Pharmacodynamics
- For a simpler and less technical explanation of amphetamine's mechanism of action, see Adderall §Mechanism of action.
Amphetamine exerts its behavioral effects by altering the use of monoamines as neuronal signals in the brain, primarily in catecholamine neurons in the reward and executive function pathways of the brain. The concentrations of the main neurotransmitters involved in reward circuitry and executive functioning, dopamine and norepinephrine, increase dramatically in a dose-dependent manner by amphetamine because of its effects on monoamine transporters. The reinforcing and motivational salience-promoting effects of amphetamine are due mostly to enhanced dopaminergic activity in the mesolimbic pathway. The euphoric and locomotor-stimulating effects of amphetamine are dependent upon the magnitude and speed by which it increases synaptic dopamine and norepinephrine concentrations in the striatum.
Amphetamine potentiates monoaminergic neurotransmission primarily by entering axon terminals either through active transport by monoamine transporters (DAT, NET, and SERT) or by passive diffusion across neuronal membranes. The uptake of amphetamine through these transporters produces competitive reuptake inhibition, since amphetamine competes with endogenous monoamines for transporter-mediated clearance from the synaptic cleft. Once inside the neuronal cytosol, amphetamine can interact with its receptor protein targets to initiate signaling cascades that activate intracellular effectors which regulate monoamine transporter function and surface expression at the plasma membrane. The effect of amphetamine on monoamine transporters appears to involve phosphorylation, in which activated protein kinases attach a phosphate group to a specific amino acid residue on the transporter protein. Depending on the protein kinase involved and the residue(s) phosphorylated, phosphorylation can shift transporter function into an efflux-permissive state that causes the reverse transport of cytosolic monoamines into the synaptic cleft, or it can promote transporter internalization, whereby phosphorylated transporters are withdrawn from the plasma membrane and lower total reuptake capacity (i.e., non-competitive reuptake inhibition). As of January 2026, protein kinase A (PKA), protein kinase C (PKC), Ca2+/calmodulin-dependent protein kinase II (CaMKII), and Ras homolog family member A (RhoA) have all been demonstrated experimentally to regulate monoamine transporter function activity following amphetamine exposure.
Amphetamine has been identified as a full agonist of trace amine-associated receptor 1 (TAAR1), a Gs-coupled and G13-coupled G protein-coupled receptor (GPCR) discovered in 2001, which is important for regulation of brain monoamines. Several reviews have linked amphetamine's agonism at TAAR1 to modulation of monoamine transporter function and subsequent neurotransmitter efflux and reuptake inhibition at monoaminergic synapses. Upon activation by amphetamine, TAAR1 can couple to the Gs alpha subunit and increase intracellular cAMPTooltip cyclic adenosine monophosphate production via adenylyl cyclase activation, which triggers PKA- and PKC-mediated transporter phosphorylation. When TAAR1 couples to the G13 alpha subunit, RhoA activity increases near the endoplasmic reticulum and leads to the downstream internalization of monoamine transporters; TAAR1-dependent RhoA signaling has also been shown to internalize EAAT3Tooltip excitatory amino acid transporter 3, a neuronal glutamate transporter expressed in some monoaminergic neurons. Monoamine autoreceptors (e.g., D2 short, presynaptic α2, and presynaptic 5-HT1A) have the opposite effect of TAAR1, and together these receptors provide a regulatory system for monoamines. Notably, amphetamine and trace amines possess high binding affinities for TAAR1, but not for monoamine autoreceptors. Although TAAR1 is implicated in amphetamine-induced transporter phosphorylation, the magnitude of TAAR1-mediated monoamine release in humans remains unclear. Beyond its Gs- and G13-coupled receptor-mediated effects on monoamine transporter function, TAAR1 also opens G protein-coupled inwardly rectifying potassium channels through a separate pathway, an action that reduces neuronal firing.
