Xelstrym

Xelstrym (dextroamphetamine transdermal system): Overview

​Xelstrym is a transdermal patch containing dextroamphetamine, approved by the FDA in 2022 for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in individuals aged 6 years and older. It offers a non-oral, long-acting delivery system for stimulant treatment, making it a unique option for patients who may have difficulty swallowing pills or who prefer an alternative dosing method
Mechanism of Action
Dextroamphetamine is a central nervous system (CNS) stimulant. It works by increasing the levels of dopamine and norepinephrine in the brain through the following mechanisms:
  1. Blocking Reuptake: Prevents the reabsorption of dopamine and norepinephrine into presynaptic neurons, enhancing their availability in the synaptic cleft.
  2. Stimulating Release: Promotes the release of these neurotransmitters from presynaptic neurons.
  3. Inhibition of Monoamine Oxidase (MAO): Reduces the breakdown of dopamine and norepinephrine.
This leads to improved attention, focus, and impulse control.

​Clinical Benefits
  1. Effective ADHD Symptom Management:
    • Reduces hyperactivity, impulsivity, and inattention.
  2. Non-Oral Administration:
    • Ideal for patients with swallowing difficulties or who prefer non-oral treatment options.
    • Provides a controlled, consistent delivery of medication throughout the day.
  3. Long-Lasting Effects:
    • Offers therapeutic effects for up to 9 hours.
  4. Flexibility:
    • Can be removed earlier if shorter duration of effect is desired.
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Dosage
Xelstrym is available in several strengths, corresponding to different patch sizes, delivering 4.5 mg, 9 mg, 13.5 mg, or 18 mg of dextroamphetamine per 9-hour wear period.
  1. Starting Dose:
    • Begin with the 4.5 mg/9 hours patch, applied once daily in the morning.
  2. Titration:
    • Adjust dose weekly based on clinical response and tolerability.
    • Maximum dose: 18 mg/9 hours patch per day.
  3. Administration Notes:
    • Apply to clean, dry, intact skin on the hip, upper arm, or upper back.
    • Rotate application sites daily.
    • Do not wear the patch for more than 9 hours.

Prevalence of Side EffectsXelstrym shares a side effect profile with other stimulant medications but may have unique considerations due to its transdermal delivery system.
  1. Common Side Effects (5-20%):
    • Decreased appetite.
    • Insomnia.
    • Irritability or mood swings.
    • Headache.
    • Nausea.
  2. Application Site Reactions (up to 10%):
    • Skin irritation, redness, or rash at the patch site.
    • Rotate application sites to minimize irritation.
  3. Less Common Side Effects (1-5%):
    • Increased heart rate or blood pressure.
    • Dry mouth.
    • Dizziness.
  4. Rare but Serious Side Effects (<1%):
    • Psychiatric symptoms: Agitation, hallucinations, or mania.
    • Cardiovascular events: Risk of stroke, heart attack, or sudden death in patients with structural cardiac abnormalities.
  5. Abuse Potential:
    • As a Schedule II controlled substance, Xelstrym carries a risk of abuse and dependence.

EfficacyClinical studies have shown that Xelstrym:
  • Significantly reduces ADHD symptoms compared to placebo.
  • Provides sustained symptom control throughout the day, with a convenient once-daily application.

Summary
​Xelstrym offers a novel, transdermal approach to ADHD treatment with consistent and long-lasting efficacy. Its non-oral delivery system and adjustable wear time make it an excellent option for patients seeking flexibility and convenience. Monitoring for side effects, especially skin reactions and potential abuse, is essential.