Adderall (dextroamphetamine-amphetamine) is a stimulant medication that is a mixture of various salts of amphetamine. It can help reduce or improve the symptoms of attention deficit / hyperactivity disorder (ADHD) , including poor attention and / or hyperactivity and impulsivity. This drug is also prescribed for narcolepsy because it can help people with sleep disorders stay alert and alert throughout the day.
The therapeutic effect of Adderall remains unclear, but it is believed to increase the amount of chemicals in the brain that play key roles in attention and thinking, such as dopamine and norepinephrine.
Adderall is also available as a generic tablet, which is usually given twice a day. Adderall XR is a long-acting form of this stimulant that comes in sustained-release capsules and can only be taken once a day.
Adderall is approved for the treatment of ADHD and is prescribed to improve attention and focus and to address behavior problems. Although it is also prescribed for narcolepsy, it should not be used to treat daytime sleepiness in people without sleep disorders.
Adderall is approved for use in adults and children 3 years and older. Adderall XR is approved for use in adults and children over 6 years of age.
Use not indicated on the label
Adderall can sometimes be off-label as an add-on treatment for treatment-resistant depression .
The diagnosis of ADHD requires a comprehensive evaluation by a pediatrician, psychologist, or psychiatrist with experience treating ADHD. The disorder can begin at 3 to 6 years of age and can continue into adolescence and adulthood.
The first treatment for ADHD in children under 6 years of age is behavioral therapy, which includes parenting education in behavior management and behavioral interventions in the classroom. This is done before considering any medication. For children between the ages of 6 and 18, treatment is first-line treatment along with behavioral therapy.
Stimulants are usually the first medications used to treat ADHD, and the two most common types are Ritalin (methylphenate) and various forms of amphetamines, including Adderall and Vivans (lisdexamphetamine). There are also extended-release versions like Concerta (methylphenate) and Adderall XR, which last longer and can be taken once a day.
Each of the stimulants prescribed for ADHD can have similar effects, but a person's response to methylphenate or amphetamine is different. If the first type taken proves ineffective, they can be changed to another.
Research shows that around 40% of people respond to both methylphenate and amphetamine, and around 40% respond to just one type .
As an alternative to stimulants, there are also non-stimulant ADHD medications that have been shown to help reduce ADHD symptoms in children and teens, but are less reliable than stimulants. These include Strattera (atomoxetine), Intuniv (guanfacine), and Capway (clonidine).
Non-stimulants may be prescribed for those who cannot tolerate the side effects of stimulants or who have health problems such as heart disease or drug abuse that prevent them from taking them. Non-stimulants are also sometimes used as complementary therapy to stimulants like Adderall.
For narcolepsy, medications commonly used as first-line treatment are the wakefulness agents Provigil (Modafinil) or Nuvigil (Armodafinil), or the central nervous system (CNS) depressant Xyrem (sodium oxybate), which can ( among other things) things) improve daytime symptoms by promoting better night's sleep.
If Provigil, Nuvigil, or Xyrem are not fully effective in improving excessive daytime sleepiness and episodes of sleep, or the person is unable to take these medications, stimulants such as Adderall are generally prescribed as a secondary option to improve alertness during sleep. day.
Precautions and contraindications.
Given the risks associated with taking Adderall in certain cases, you will be asked to provide a detailed physical and mental health history. In addition to details about yourself, be sure to tell your healthcare provider about your family history of illnesses, including any sudden death, ventricular arrhythmias, suicide, bipolar disorder , depression, or addiction.
You will also have a physical exam and may have tests such as an electrocardiogram (ECG) and echocardiogram to check for heart abnormalities. Stimulant medications carry serious heart risks, including the risk of sudden death for children and adults with pre-existing heart problems .
Adderall should not be used if you are in any of the following cases:
- Dilated arteriosclerosis (hardening of the arteries)
- Symptomatic cardiovascular disease
- Moderate to severe hypertension (high blood pressure)
- Agitated states
- Known allergy or sensitivity to stimulants.
- History of drug abuse (Adderall is addictive).
- Glaucoma – There may be increased pressure in the eye, resulting in loss of vision.
- Breastfeeding: Amphetamines can be passed to a baby through breast milk.
There are additional medical conditions and warnings that could make taking Adderall risky or possibly prevent its use, including:
- Hypertension and other cardiovascular diseases: Stimulants cause an increase in mean blood pressure and heart rate, which can carry risks for people with any underlying medical conditions, such as mild hypertension, heart failure, recent myocardial infarction, or ventricular arrhythmia. In general, people with structural heart abnormalities, cardiomyopathy, severe heart rhythm disturbances, coronary artery disease, or other serious heart problems should not take stimulants.
