Xelstrym
Xelstrym (dextroamphetamine) is the second stimulant patch approved for the treatment of attention deficit-hyperactivity disorder (ADHD). It's placed on the skin 2 hours before you need the effects of the medication to start, and it's kept on for up to 9 hours to last throughout the day. This medication can commonly cause headache, trouble sleeping, and a loss of appetite. Xelstrym (dextroamphetamine) is a controlled substance due to the risk of abuse and dependence.
What is Xelstrym (dextroamphetamine)?
What is Xelstrym (dextroamphetamine) used for?
- Attention deficit-hyperactivity disorder (ADHD)
How Xelstrym (dextroamphetamine) works
Xelstrym (dextroamphetamine) is a stimulant medication. It's not exactly known how Xelstrym (dextroamphetamine) helps to improve attention and focus, but it's thought to work by raising the levels of chemicals in your brain called norepinephrine, dopamine, and serotonin.
Drug facts
Risks and warnings for Xelstrym (dextroamphetamine)
Xelstrym (dextroamphetamine) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Abuse and dependence
- Risk factors: History of substance or alcohol abuse | Suddenly stopping Xelstrym (dextroamphetamine) after long-term use
Xelstrym (dextroamphetamine) has a risk of abuse and dependence. Abuse is when a medication is used for non-medical reasons for its desirable physical or emotional effects (e.g., having a lower appetite). Abusing or misusing Xelstrym (dextroamphetamine) raises your risk for serious side effects such as high heart rate, high blood pressure, aggressive behavior, and even thoughts of hurting yourself or others. In addition, over time, you can become physically dependent on Xelstrym (dextroamphetamine) to function normally. This is usually related to having withdrawal symptoms, like anxiety, irritability, nightmares, and sleep problems, if you use the medication for a long time and then suddenly stop. Use Xelstrym (dextroamphetamine) exactly as prescribed to you. Don't change the dose or how often you use it without talking to your provider first.
Serious heart problems
- Risk factors: History of heart problems
There have been reports of sudden death, stroke, and heart attack in people who took stimulants at recommended doses. Xelstrym (dextroamphetamine) can also raise your blood pressure and heart rate. Tell your healthcare provider if you have a history of heart problems before starting Xelstrym (dextroamphetamine) to make sure it's safe for you to use. Let your provider know if you experience unexplained fainting, chest pain with physical activity, or irregular heartbeat while you're taking Xelstrym (dextroamphetamine). Your provider will check your heart for any problems.
Aggressive behavior and other changes in behavior
- Risk factors: History of psychotic episodes, bipolar disorder, or other mental health or mood-related conditions
Some people who've taken a stimulant like Xelstrym (dextroamphetamine) can have mental health problems, such as hallucinations (seeing things that aren't really there), aggressive behavior, unclear thinking, and mania. This medication can worsen behavior-related problems that you already have, but these changes in behavior can also happen even if you haven't had these problems before. If you develop these mood- or behavior-related symptoms while taking Xelstrym (dextroamphetamine), talk to your healthcare provider right away because you might have to stop taking it.
Slowed growth in children
In studies, stimulants slowed the growth rate (both in height and weight) in children. Your child's healthcare provider will track your child's growth progress closely. If they suspect slowed growth, they might pause or stop your child's Xelstrym (dextroamphetamine) treatment. If your child isn't getting enough nutrition, if you notice major changes in weight, or if you have any concerns, talk to your child's provider.
Blood circulation problems (such as Raynaud's phenomenon)
Xelstrym (dextroamphetamine) might be linked to poor blood circulation problems, such as Raynaud's phenomenon. People with Raynaud's phenomenon can experience episodes of poor blood flow to the fingers and toes, which can cause the skin to turn pale and to feel cold, numb, or painful. If this happens, symptoms are typically mild. But rarely, it can cause sores or ulcers in more serious cases. Let your healthcare provider know if you notice symptoms of circulation problems, such as bouts of numbness or pain in your fingers or toes. Your provider might need to lower your dose of Xelstrym (dextroamphetamine) or ask you to consider a different medication.
Serotonin syndrome
- Risk factors: Taking monoamine oxidase inhibitors (MAOI) within 14 days of starting Xelstrym (dextroamphetamine) | Taking other medications that raise serotonin levels in your brain
Serotonin syndrome is a rare, but potentially life-threatening condition where there's too much serotonin in the brain. Serotonin is one of the chemicals in your brain responsible for your mood. Since Xelstrym (dextroamphetamine) might raise your serotonin levels in the brain, your risk for this condition goes up if you use Xelstrym (dextroamphetamine) with other medications that also affect serotonin levels, such as antidepressants (e.g., sertraline (Zoloft), duloxetine (Cymbalta)), MAOIs (e.g., phenelzine (Nardil)), and certain migraine medications (e.g., sumatriptan (Imitrex)). Tell your healthcare provider and pharmacist about all the medications you take or plan to take (including over-the-counter medications and supplements) so they can make sure your medications are safe for you. Symptoms of serotonin syndrome include fast heart rate, sweating, muscle stiffness or spasms, high fever, and confusion. Get medical help right away if you have any of these symptoms.