Amphetamine is also a substrate for the vesicular monoamine transporters VMAT1 and VMAT2. Under normal conditions, VMAT2 transports cytosolic monoamines into synaptic vesicles for storage and later exocytotic release. When amphetamine accumulates in the presynaptic terminal, it collapses the vesicular pH gradient and releases vesicular monoamines into the neuronal cytosol. These displaced monoamines expand the cytosolic pool available for reverse transport, thereby increasing the capacity for monoamine efflux beyond that achieved by amphetamine-mediated transporter phosphorylation alone. Although VMAT2 is recognized as a major target in amphetamine-induced monoamine release at higher doses, some reviews have challenged its relevance at therapeutic doses.
In addition to membrane and vesicular monoamine transporters, amphetamine also inhibits SLC1A1, SLC22A3, and SLC22A5. SLC1A1 is excitatory amino acid transporter 3 (EAAT3), a glutamate transporter located in neurons, SLC22A3 is an extraneuronal monoamine transporter that is present in astrocytes, and SLC22A5 is a high-affinity carnitine transporter. Amphetamine is known to strongly induce cocaine- and amphetamine-regulated transcript (CART) gene expression, a neuropeptide involved in feeding behavior, stress, and reward, which induces observable increases in neuronal development and survival in vitro. The CART receptor has yet to be identified, but there is significant evidence that CART binds to a unique Gi/Go-coupled GPCR. Amphetamine also inhibits monoamine oxidases at very high doses, resulting in less monoamine and trace amine metabolism and consequently higher concentrations of synaptic monoamines. In humans, the only post-synaptic receptor at which amphetamine is known to bind is the 5-HT1A receptor, where it acts as an agonist with low micromolar affinity.
The full profile of amphetamine's short-term drug effects in humans is mostly derived through increased cellular communication or neurotransmission of dopamine, serotonin, norepinephrine, epinephrine, histamine, CART peptides, endogenous opioids, adrenocorticotropic hormone, corticosteroids, and glutamate, which it affects through interactions with CART, 5-HT1A, EAAT3, TAAR1, VMAT1, VMAT2, and possibly other biological targets. Amphetamine also activates seven human carbonic anhydrase enzymes, several of which are expressed in the human brain.
Dextroamphetamine displays higher binding affinity for DAT than levoamphetamine, whereas both enantiomers share comparable affinity at NET; Consequently, dextroamphetamine produces greater CNS stimulation than levoamphetamine, roughly three to four times more, but levoamphetamine has slightly stronger cardiovascular and peripheral effects. Dextroamphetamine is also a more potent agonist of TAAR1 than levoamphetamine.
Dopamine
In certain brain regions, amphetamine increases the concentration of dopamine in the synaptic cleft by modulating DAT through several overlapping processes. Amphetamine can enter the presynaptic neuron either through DAT or, to a lesser extent, by diffusing across the neuronal membrane directly. As a consequence of DAT uptake, amphetamine produces competitive reuptake inhibition at the transporter. Upon entering the presynaptic neuron, amphetamine provokes the release of Ca from endoplasmic reticulum stores, an effect that raises intracellular calcium to levels sufficient for downstream kinase-dependent signalling. In parallel, amphetamine also increases intracellular cAMPTooltip cyclic adenosine monophosphate, which activates protein kinase A (PKA) and protein kinase C (PKC), whilst elevated intracellular Ca activates PKC alone. Phosphorylation of DAT by either kinase induces transporter internalization (non-competitive reuptake inhibition), but PKC-mediated phosphorylation alone induces the reversal of dopamine transport through DAT (i.e., dopamine efflux).
