D-amphetamine salt combo is the generic pharmacy name for a medication most people know as Adderall. It contains a specific blend of four amphetamine salts: dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate. The “d” refers to dextroamphetamine, the more active form of amphetamine, which makes up 75% of the blend. The remaining 25% is levoamphetamine, a slightly different form that works more slowly. This 3:1 ratio is what distinguishes this medication from pure dextroamphetamine products.
What It Treats
The FDA has approved d-amphetamine salt combo for two conditions: attention deficit hyperactivity disorder (ADHD) and narcolepsy. For ADHD, it can be prescribed to children as young as 3 years old (immediate-release) or 6 years old (extended-release), as well as adolescents and adults. For narcolepsy, a condition causing sudden, uncontrollable episodes of sleep during the day, the medication is approved for patients 6 and older, though narcolepsy rarely appears in children under 12.
The medication works by increasing levels of certain brain chemicals that regulate attention, impulse control, and wakefulness. The two forms of amphetamine in the blend have slightly different speeds and durations, which is designed to produce a smoother, more sustained effect than a single-salt product.
Immediate-Release vs. Extended-Release
D-amphetamine salt combo comes in two main formulations. The immediate-release version (often labeled “IR” or simply “amphetamine salts”) starts working within 30 to 45 minutes and lasts about 4 to 6 hours. Many people take it twice a day to cover the full school or work day.
The extended-release version (Adderall XR) also kicks in within 30 to 45 minutes but lasts 8 to 12 hours, making a single morning dose sufficient for most people. A third extended-release option, Mydayis, is approved for patients 13 and older and is designed to last even longer into the evening. Your pharmacy label will typically say “d-amphetamine salt combo” for any of these versions, so check whether it specifies “ER,” “XR,” or “IR” to know which formulation you have.
Typical Dosing
For adults starting treatment for the first time, the typical dose of the extended-release version is 20 mg once daily in the morning. Children ages 6 to 12 usually start at 5 or 10 mg daily, with adjustments of 5 to 10 mg per week until the right dose is found. The maximum recommended dose for children in that age range is 30 mg per day. Adolescents ages 13 to 17 typically start at 10 mg daily and may increase to 20 mg after one week.
The immediate-release version uses smaller individual doses taken multiple times a day. Children 6 and older generally start at 5 mg once or twice daily, with weekly increases of 5 mg. Finding the right dose is a gradual process, not a one-size-fits-all number.
Common Side Effects
The most frequently reported side effects include decreased appetite, trouble sleeping, dry mouth, increased heart rate, and nervousness or anxiety. Weight loss is common, especially in children, because the medication can significantly suppress hunger. Many people find that side effects are strongest in the first few weeks and then ease as the body adjusts.
Stimulants like this one can raise blood pressure and heart rate modestly. For most healthy people this isn’t dangerous, but the FDA warns that sudden death has been reported in patients with structural heart abnormalities or other serious cardiac conditions who took stimulant medications at normal doses.
Who Should Not Take It
D-amphetamine salt combo is not appropriate for everyone. The FDA lists several absolute contraindications:
- Heart conditions including symptomatic cardiovascular disease, advanced hardening of the arteries, or serious arrhythmias
- Moderate to severe high blood pressure
- Overactive thyroid
- Glaucoma
- MAOI antidepressants, either currently or within the past 14 days, due to the risk of a dangerous spike in blood pressure
- History of drug abuse
- Known allergy to amphetamine or related stimulants
- Agitated states such as severe anxiety or agitation
Scheduling and Prescription Rules
D-amphetamine salt combo is classified as a Schedule II controlled substance by the DEA, the same category as oxycodone and morphine. This means it has a recognized medical use but also a high potential for abuse and physical or psychological dependence. The FDA’s boxed warning, the most serious type of safety alert, states that misuse can lead to overdose and death, particularly at high doses or when the drug is snorted or injected rather than swallowed.
Because of its Schedule II status, prescriptions cannot include automatic refills. You need a new prescription each time, and in most states, prescriptions expire after a set period (often 90 days). Many providers now send electronic prescriptions directly to the pharmacy, but the process still requires an active, current prescription for every fill.
Ongoing Supply Shortages
If you’ve had trouble filling your prescription recently, you’re not alone. Multiple manufacturers have reported limited supply of immediate-release amphetamine salt tablets due to active ingredient shortages, shipping delays, and increased demand. Some generic makers, including Mylan, Zydus, and Solco, have discontinued their versions entirely. Others like Teva, Lannett, and Sandoz have certain strengths on intermittent back order, with some not estimating restock dates. Brand-name Adderall from Teva remains available, though specific generic strengths (particularly 5 mg, 10 mg, 20 mg, and 30 mg tablets) vary in availability depending on the manufacturer and region.
If your pharmacy can’t fill your usual generic, ask whether a different manufacturer’s version is in stock. Your prescriber may also be able to switch you to a different strength or formulation that’s more readily available.