Skin reactions and skin sensitivity
Using Xelstrym (dextroamphetamine) can cause dry, itchy skin (contact dermatitis), a type of skin sensitivity. Skin redness is common and isn't a sign of skin sensitivity by itself. But skin redness that happens with swelling, small skin-colored bumps, or blisters that don't get better within 2 days or spreads to other areas of skin could be signs of severe skin sensitivity. Contact your provider right away if you have any of these symptoms.
Side effects of Xelstrym (dextroamphetamine)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Low appetite (12%)
- Difficulty sleeping (8%)
- Headache (6%)
*Side effects were reported for children younger than 18 years old. Side effects might differ in adults.
Less Common Side Effects
- Application site reaction (e.g., discomfort, irritation)
- Nausea
- Vomiting
- Stomach pain
- Irritability
- Higher blood pressure
- Fast heart rate
Xelstrym (dextroamphetamine) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Allergic skin reactions: skin redness, swelling, small skin-colored bumps, blisters that don't get better within a few days or spreads to other areas of skin
- Heart problems: heart attack, fast heart rate, high blood pressure
- Brain-related problems: seizures, stroke
- Mental health-related problems: manic episodes, changes in thoughts or behavior, hallucinations
- Serotonin syndrome: fast heart rate, sweating, muscle stiffness or spasms, fever, confusion
The following Xelstrym (dextroamphetamine) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- Increase in blood pressure
- Irritability, confusion, fast or irregular heartbeat, muscle stiffness, twitching muscles, sweating, high fever, seizure, chills, vomiting, diarrhea, which may be signs of serotonin syndrome
- Mood and behavior changes—anxiety, nervousness, confusion, hallucinations, irritability, hostility, thoughts of suicide or self-harm, worsening mood, feelings of depression
- Prolonged or painful erection
- Raynaud syndrome—cool, numb, or painful fingers or toes that may change color from pale, to blue, to red
- Seizures
- Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Dry mouth
- Headache
- Irritation at application site
- Loss of appetite with weight loss
- Nausea
- Stomach pain
- Trouble sleeping
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Pros and cons of Xelstrym (dextroamphetamine)
Pros
- Can use in adults and children 6 years and older
- Used once per day because it lasts a long time
- An option to switch from taking stimulants by mouth to Xelstrym (dextroamphetamine) patch – but with some dose adjustments
- Can bathe, shower, or swim with the patch on
Cons
- Takes 2 hours to start working
- A controlled medication, so there are special requirements for getting the prescription filled
- Not the best choice for pregnant or breastfeeding females or people with heart conditions
- Might worsen tics or Tourette syndrome if you already have these problems
Pharmacist tips for Xelstrym (dextroamphetamine)
- Use Xelstrym (dextroamphetamine) exactly as your provider instructed you to. Don't change your dose or stop using the medication without talking to your provider first. Doing so can lead to withdrawal symptoms, such as large appetite, irritability, trouble sleeping, and depression. If you want to stop Xelstrym (dextroamphetamine), your provider will lower your dose slowly over time before you can completely stop.
- Avoid driving the first few days after you start Xelstrym (dextroamphetamine) and after dose changes until you know how this medication affects you. Some people have reported blurry vision or other changes in vision while using stimulants, which could affect your ability to drive.
- Your skin might get irritated while using Xelstrym (dextroamphetamine) patches. Skin reactions, like pain, itching, burning, redness, discomfort, and swelling, typically go away within 2 to 4 hours after applying the patch. Contact your provider if they don't go away or become severe.
- Avoid direct heat (e.g., hair dryers, heating pads, electric blankets) while wearing the Xelstrym (dextroamphetamine) patch. Heat can cause the patch to release more medication into your body, which can raise the risk of severe side effects like distress, aggressive behavior, and confusion.
How to use Xelstrym (dextroamphetamine)
- Make sure you know how to apply Xelstrym (dextroamphetamine) patches properly and safely. Carefully read the instructions for use, and ask your pharmacist if you have any questions on how to apply the patch.
- Apply a Xelstrym (dextroamphetamine) patch 2 hours before you need it to start working, and leave it on for at most 9 hours. Don't reuse patches or use more than one patch in a 24-hour period.
- Before applying Xelstrym (dextroamphetamine), clean the area of skin with soap and water, and dry well. Make sure the area isn't too hairy and doesn't have any lotion, oils, or gels on it so the patch can stay on better.
