oral)
Duration: 3-4 hours with peak lasting 1-1.5 hours.
6.4 Summary of Harm Reduction for Amphetamines and Cathinones
Start Low and Go Slow: Users are advised to start with the lowest possible dose and gradually increase if necessary, paying close attention to their body’s response. Just remember, you can always take more, but you can't take less.
Avoid Mixing Substances: Combining amphetamines with other stimulants or depressants can amplify risks and unpredictability of effects.
Stay Hydrated: Especially with MDMA or other stimulants that increase activity levels, maintaining hydration is crucial to prevent hyperthermia and dehydration.
Seek Support: Access to medical and psychological support is critical for those who are struggling with dependence or experiencing severe side effects.
Avoid Mixing Substances: Combining amphetamines with other stimulants or depressants can amplify risks and unpredictability of effects.
Stay Hydrated: Especially with MDMA or other stimulants that increase activity levels, maintaining hydration is crucial to prevent hyperthermia and dehydration.
Seek Support: Access to medical and psychological support is critical for those who are struggling with dependence or experiencing severe side effects.
I am still working on section 6, but for the most part, this guide is complete. I tried to keep it as basic as possible. If you see an error, something that should be added or anything else. Let me know.
Stay safe and Stay High
Last edited:
