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AdderallXR: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on Feb 5, 2021.

1. How it works

  • Adderall XR is a long-acting, amphetamine-type product that consists of four different amphetamine salts (dextroamphetamine saccharate, dextroamphetamine sulfate, amphetamine aspartate and amphetamine sulfate).
  • Experts aren't sure exactly how Adderall XR works in Attention Deficit Hyperactivity Disorder (ADHD) but suggest it blocks the reuptake of the neurotransmitters, dopamine, and norepinephrine, which increases their concentration in the neuronal synapse (the space between two nerves).
  • Adderall XR belongs to the group of medicines known as central nervous system (CNS) stimulants.

2. Upsides

  • May be used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) to increase attention and decrease hyperactivity and impulsiveness.
  • Adderall XR only needs to be given once a day. People taking a twice-daily dosage of immediate-release Adderall (immediate-release) may be switched to Adderall XR at the same total daily dose taken once daily.
  • Should be used in conjunction with other treatment options (such as psychotherapy, education about the disorder, social integration advice).
  • FDA approved for children over the age of six.
  • May be taken with or without food.
  • Taken as a once daily dose in the morning upon awakening. The usual starting dosage in children over the age of six is 10mg once daily and in adults 20mg once daily.
  • Available in six different strengths: 5mg, 10mg, 15mg, 20mg, 25mg, and 30mg.
  • Adderall XR is available as a generic under the name amphetamine salt combo XR.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Insomnia (inability to sleep), headache, dry mouth, loss of appetite, nervousness, and nausea are the most common side effects.
  • May also cause heart palpitations, constipation and other GI disturbances, weight loss, changes in libido, alopecia (hair loss), elevated blood pressure and muscle twitching, stiffness, or tightness.
  • Should be taken in the morning. Avoid afternoon doses because of the portential for insomnia.
  • High potential for dependence especially when administered for long periods of time.
  • High potential for abuse. May be sought after by drug abusers or people with addiction disorders. Misuse may cause sudden death or cardiovascular events. Overdosage has resulted in psychosis which is indistinguishable from schizophrenia.
  • May not be suitable for people with certain heart conditions, because it has been associated with a higher risk of sudden death even at usual dosages. May also not be suitable for people with thyroid disease, glaucoma, psychiatric disease, a history of drug abuse or agitation, a tic disorder, seizures, or liver or kidney disease or circulation problems.
  • The initial dosage of Adderall should be decreased in people with severe kidney disease to 5mg in children and 15mg in adults.
  • May exacerbate preexisting psychiatric disorders such as bipolar disorder, psychotic disorder or mania; and increase anxiety, tension, and agitation.
  • May impair judgment or reaction skills; exercise caution before driving or operating machinery until the full effects of Adderall XR are known.
  • Reports indicate some temporary slowing of growth may occur when Adderall XR is given regularly to children aged 7 through 10 years. Doctors should monitor height and weight and consider treatment interruption if growth suppression suspected.
  • May increase the risk of seizures and peripheral circulatory problems and cause visual problems. May not be suitable for people with heart disease, thyroid problems, glaucoma, agitation, or a history of drug abuse.
  • May cause heart palpitations, dry mouth, constipation and other GI disturbances, headache, weight loss, changes in libido, alopecia (hair loss), elevate blood pressure and affect the muscles.
  • May precipitate depression during withdrawal from Adderall XR, particularly in those who have been overusing it.
  • May interact with other medicines, particularly those that also increase serotonin such as tramadol, fentanyl, lithium, and antidepressants.
  • Interaction or overdosage may cause serotonin syndrome (symptoms include mental status changes [such as agitation, hallucinations, coma, delirium]), fast heart rate, dizziness, flushing, muscle tremor or rigidity and stomach symptoms (including nausea, vomiting, and diarrhea).
  • Extreme fatigue and depression have been reported when Adderall XR has been stopped suddenly, particularly in those who have been taking more than the recommended dose.
  • Rare cases of priapism (painful erections more than 6 hours in duration) have been reported.
  • Adderall XR should not be used during pregnancy unless the potential benefit justifies the risk. There are no well controlled studies investigating its use in humans during pregnancy. Case reports document severe congenital bone deformity and other birth defects; animal studies have reported long-term neurochemical and behavioral alterations in pups exposed to amphetamines in utero.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Adderall XR is a long-acting, once-daily formulation that combines four different amphetamine salts into one product and is used for the treatment of ADHD. Adderall XR is potentially addictive and can cause insomnia.

