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XELSTRYM (dextroamphetamine transdermal)

Xelstrym (dextroamphetamine) transdermal system is the first and only available amphetamine patch, FDA-approved in March 2022 for treatment of ADHD in ages 6+.

Xelstrym visual mnemonic Jason Cafer MD Cafermed

Visual mnemonic: “Zelda strums”

Mnemonic for amphetamine product: amp

Mnemonic for CYP2D6 substrate: beach ball


❖ Amphetamine stimulant

❖ DA > NE reuptake inhibitor

❖ DA > NE releaser

❖ DEA Schedule II


Available strengths:

4.5 mg / 9 hr

9 mg / 9 hr

13.5 mg / 9 hr

18 mg / 9 hr



The patch should be applied 2 hours before an effect is needed. It is worn for 9 hours on the hip, upper arm, chest, upper back, or flank.


Transdermal delivery allows the patient to determine duration of effect. The main disadvantage is the 2-hour delay in onset.


Adverse effects at the application site were about twice as likely than with placebo patch. Localized dermal complaints included irritation (94%), discomfort (69%), pain (13%), severe discomfort (10%), and pruritus (7%). Refer to pages 218–219 of Cafer's Psychopharmacology for general information about stimulants, with risks and warnings.


CYP2D6 substrate mnemonic for amphetamine
2D6 substrate (minor)

Dynamic interactions:

❖ CNS stimulant

❖ Hypertensive effects

❖ Lowers seizure threshold

❖ Serotonergic (mild)


Kinetic interactions:

❖ 2D6 substrate (minor)

❖ Reduced excretion in alkaline urine, e.g., caused by acetazolamide (Diamox) can potentially lead to amphetamine toxicity


Check out Cafer's Psychopharmacology: Visualize to Memorize 270 Medication Mascots for a visual mnemonic system for generic/trade name pairings, drug-drug interactions, and remembering which of the numerous available stimulant products are methylphenidates vs amphetamines.

Amphetamine product

Approx

duration


Formulation

Notes


Adderall (mixed amphetamine salts)

5 hr

Capsule

75% D- and 25% L- amphetamine isomers

Adderall XR

10 hr

Capsule (can sprinkle)

Half is immediate release

Adzenys XR-ODT

10 hr

Orally disintegrating tablet (ODT)

[add ZEN iss]


Mydayis

16 hr

Capsule (can sprinkle)

pH-dependent release

Vyvanse (lisdexamfetamine)

10-14 hr

Capsule (can dissolve contents)

​Prodrug converted to 100% D-amphetamine in RBCs. OK that it's powder because effect is no faster if snorted.

Dexedrine

4 hr

Capsule (can sprinkle)

100% D-amphetamine

Evekeo (formerly Benzedrine)

4 hr

Splittable tablet

50% D- and 50% L- isomers

Desoxyn (methamphetamine)

4 hr

Splittable tablet

It’s legal methamphetamine, very rarely prescribed


Dyanavel XR

10 hr

Liquid

[dy ANN a vel] 3.2 to 1 D- to L-amphetamine ratio

​Xelstrym (transdermal)

9 hr

Patch

Apply 2 hours prior to needed effect





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