Adderall: Everything You Need to Know

What Is Adderall?

Adderall is a controlled stimulant medication that may be prescribed for the treatment of ADHD or narcolepsy. It is controlled by the DEA due to its abuse potential. It requires a prescription from your medical doctor as well as counseling about its abuse potential and side effects.

Adderall works through increasing the amount of neurotransmitters in the brain. It can increase both the release of neurotransmitters and decrease its uptake as well.¹ Adderall can be used as a first line treatment for people with ADHD greater than 6 years old.¹ Stimulant medication has been shown to increase concentration and decrease agitation in patients with a 70% success rate.¹ Adderall can also be used as a second line therapy for the the treatment of narcolepsy.²

Uses of Adderall

Adderall is FDA approved for the treatment of ADHD and narcolepsy. It is part of a class of medications called stimulants that have similar functions.

Adderall comes in two forms, an immediate release and an extended release. Both Adderall extended release (XR) and Adderall are a combination of two different types of stimulant medications,  dextroamphetamine and amphetamine. While Adderall immediate release releases all of the medication at once, Adderall XR releases it slowly over time.² The choice for using the immediate release or the extended release for the treatment of ADHD is based on shared decision-making between the prescriber and client, as both have been shown to be useful.¹

Adderall effects start within one hour of administration and last 3-4 hours.⁴ Due to the duration of action, Adderall requires multiple doses during the day. Adderall XR effects start within one hour of administration as well but last 8-12 hours.⁴ Due to this reason, patients may only require one or two Adderall doses per day.⁴ Similarly, patients that need the benefits of Adderall during work or school times may elect to take Adderall instead of Adderall XR. The decision to use Adderall as well as which type of Adderall to use should be a joint decision between doctors and patients.

Adderall is not used as a first-line medication for narcolepsy (it is typically treated with modafinil).³ Both immediate release and extended release can be used in narcolepsy as well.³ For patients that do not respond to modafinil, extended release medications can be used once or twice daily.³ For patients that need additional treatment to fight off daytime drowsiness, Adderall immediate release can be used in conjunction with modafinil.³

Adderall Dosage

Adderall comes in two different oral forms: An extended release capsule and an immediate release tablet. Dosages are different for different ages of patients. For patients older than 6 that choose to take an immediate release tablet, an initial dose of 5mg once or twice a day should be given.⁶ This can be increased by 5mg weekly, up to 40 mg per day total.

For patients older than 6 who choose to take an extended release tablet, a starting dose of 5mg to 10mg should be used in the morning.⁶ The maximum dose for an extended release capsule is 30mg a day. For extended release capsules it is recommended that patients have an initial dose of 20 mg once daily in the morning.⁶ This dosage pattern is similar for adolescent patients and adult patients with ADHD.⁶

Side Effects of Adderall

Adderall can be incredibly helpful for many, however it does come with side effects that patients should be aware of in order to weigh its risks and benefits. Common side effects of Adderall include a feeling of nervousness, weight loss, nausea/vomiting, dry mouth, and/or increased blood pressure, and side effects in females can include problems with pregnancy and differing effects during menstruation.⁴ Patients can begin to see these effects at the beginning of starting Adderall or even after years of use.

Common Adderall side effects can include:

• Nausea/vomiting
• Weight loss
• Mildly increase blood pressure

Serious Adderall Side Effects

Serious side effects of Adderall can include:

• Dependency
• Myocardial infarction (heart attack)
• Cerebrovascular accident (stroke)
• Serotonin syndrome (when the body has built up toxic levels of serotonin)
• Steven Johnson syndrome (a rare, serious disorder of the skin and mucous membranes)

People should contact 911 or go to their nearest emergency if they begin having chest pain or shortness of breath. Patients should also go to the emergency room if they begin having high blood pressure, agitation, feel delirious, and/or have uncontrolled shaking. Patients that have a history of heart conditions should have clearance from a cardiologist before starting a stimulant medication.