5. Tips

  • Take in the morning. Avoid taking in the afternoon because of the potential for insomnia.
  • May be taken with or without food.
  • Adderall XR capsules may be swallowed whole, or the capsule opened and the contents mixed with applesauce and consumed immediately, without chewing. Do not attempt to divide contents of a capsule or store mixed applesauce/Adderall XR product.
  • Administer at the lowest effective dosage and take exactly as directed by your doctor; never increase the dosage without their advice.
  • Ensure your child partakes in other psychological, educational, or social treatment measures as recommended by your doctor as these are also an important part of ADHD treatment.
  • Do not suddenly stop taking Adderall, unless it is an emergency. Sudden discontinuation may precipitate a withdrawal reaction. Symptoms include extreme tiredness, depression, or agitation.
  • Seek medical advice if symptoms persist or worsen despite treatment, or if psychotic symptoms (such as hearing voices or signs of paranoia) or hallucinations develop.
  • Seek urgent medical help if you experience chest pain, shortness of breath or fainting while taking Adderall XR or other worrying symptoms such as unexplained nausea or vomiting, a fast heartbeat, agitation, hallucinations, coma, delirium, flushing, muscle tremor or rigidity.
  • Do not drive or operate machinery if Adderall impairs your judgment or reaction skills. Alcohol may contribute to these effects and should be avoided.
  • Seek medical advice if any new numbness, pain, skin color change, sensitivity or unexplained wounds occur in your fingers or toes.
  • You should talk with your doctor about continued therapy and occasional interuption of therapy to determine if there is a recurrence of behavioral symptoms.
  • Keep out of reach of children and pets. Keep your medicine in a safe, private storage area, out of view of any person that may illegally misuse it.
  • Do not use if pregnant or breastfeeding unless specifically recommended by your doctor.

6. Response and effectiveness

  • Peak concentrations are reached within seven hours following a single dose of Adderall XR. This is about four hours longer than the time it takes for immediate-release Adderall to reach its peak. One dose of Adderall XR lasts for approximately 24 hours.
  • Not all the hepatic enzymes involved in the metabolism of Adderall XR have been defined; however, CYP2D6 is known to be one of the enzymes responsible, which means that variations may occur in the way different individuals metabolize Adderall XR. Many other drugs rely on CYP2D6 for metabolism and may interact with Adderall.

7. Interactions

Medicines that interact with Adderall XR may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Adderall XR. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Adderall XR include:

  • anticoagulants (blood thinners), such as warfarin, or other drugs that have blood-thinning effects such as aspirin or NSAIDs
  • anticonvulsants, such as phenytoin, phenobarbital, or primidone
  • antidepressants, such as tricyclic antidepressants (eg, amitriptyline), monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine), or SSRIs (eg, fluoxetine, sertraline)
  • antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, olanzapine, quetiapine, ziprasidone)
  • any medication that may cause drowsiness, such as benzodiazepines (eg, diazepam, lorazepam), first-generation antihistamines (such as doxylamine or promethazine), metoclopramide, or opioids (such as codeine, morphine)
  • beta blockers, such as atenolol, labetalol or metoprolol
  • cold, flu, or allergy medications that contain decongestants such as phenylephrine or pseudoephedrine
  • diuretics such as furosemide
  • medications that increase or decrease the pH of the stomach or urinary tracts, such as PPIs (eg, omeprazole, pantoprazole), sodium bicarbonate, acetazolamide, ascorbic acid, or ammonium chloride
  • medications that inhibit CYP2D6 enzymes
  • heart medications such as doxazosin, prazosin, clonidine or methyldopa
  • HIV medications (fosamprenavir, ritonavir)
  • other medications that affect serotonin, such as amphetamines, fentanyl, lithium, tramadol, triptans (eg, almotriptan, eletriptan, or sumatriptan), or St. John's Wort
  • propoxyphene.

Avoid drinking alcohol or taking illegal or recreational drugs while taking Adderall XR.

Note that this list is not all-inclusive and includes only common medications that may interact with Adderall XR. You should refer to the prescribing information for Adderall XR for a complete list of interactions.

More about Adderall XR (amphetamine / dextroamphetamine)

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References

Adderall XR (dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate) [Package Insert]. Revised 12/2020. Takeda Pharmaceuticals America, Inc. https://www.drugs.com/pro/adderall-xr.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use AdderallXR only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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