Adderall: 7 things you should know

Medically reviewed by Carmen Pope, BPharm. Last updated on April 4, 2023.

1. How it works

• Adderall is a combination of four different amphetamine salts: dextroamphetamine saccharate, dextroamphetamine sulfate, amphetamine aspartate, and amphetamine sulfate.
• Experts aren't sure exactly how Adderall 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 belongs to the group of medicines known as central nervous system (CNS) stimulants.

2. Upsides

• Used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) to increase attention and decrease hyperactivity and impulsiveness.
• May be given to increase alertness in people with the sleep disorder, narcolepsy.
• When given for ADHD, Adderall should be used in conjunction with other treatment options, such as psychotherapy, education about the disorder, and social integration advice.
• FDA approved for children over the age of three.
• Adderall is available as a generic under the name mixed amphetamine salts (which may be abbreviated to MAS or M. amphet salts).

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.
• 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 exacerbate pre-existing 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 are known.
• Reports indicate some temporary slowing of growth may occur when regular Adderall is given to children aged 7 through 10 years. Doctors should monitor height and weight and consider treatment interruption if growth suppression is suspected.
• May increase the risk of seizures and peripheral circulatory problems and cause visual problems.
• May not be suitable for people with certain heart conditions, as the risk of sudden death is increased even with 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, liver or kidney disease, or circulation problems.
• May interact with a number of other drugs including other antidepressants, medications used to treat heart disease, blood thinners, decongestants, tramadol, and proton pump inhibitors.
• 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 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 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 is a combination of four different amphetamine salts and may be used to improve attention, focus, or reduce impulsive behaviors in children over the age of 3 and adults with ADHD. It can also be used to treat narcolepsy. Adderall is potentially addictive and can cause insomnia.

5. Tips

• Take in the morning if using once daily. If using twice daily, avoid late evening dosages to reduce the risk of insomnia.
• May be taken with or without food.
• Take exactly as directed by your doctor and never increase the dosage without his or her 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 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.
• 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

• Parent training in behavior management and/or behavioral classroom interventions should be used before medicines to treat ADHD.
• Effective at improving symptoms such as attention and focus and reducing impulsive behaviors.
• Small trials have reported similar effectiveness to Vyvanse. One study reported that both seemed equally effective at improving attention-span, rule-following, and interactions with peers and adults for classroom-based behavior in a group of children with ADHD. Similar results were reported in a trial of 18 adults with ADHD. It took about two hours for Adderall to start working and three hours for Vyvanse, and the effects of each drug lasted for approximately 16 hours. Side effects such as decreased appetite, insomnia, and abdominal symptoms are common to most ADHD treatments.
• Peak concentrations are reached within three hours following a single dose.
• Not all the hepatic enzymes involved in the metabolism of Adderall 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. Many other drugs rely on CYP2D6 for metabolism and may interact with Adderall.

7. Interactions

Medicines that interact with Adderall may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Adderall. 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 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.

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

References

• Adderall (dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate) [Package Insert]. Revised 02/2022. Teva Pharmaceuticals USA, Inc. https://www.drugs.com/pro/adderall.html
• Biederman J, Boellner SW, Childress A, Lopez FA, Krishnan S, Zhang Y. Lisdexamfetamine dimesylate and mixed amphetamine salts extended-release in children with ADHD: a double-blind, placebo-controlled, crossover analog classroom study. Biol Psychiatry. 2007 Nov 1;62(9):970-6. doi: 10.1016/j.biopsych.2007.04.015. Epub 2007 Jul 12. PMID: 17631866.
• Briars L, Todd T. A Review of Pharmacological Management of Attention-Deficit/Hyperactivity Disorder. J Pediatr Pharmacol Ther. 2016;21(3):192-206. doi:10.5863/1551-6776-21.3.192

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Adderall 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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