TAAR1 has been identified as a biomolecular target of amphetamine that initiates some of amphetamine's kinase-dependent signaling cascades. When TAAR1 signals via Gs-coupled receptors, intracellular cAMP increases through adenylyl cyclase activation and activates PKA and PKC, in turn phosphorylating DAT. TAAR1 also couples G-protein alpha subunit G13; when triggered by amphetamine, this pathway activates Ras homolog A (RhoA) and its downstream protein kinase, Rho-associated coiled-coil kinase (ROCK), an effect that internalizes both DAT and the neuronal glutamate transporter EAAT3. Transporter internalization via TAAR1's G13-coupled pathway is transient because Gs-cAMP-PKA signaling functionally inhibits RhoA's downstream activity; once intracellular cAMP sufficiently accumulates, PKA is activated and phosphorylates RhoA, thereby terminating ROCK-mediated transporter internalization. In addition to presynaptic actions that regulate DAT, TAAR1 activation exerts a somatodendritic inhibitory influence on midbrain dopamine neurons by reducing their firing rate via G protein-coupled inwardly-rectifying potassium channels, an effect that is expected to reduce action potential-dependent (vesicular) dopamine release into the synaptic cleft.
Amphetamine's effect on intracellular calcium is associated with DAT phosphorylation through Ca/calmodulin-dependent protein kinase II alpha (CAMKIIα), in turn producing dopamine efflux. Because conventional PKC isoforms can be activated by Ca and diacylglycerol, elevated intracellular calcium can promote PKC-dependent DAT phosphorylation independent of TAAR1.
Amphetamine is also a substrate for the presynaptic vesicular monoamine transporter, VMAT2. Following amphetamine uptake at VMAT2, amphetamine induces the collapse of the vesicular pH gradient, which results in a dose-dependent release of dopamine molecules from synaptic vesicles into the cytosol via dopamine efflux through VMAT2. Subsequently, the cytosolic dopamine molecules are released from the presynaptic neuron into the synaptic cleft via reverse transport at DAT.
Norepinephrine
Similar to dopamine, amphetamine dose-dependently increases the level of synaptic norepinephrine, the direct precursor of epinephrine. Amphetamine is believed to affect norepinephrine analogously to dopamine. In other words, amphetamine induces competitive NET reuptake inhibition, TAAR1-mediated non-competitive reuptake inhibition and reverse transport at phosphorylated NET, CAMKIIα-mediated NET efflux independent of TAAR1, and norepinephrine release from VMAT2. In locus coeruleus norepinephrine neurons, TAAR1-dependent RhoA signaling promotes EAAT3 internalization and subsequent glutamate reuptake inhibition.
Serotonin
Amphetamine exerts analogous, yet less pronounced, effects on serotonin as on dopamine and norepinephrine. Amphetamine affects serotonin via VMAT2 inhibition and SERT phosphorylation. Like dopamine, amphetamine has low, micromolar affinity at the human 5-HT1A receptor.
Other neurotransmitters, peptides, hormones, and enzymes
Acute amphetamine administration in humans increases endogenous opioid release in several brain structures in the reward system. Extracellular levels of glutamate, the primary excitatory neurotransmitter in the brain, have been shown to increase in the striatum following exposure to amphetamine. This increase in extracellular glutamate presumably occurs via the amphetamine-induced internalization of EAAT3, a glutamate reuptake transporter in some dopamine and norepinephrine neurons. This internalization is mediated by RhoA activation and its downstream effector ROCK, a process that is TAAR1-dependent. Amphetamine also induces the selective release of histamine from mast cells and efflux from histaminergic neurons through VMAT2. Acute amphetamine administration can also increase adrenocorticotropic hormone and corticosteroid levels in blood plasma by stimulating the hypothalamic–pituitary–adrenal axis.
In December 2017, the first study assessing the interaction between amphetamine and human carbonic anhydrase enzymes was published; of the eleven carbonic anhydrase enzymes it examined, it found that amphetamine potently activates seven, four of which are highly expressed in the human brain, with low nanomolar through low micromolar activating effects. Based upon preclinical research, cerebral carbonic anhydrase activation has cognition-enhancing effects; but, based upon the clinical use of carbonic anhydrase inhibitors, carbonic anhydrase activation in other tissues may be associated with adverse effects, such as ocular activation exacerbating glaucoma.