Long Term Effects of Adderall

Patients that are diagnosed with ADHD or narcolepsy may take Adderall for a long duration of time. Patients that do take Adderall for a long period of time should have regular follow-up appointments to scan for signs of adverse effects. One study showed that children who took Adderall for a long period of time (24 months) had an increased risk for anorexia, insomnia, and headaches.⁷ However, young patients who have regular follow up will have their height and weights monitored closely to ensure adequate growth.⁷

Potential long-term negative effects of Adderall may include:

• Anorexia
• Insomnia
• Headache
• Heart disease
• Loss of appetite

Adderall Risks & Warnings

Adderall is a controlled substance in the US and therefore should be treated with caution. It is a controlled substance due to its risk of dependency. Patients with a history of substance abuse should take the medication with caution. Patients should store medications in a safe area away from the reach of children. Similarly, patients should only take the medication as prescribed and talk to their doctor about dosage changes if needed.

People should avoid other stimulants such as caffeine while taking Adderall, and patients should have a review of all other medications before starting a new Adderall prescription.

Is Adderall Addictive?

Adderall medication can cause dependency, meaning your body’s physiology changes and needs the medication, and therefore should be used with caution. Although dependency is physiological, this can put you at an increased risk of abuse and possible Adderall addiction. It is estimated that addiction happens in 1-3% of patients treated with stimulants for their narcolepsy.⁵ The FDA requires that doctors prescribe stimulants without refills and request that patients follow up with them before they are given another prescription. Studies have shown a benefit of regular primary care physician follow-ups in pediatric patients treated with stimulants.⁵

Interactions to Avoid

Adderall is a stimulant medication and patients should avoid taking other stimulant medications at the same time. Patients should also avoid highly caffeinated products, including coffee, headache relief medication, and energy drinks. Patients should avoid all MAO inhibitor drugs, like some antidepressants and neuropathic pain medications, for 14 days before starting a stimulant medication.⁴ Also, patients should avoid using SSRI/SNRI antidepressant and antianxiety medication while taking stimulant medications for the increased risk of serotonin syndrome.⁴

Things to avoid while taking Adderall include:

• Highly caffeinated products
• MAOIs such as Nardil and parnate
• SSRIs and SNRIs such as venlafaxine, wellbutrin, and prozac

This is not a comprehensive list and a doctor or pharmacist should always be consulted about any medications, herbs, or supplements you are taking or plan to take while before starting Adderall. It will also be important to consult a doctor or pharmacist before starting any new medication, herb, or supplement while taking Adderall.

Adderall Withdrawal

Adderall medication can cause withdrawal if abruptly stopped after a long time of use. This is because of the physiological dependency that can occur. Patients are generally advised to taper off the medication instead of discontinuing abruptly.

Signs of amphetamine withdrawal can include:⁶

• Increase in appetite
• Sleepiness or problems falling asleep
• Fatigue
• Depression
• Suicidal ideation with craving for amphetamine

Generally these symptoms last for a week after medication is stopped.⁶ It is important to get medical advice if facing any symptoms of withdrawal as you may need a slower tapering dose.

Questions to Ask Your Health Team About Adderall

Starting Adderall for the treatment of ADHD and narcolepsy is a decision that requires shared information between doctors, patients, and psychiatrists. It is important that patients understand not only their diagnosis and the challenges that come with it, but also their treatment plan. Patients should have a general understanding of the symptoms that the medication will improve.

Questions to ask your care team about whether Adderall is right for you include:

• What benefits am I supposed to see?
• What is the dosage of the medication?
• How often should I take the medication?
• What are common side effects?
• Who should I contact for serious side effects?
• Are there Adderall alternatives for me to consider if it doesn’t work or has too many side effects?

Final Thoughts

Adderall may benefit you if you are diagnosed with ADHD or narcolepsy. It is important to bring up your concerns to your doctor and discuss whether Adderall or other stimulant medications are a good choice for you.