- Seizures: Stimulants can lower the seizure threshold and increase seizures in patients with a history of previous seizures or abnormal EEG (brain wave test) seizures.
- Pre- existing psychosis: Stimulants can worsen the symptoms of thought and behavior disorders in patients with psychotic disorders.
- Bipolar Disorder: Stimulants can cause a mixed / manic episode in patients with bipolar disorder.
- Tics: The drug can aggravate motor and sound tics and Tourette's syndrome. You don't need to worry about Adderall causing tics like some medications, but it can cause tics that should otherwise become more noticeable.
- Liver or kidney problems: These organs can be affected by long-term use of Adderall.
- Pregnancy: There are no adequate and well-controlled studies in pregnant women, and there may be long-term behavioral risk, including learning and memory deficits, or neurochemical changes in babies born to mothers who took amphetamines during pregnancy.
Some medications and ingredients can interact with Adderall and can alter the effectiveness or risk of dangerous side effects. Your healthcare provider will evaluate your medication regimen and may adjust it if you need to take Adderall. You may also need to be closely monitored if you are taking Adderall with other medications.
Medications that interact with Adderall include:
- Monoamine oxidase inhibitors (MAOIs) or other antidepressants: Do not take Adderall if you have been taking an MAOI for 14 days. MAOIs slow down the metabolism of amphetamines and increase their effect. This can lead to hypertensive crisis and various neurological toxic effects and malignant hyperpyrexia, which can be fatal.
- Blood pressure medications: These medications can interact with Adderall in different ways. Alpha blockers (also called adrenergic blockers) are suppressed by amphetamines, rendering them ineffective. Some thiazide diuretics decrease urinary amphetamine excretion by increasing the level of amphetamines in the blood. Guanethidine and reserpine are gastrointestinal acidifying agents that reduce amphetamine levels. Amphetamines also inhibit the action of the alkaloids in veratrum, which can be taken by people with high blood pressure.
- Antacids (baking soda): Do not take antacids with Adderall. These alkalizing agents in the gastrointestinal tract increase the absorption and blood levels of amphetamines.
- Diamox (acetazolamide): Diomox reduces the excretion of urine or amphetamines by increasing the level of amphetamines in the blood.
- Antidepressants: Amphetamines may enhance the activity of tricyclic or sympathomimetic agents in antidepressants. Furthermore, this combination can also increase the concentration of d-amphetamine in the brain and increase the likelihood of cardiovascular effects.
- Anticoagulants: Harmful interactions with both drugs can occur.
- Antipsychotics: Haloperidol for schizophrenia blocks dopamine receptors, suppressing the stimulant effects of amphetamines. Chlorpromazine blocks dopamine and norepinephrine receptors, suppressing the stimulant effects of amphetamines (which is why chlorpromazine can be used to treat amphetamine poisoning).
- Lithobide (lithium) for bipolar disorder: Lithium carbonate can suppress the stimulant effects of amphetamines.
- Opioid pain relievers: Amphetamines can enhance the pain relieving effect of opioids such as demerol (meperidine).
- Methenamine therapy for bladder or kidney infections: The acidifying agents used in Hiprex (methenamine) increase urinary excretion of amphetamines, making them less effective.
- Norepinephrine: Amphetamines enhance the effects of norepinephrine.
- Anticonvulsants: Amphetamines can delay intestinal absorption of anticonvulsants such as phenobarbital, Dilantin (phenytoin), and Zarontin (ethosuximide).
- Cold or Allergy Medicines Containing Decongestants or Antihistamines: Both Adderall and decongestants can increase blood pressure and heart rate, and these effects can be enhanced when taken together. Amphetamines can also counteract the sedative effects of antihistamines.
Talk to your doctor about all the medications, supplements, and vitamins that you are currently taking. While some medications carry little risk of interactions, others may directly contraindicate their use or prompt careful consideration of whether the benefits of treatment outweigh the disadvantages in your case.
Adderall comes in double-scored tablets (for easy separation), which are available in 5 milligram (mg), 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, 25 mg, and 30 mg versions.
Adderall XR capsules are available in 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, and 30 mg versions.
As with other stimulants, the usual philosophy is to start with a low dose, gradually increasing at weekly intervals as needed. Never increase your dose of Adderall without your doctor's approval.
