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Comment by loeg | Hacker News Reader

Adderall is a mix of four amphetamine salts, of which dex is one. My impression is people went to dex because it was available as a cheap generic before Adderall's patent expired. But you can get generic Adderall now because the patent expired (cue: Vyvanse), so there isn't much of a cost reason to go on dex.

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I was getting increasingly confused so I just looked up the history.

Adderall was invented to renew the approval of a weight loss drug which contained two salts each of methamphetamine and amphetamine. They replaced the methsalts with 2 more amphetamine salts, for some reason. That's why the 4 salts. Adderall was introduced in 1997, which suprised me. I always assumed adderall was first because surely it would be easier to synthesize than enantiomerically pure d-amph.

But apparently Dexedrine has been around as a treatment for narcolepsy and attention problems since 1937.

So it's not so much that the world moved on to dex, more that the US moved on to adderall for historical reasons having to do with pharmaceutical patents, approval and marketing. And the rest of the world were just fine staying with dex, which makes perfect sense to me.

> I always assumed adderall was first because surely it would be easier to synthesize than enantiomerically pure d-amph.

I am not a chemist/pharmacist, but I am under the impression that amphetamine synthesis is neither complicated nor recent. I am under this impression because a) References to different amphetamines are common place as early as the 40s and b) The United States has a rich criminal history of amateur methamphetamine production.

Amphetamines were extremely common during and after WW2, for example.

They were often included in WW2 military rations. The name of the German variant was Pervertin. Based on the side effects encountered when using it.

Pervitin was a German methamphetamine brand. Do you have evidence it was named for side effects?

Random Trivia: the 80s band ”Dexys Midnight Runners" were named for the recreational use of Dexedrine which was apparently common in the UKs Northern Soul community.

My impression was that dextroamphetamine also worked better in many patients than drugs that combine it with levoamphetamine such as Adderall. Even when Vyvanse was under patent and expensive, it was preferred by many for this reason (Vyvanse is converted into dextroamphetamine in the body). Levoamphetamine primarily acts on the norepinephrine system, while Dextroamphetamine acts primarily on dopamine, being 3-4 times as strong as Levoamphetamine in that sense (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670101/). As a result, many patients find levoamphetamine to cause much more physical side effects like racing heart, jitteriness, etc. and be less effective at promoting mental focus than Dextroamphetamine.

Adderall is still 75% Dextroamphetamine, but I haven't seen much literature on why it would be preferred over drugs like Vyvanse that include no Levoamphetamine.

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