# Adderall pathway

Source: Orca session `omp_c2f935d5_1054_44fe_92ad_6e1e97e62cb0`, native session `01a155d1-0ef1-7259-b21a-7a511363dacc`, October 19, 2026.

This is the original session write-up, preserved verbatim below. Desktop paths and verification claims refer to that original session, not this import. Full physician-level reference notes are preserved in [notes.html](../renders/anatomy-adderall/notes.html) and embedded below the figure in both rendered HTML pages.

Educational material only; not a clinical protocol. The original write-up distinguishes values attributed to the FDA label from unsourced teaching assumptions, including effect curves, tolerance, dopamine fold-change, and CYP2D6 inhibition. These medical and source claims have not been independently verified during import. Clinical review is required before teaching or patient-care use.

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I built an interactive figure of the Adderall pathway, from capsule to blood, brain, synapse and urine. It's in `~/Desktop/02_projects/anatomy-adderall/`: open `adderall.html` (dark) or `adderall-light.html`. Both pages build without errors and show no console errors in the browser, and the skill's line check passed on both.

**What the figure shows**, as one bench machine read left to right:
- **Gut:** two bead canisters. The right one has a 4 h timer for the delayed-release beads in XR, or for the second tablet in the twice-daily IR option.
- **Plasma:** a measuring column showing d-amphetamine under l-amphetamine, in ng/mL.
- **Blood-brain barrier:** a slotted plate the drug duct passes through.
- **Dopamine nerve ending:** four storage canisters (vesicles) on VMAT2 collars, a pool of free dopamine, and a TAAR1 lever. The highlighted rotor is the dopamine transporter: it runs forward for normal reuptake and backward when amphetamine makes it pump dopamine out.
- **Synapse and effects:** a tank whose level is synaptic dopamine relative to baseline, plus dials for prefrontal tone and heart rate.
- **Elimination:** a liver cartridge (CYP2D6) and a kidney block with a urine pH knob, each filling a beaker with the share of the dose cleared.

**How to use it:** hovering scrubs from 0 to 24 h after the dose. Buttons under the figure switch between XR 20 mg, IR 20 mg and IR 10 mg twice; urine pH 5.5, 6.5 or 8.0; and normal or strongly inhibited CYP2D6.

**Below the figure** are physician-level notes:
- mechanism by target (DAT/NET, VMAT2, TAAR1, SERT, MAO) and circuit effects (prefrontal D1/α2A, nucleus accumbens, periphery)
- labeled dosing
- the boxed warning, contraindications and safety monitoring
- drug interactions
- overdose management
- drug-test interpretation

**How accurate the numbers are:**
- **From the FDA label:** the drug levels. For XR 20 mg the model gives d-amphetamine 27 ng/mL at 7.1 h (label: 28.1, ~7 h), half-lives of 10 h for d and 13 h for l, and 35% excreted unchanged at usual urine pH (label: 30–40%).
- **My teaching assumptions, not from a source:** the effect curves, the tolerance rate, the dopamine fold-change scale and the 30% clearance drop with a CYP2D6 inhibitor.
- **Tolerance:** I added acute tolerance after the first version kept the effect high at 24 h. Effects now fade by about 10–12 h on XR while plasma levels are still a third of the peak.

The figure sizes the build as a "Hero" (about 120 parts). It hasn't been through the deeper geometry audit, because it has no pipes or turned parts. The files are `build.mjs` (rebuild with `node build.mjs` and `node build.mjs --light`), `model.mjs`, `notes.html`, the two HTML pages, and `preview-dark.png` / `preview-light.png`.