Sex-dependent differences
Clinical research indicates that the pharmacological effects of amphetamine may vary depending on sex and menstrual cycle phase, possibly due to fluctuations in female sex hormones. In menstruating individuals, subjective and behavioral responses to amphetamine are heightened during the follicular phase (i.e., when estrogen levels are higher), and reduced during the luteal phase (i.e., when progesterone is elevated). Reviews of human studies have also noted that men typically report stronger positive subjective responses to amphetamine compared to women tested during the luteal phase, whereas these sex differences are absent when women are tested during the follicular phase; subjective responses to amphetamine appear to correlate positively with plasma or salivary estrogen concentrations. Moreover, neuroimaging studies have reported significant sex differences in the neural response to amphetamine in humans, including differences in dopamine release within the striatum and other brain regions.
Preclinical studies have also produced findings of sex-dependent differences in drug response to amphetamine. In contrast to human studies, adult female rats exhibit markedly greater dopamine release in the nucleus accumbens and more pronounced behavioral effects from amphetamine administration relative to males, effects that may be modulated by fluctuating estradiol levels across the estrous cycle or more broadly by adult gonadal hormones.
Some evidence suggests that amphetamine interacts more strongly with female sex hormones than other psychostimulants such as methylphenidate, which may result in relatively greater variability in drug response across the menstrual cycle. Although preliminary observational evidence suggests potential benefit from adjusting amphetamine doses according to menstrual cycle phases, randomized controlled trials have not evaluated this practice.
Pharmacokinetics
The oral bioavailability of amphetamine varies with gastrointestinal pH; it is well absorbed from the gut, and bioavailability is typically 90%. Amphetamine is a weak base with a pKa of 9.9; consequently, when the pH is basic, more of the drug is in its lipid soluble free base form, and more is absorbed through the lipid-rich cell membranes of the gut epithelium. Conversely, an acidic pH means the drug is predominantly in a water-soluble cationic (salt) form, and less is absorbed. Approximately 20% of amphetamine circulating in the bloodstream is bound to plasma proteins. Following absorption, amphetamine readily distributes into most tissues in the body, with high concentrations occurring in cerebrospinal fluid and brain tissue.
The half-lives of amphetamine enantiomers differ and vary with urine pH. At normal urine pH, the half-lives of dextroamphetamine and levoamphetamine are 9–11hours and 11–14hours, respectively. Highly acidic urine will reduce the enantiomer half-lives to 7hours; highly alkaline urine will increase the half-lives up to 34hours. The immediate-release and extended release variants of salts of both isomers reach peak plasma concentrations at 3hours and 7hours post-dose respectively. Amphetamine is eliminated via the kidneys, with 30–40% of the drug being excreted unchanged at normal urinary pH. When the urinary pH is basic, amphetamine is in its free base form, so less is excreted. When urine pH is abnormal, the urinary recovery of amphetamine may range from a low of 1% to a high of 75%, depending mostly upon whether urine is too basic or acidic, respectively. Following oral administration, amphetamine appears in urine within 3hours. Roughly 90% of ingested amphetamine is eliminated 3days after the last oral dose.