- Stick the Xelstrym (dextroamphetamine) patch onto your hip, upper arm, chest, upper back, or the side of your body near your stomach. Use different places each time you use a new patch to prevent skin irritation.
- Avoid touching the sticky side of the patch because this is where the medication is. If you accidentally touch it, wash your hands with soap and water right away.
- If the edges of the patch lift up while you're wearing it, press them down firmly to stick it back on your skin. Don't use tape, dressings, or other adhesives to keep the edges down. If the patch comes off completely, throw it away, and apply a brand new patch. Make sure the total amount of time you have a patch on (the one that fell off and the new one) is no more than 9 hours.
- After removing Xelstrym (dextroamphetamine), throw the patch away by folding it in half with the sticky sides together and putting it in a lidded trash can to prevent exposing pets or children to this medication. Don't flush Xelstrym (dextroamphetamine) down the toilet. Remember to wash your hands with soap and water afterwards.
Common questions about Xelstrym (dextroamphetamine)
While it's FDA approved, the manufacturer announced that Xelstrym (dextroamphetamine) will be available by prescription sometime in 2023. Discuss with your healthcare provider about whether Xelstrym (dextroamphetamine) is right for you and ask your pharmacy if they have it in stock at that time.
Avoid alcohol while using Xelstrym (dextroamphetamine). Alcohol can make your ADHD symptoms worse. Drinking alcohol with Xelstrym (dextroamphetamine) can also cause dangerous side effects, including alcohol poisoning and heart problems.
Xelstrym (dextroamphetamine) and Daytrana (methylphenidate) are stimulant medications for ADHD that are available as patches placed on the skin. When comparing these two medications, both are approved for children who are at least 6 years old, but Xelstrym (dextroamphetamine) is approved for use in adults as well. Another major difference is that Xelstrym (dextroamphetamine) can be applied onto more places on the body than Daytrana (methylphenidate). You can put Xelstrym (dextroamphetamine) on the hip, upper arm, chest, upper back, or the side of your body near your stomach; but you can only put Daytrana (methylphenidate) onto your hips. Discuss with your provider which patch is best for you.
There isn't consistently strong evidence to know for sure if stimulants like Xelstrym (dextroamphetamine) are safe to use during pregnancy. Studies suggest that people who took a stimulant during pregnancy might be at higher risk of developing high blood pressure during pregnancy (preeclampsia) or having an early (preterm) delivery. In addition, newborn babies born to females who take stimulants during pregnancy might have a low birth weight or develop withdrawal symptoms (e.g., drowsiness, poor feeding, irritability). If you're pregnant or thinking of getting pregnant, talk to your provider about the risks and benefits of Xelstrym (dextroamphetamine) to you and your unborn baby. If you're currently pregnant and taking this medication, it's encouraged that you enroll in the National Pregnancy Registry for ADHD Medications, which monitors your and your baby's health. Enroll in this registry by calling 1-866-961-2388 or by visiting their website.
Avoid breastfeeding while using Xelstrym (dextroamphetamine). Stimulants can get into breast milk, which raises the risk of serious side effects in your baby (e.g., high blood pressure, heart rate changes, growth problems). Talk to your provider about other ways to feed your baby while taking Xelstrym (dextroamphetamine).
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Xelstrym (dextroamphetamine) dosage
Carton| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 30 patches of 4.5mg/9 hours | 1 carton | $492.92 | $492.92 |
| 30 patches of 9mg/9 hours | 1 carton | $496.65 | $496.65 |
| 30 patches of 13.5mg/9 hours | 1 carton | $494.79 | $494.79 |
| 30 patches of 18mg/9 hours | 1 carton | $492.87 | $492.87 |
Typical dosage for Xelstrym (dextroamphetamine)
In general, apply 1 patch onto the skin once per day, 2 hours before you need it to start working. Keep the patch on for up to 9 hours, and then remove.
There are four patch strengths: 4.5 mg, 9 mg, 13.5 mg, and 18 mg.
- Adults aged 18 years and older: The typical starting dose is 9 mg once per day.
- Children 6 to 17 years old: The typical starting dose is 4.5 mg once per day.
Your provider will adjust your dose based on how well it's helping your ADHD symptoms and if you're having side effects. The typical maximum dose is 18 mg once per day, but it can differ if you have severe kidney problems.
How much does Xelstrym (dextroamphetamine) cost?
$492.87
Xelstrym (dextroamphetamine) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Xelstrym (dextroamphetamine) will not be safe for you to take.
- Severe allergy to amphetamine-containing products
- Currently take or have taken an MAOI, linezolid (Zyvox), or methylene blue (ProvayBlue) in the last 14 days
What are alternatives to Xelstrym (dextroamphetamine)?