Since there is some concern that the drug may restrict growth in children, those taking the drug may be stopped periodically under the guidance of a healthcare provider to see if it is needed over time.
|Indication||Age||Typical starting dose|
|ADHD||3-5 years||2.5 mg|
|ADHD||6 years +||5 mg|
|Narcolepsy||6-12 years||5 mg|
|Narcolepsy||Over 12 years old||
Usually the dose of Adderall is about half that of Ritalin (methylphenidate). That is, 20 mg of Ritalin will be equivalent to approximately 10 mg of Adderall.
For those who switch from the regular version of Adderall to the extended release version, the total daily dose is usually the same. For example, if a child took 10 mg of Adderall twice a day (20 mg total), they will now take a 20 mg capsule of Adderall XR each morning.
How to take and store
For both ADHD and narcolepsy, the first dose is usually taken in the morning, four to six hours apart. It should be avoided late at night to prevent insomnia.
If you forget your morning dose, take it as soon as you remember. But if there are hours left before your next dose, skip it and just take the next one on schedule. If you miss your average daily dose, skip it and take the next dose the next morning as taking it too late in the afternoon can interfere with sleep.
Adderall XR is taken once a day in the morning. If you forget to take an extended-release capsule, do not take it later in the day. Instead, take your next dose at the usual time the next morning.
Adderall can be taken with or without food and should be stored at room temperature (ideally 68 to 77 degrees Fahrenheit). As with all medicines, keep it out of the reach of children.
If you or your child take too much Adderall, call your doctor or poison control center right away or get emergency help.
Although generally well tolerated, Adderall carries a risk of side effects, especially when the drug is first taken. Because the side effects can be serious, it is important to consider them when you start taking the medicine.
Adderall has not been evaluated for long-term use.
The main side effects of Adderall and Adderall XR include:
- Loss of appetite
- Mild Weight Loss: Tell your pediatrician that your child is not gaining or growing as expected, or is losing weight for unexplained reasons.
- Insomnia (trouble sleeping), especially if the second dose is taken too late.
- Mood and irritability
- Dry mouth
- Increased tics in people prone to them.
- Impotence or changes in sexual desire.
Many children and adults have mild side effects that can go away over time. If the side effects don't improve, your doctor may need to lower your dose or consider switching to another ADHD medication such as Vyvanse, Concerta, or Strattera.
Stimulants can cause serious and life-threatening side effects, such as heart attack, stroke, or allergic reactions. Get immediate medical attention if you have any of the following symptoms:
- Chest pain with exertion
- Unexplained fainting
- Fast breathing or shortness of breath
- Psychotic episode; hallucinations
- Seizures; convulsions
- Rash or hives
- Swelling of the throat or face
- Vision changes
- Manic symptoms such as euphoria or frantic mood.
- Increased aggression
- Speak slow or difficult
- Growth or slower growth in children
Warnings and interactions
Given the potential risks associated with taking Adderall, and especially if you have certain health problems, your healthcare provider may want to regularly monitor your blood pressure and heart rate, perform more complex heart tests, and regularly assess your mental health for any alarming alarm. changes.
Growth suppression can occur in children who are constantly taking drugs and must be closely monitored. Those who are not gaining or growing as expected may need to stop taking the drug.
While taking stimulants, vision problems can occur, including blurred vision, and may require monitoring or stopping the medication.
It is important that you keep up with the recommended follow-up visits.
In addition to the information on drug interactions mentioned above, keep in mind that Adderall also interacts with:
- Alcohol: Taking Adderall with alcohol can increase the risk of heart problems and can alter the perception of drunkenness, increasing the risk of alcohol poisoning or alcohol-related accidents. This combination can also mask the effects of Adderall, making it less effective.
- Caffeine – Like Adderall, caffeine is also a central nervous system stimulant. Therefore, it can amplify the potential side effects of Adderall and should be limited or avoided while taking the drug.
- Citrus: The ascorbic acid (vitamin C) in citrus juices and fruits is a gastrointestinal acidifying agent that can reduce the absorption of amphetamines, making them less effective. You can limit your intake of these foods and drinks while taking Adderall.
Risk of abuse and addiction
Central nervous system stimulants, including Adderall and Adderall XR, have a high potential for abuse and dependence.
Because Adderall is touted in some high school and college circles (and even in some workplaces) as a "cognitive enhancer," those who take it can be pressured to share or sell their medications.
This medication should never be used by anyone other than the person for whom it was prescribed, and parents should talk to their children about the problem (and monitor its use as well).
It should be noted that some adolescents with complex ADHD associated with developmental and / or mental health problems may need close monitoring for stimulant abuse and suicidal ideation .