Lisdexamfetamine is a prodrug of dextroamphetamine. It is not as sensitive to pH as amphetamine when being absorbed in the gastrointestinal tract. Following absorption into the blood stream, lisdexamfetamine is completely converted by red blood cells to dextroamphetamine and the amino acid L-lysine by hydrolysis via undetermined aminopeptidase enzymes. This is the rate-limiting step in the bioactivation of lisdexamfetamine. The elimination half-life of lisdexamfetamine is generally less than 1hour. Due to the necessary conversion of lisdexamfetamine into dextroamphetamine, levels of dextroamphetamine with lisdexamfetamine peak about one hour later than with an equivalent dose of immediate-release dextroamphetamine. Presumably due to its rate-limited activation by red blood cells, intravenous administration of lisdexamfetamine shows greatly delayed time to peak and reduced peak levels compared to intravenous administration of an equivalent dose of dextroamphetamine. The pharmacokinetics of lisdexamfetamine are similar regardless of whether it is administered orally, intranasally, or intravenously. Hence, in contrast to dextroamphetamine, parenteral use does not enhance the subjective effects of lisdexamfetamine. Because of its behavior as a prodrug and its pharmacokinetic differences, lisdexamfetamine has a longer duration of therapeutic effect than immediate-release dextroamphetamine and shows reduced misuse potential.
CYP2D6, dopamine β-hydroxylase (DBH), flavin-containing monooxygenase 3 (FMO3), butyrate-CoA ligase (XM-ligase), and glycine N-acyltransferase (GLYAT) are the enzymes known to metabolize amphetamine or its metabolites in humans. Amphetamine has a variety of excreted metabolic products, including 4-hydroxyamphetamine, 4-hydroxynorephedrine, 4-hydroxyphenylacetone, N-hydroxyamphetamine, benzoic acid, hippuric acid, norephedrine, and phenylacetone. Among these metabolites, the active sympathomimetics are 4-hydroxyamphetamine, 4-hydroxynorephedrine, norephedrine, and N-hydroxyamphetamine. The main metabolic pathways involve aromatic para-hydroxylation, aliphatic alpha- and beta-hydroxylation, N-oxidation, N-dealkylation, and deamination. The known metabolic pathways, detectable metabolites, and metabolizing enzymes in humans include the following:
Pharmacomicrobiomics
The human metagenome (i.e., the genetic composition of an individual and all microorganisms that reside on or within the individual's body) varies considerably between individuals. Since the total number of microbial and viral cells in the human body (over 100trillion) greatly outnumbers human cells (tens of trillions), there is considerable potential for interactions between drugs and an individual's microbiome, including: drugs altering the composition of the human microbiome, drug metabolism by microbial enzymes modifying the drug's pharmacokinetic profile, and microbial drug metabolism affecting a drug's clinical efficacy and toxicity profile. The field that studies these interactions is known as pharmacomicrobiomics.
Similar to most biomolecules and other orally administered xenobiotics (i.e., drugs), amphetamine is predicted to undergo promiscuous metabolism by human gastrointestinal microbiota (primarily bacteria) prior to absorption into the blood stream. The first amphetamine-metabolizing microbial enzyme, tyramine oxidase from a strain of E. coli commonly found in the human gut, was identified in 2019. This enzyme was found to metabolize amphetamine, tyramine, and phenethylamine with roughly the same binding affinity for all three compounds.
Related endogenous compounds
- Further informationon related compounds: Trace amine
Amphetamine has a very similar structure and function to the endogenous trace amines, which are naturally occurring neuromodulator molecules produced in the human body and brain. Among this group, the most closely related compounds are phenethylamine, the parent compound of amphetamine, and N-methylphenethylamine, a structural isomer of amphetamine (i.e., it has an identical molecular formula). In humans, phenethylamine is produced directly from L-phenylalanine by the aromatic amino acid decarboxylase (AADC) enzyme, which converts L-DOPA into dopamine as well. In turn, N-methylphenethylamine is metabolized from phenethylamine by phenylethanolamine N-methyltransferase, the same enzyme that metabolizes norepinephrine into epinephrine. Like amphetamine, both phenethylamine and N-methylphenethylamine regulate monoamine neurotransmission via TAAR1; unlike amphetamine, both of these substances are broken down by monoamine oxidase B, and therefore have a shorter half-life than amphetamine.
Amphetamine can be administered via intravenous, oral, insufflated. The route of administration can influence both the onset and intensity of serotonin syndrome.
