Adderall
Adderall is an immediate-release oral tablet combining four amphetamine salts (dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate) in a 3:1 d- to l-amphetamine ratio. Adderall is used for Attention Deficit Hyperactivity Disorder (ADHD), Narcolepsy and What it should not be used for.
Pronunciation: pronunciation varies by local usage.
- Generic name
- dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate (mixed salts of a single-entity amphetamine product)
- Brand names
- Adderall
- Drug class
- Central nervous system (CNS) stimulant; non-catecholamine sympathomimetic amine (amphetamine mixed salts)
- Form
- Immediate-release tablet; available in 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, and 30 mg strengths
- Route
- By mouth (oral)
- Legal status
- US prescription-only medicine; the label carries a boxed warning for abuse, misuse, and addiction. The US prescription is not refillable. Legal status outside the United States is not covered by the supplied sources.
Availability and supply rules vary by country
Trade names by country:
Australia: · Full directory
What dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate (mixed salts of a single-entity amphetamine product) is and how it works
Adderall is an immediate-release oral tablet combining four amphetamine salts (dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate) in a 3:1 d- to l-amphetamine ratio. It is a CNS stimulant indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) and narcolepsy. Amphetamines are thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space; the exact mode of therapeutic action in ADHD is not known. (1) (2)
Adderall is used as part of a treatment programme for ADHD that may include counselling and special education, and it is not recommended for children under 3 years of age. The label carries a boxed warning for abuse, misuse, and addiction, and patients are advised to store the medicine in a safe place, preferably locked, and never to give it to anyone else. The US prescription is not refillable, so regular appointments are needed. Adderall is a US brand and is not marketed in the UK; sources for other countries were not available for this draft.
Mechanism of action: how dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate (mixed salts of a single-entity amphetamine product) works
Amphetamines are non-catecholamine sympathomimetic amines with CNS stimulant activity. The mode of therapeutic action in ADHD is not known; amphetamines are thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space. Adderall tablets contain d-amphetamine and l-amphetamine salts in the ratio of 3:1. Following a single 10 or 30 mg dose in healthy volunteers under fasted conditions, peak plasma concentrations occurred approximately 3 hours post-dose for both d-amphetamine and l-amphetamine. Mean elimination half-life for d-amphetamine was shorter than for the l-isomer (9.77 to 11 hours vs. 11.5 to 13.8 hours). PK parameters (Cmax, AUC 0-inf) of d- and l-amphetamine increased approximately three-fold from 10 mg to 30 mg, indicating dose-proportional pharmacokinetics. The effect of food on the bioavailability of Adderall has not been studied. Amphetamine is reported to be oxidized at the 4 position of the benzene ring to form 4-hydroxyamphetamine, or on the side chain alpha or beta carbons to form alpha-hydroxy-amphetamine or norephedrine, respectively; norephedrine and 4-hydroxy-amphetamine are both active and each is subsequently oxidized to form 4-hydroxy-norephedrine, and alpha-hydroxy-amphetamine undergoes deamination to form phenylacetone, which ultimately forms benzoic acid and its glucuronide and the glycine conjugate hippuric acid. Although the enzymes involved in amphetamine metabolism have not been clearly defined, CYP2D6 is known to be involved with formation of 4-hydroxy-amphetamine; since CYP2D6 is genetically polymorphic, population variations in amphetamine metabolism are a possibility. Amphetamine is known to inhibit monoamine oxidase, whereas the ability of amphetamine and its metabolites to inhibit various P450 isozymes and other enzymes has not been adequately elucidated; in vitro experiments with human microsomes indicate minor inhibition of CYP2D6 by amphetamine. (1) (2)
What is Dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate used for?
Attention Deficit Hyperactivity Disorder (ADHD)
Adderall is indicated for the treatment of ADHD. MedlinePlus states it is used to treat ADHD in adults and children 3 years of age and older. The label describes ADHD as hyperactive-impulsive or inattentive symptoms that caused impairment and were present before age 7 years, causing clinically significant impairment in social, academic, or occupational functioning and present in two or more settings, and not better accounted for by another mental disorder. (1) (2)
Narcolepsy
Adderall is indicated for the treatment of narcolepsy. Narcolepsy is a sleep disorder causing excessive daytime sleepiness and sudden attacks of sleep. The US label notes that it seldom occurs in children under 12 and gives starting doses from age 6. (1) (2)
What it should not be used for
The combination of dextroamphetamine and amphetamine should not be used to treat excessive tiredness that is not caused by narcolepsy. (2)
Before taking dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate (mixed salts of a single-entity amphetamine product)
Do not take / not appropriate for
- Adderall is contraindicated in patients known to be hypersensitive to amphetamine or other components of Adderall. Hypersensitivity reactions such as angioedema and anaphylactic reactions have been reported with other amphetamine products. (all patients) (1)
- Adderall must not be taken by patients taking monoamine oxidase inhibitors (MAOIs), or within 14 days of stopping MAOIs (including MAOIs such as linezolid or intravenous methylene blue), because of an increased risk of hypertensive crisis. (all patients) (1) (2)
- The prescriber will probably advise against taking this medicine if you have glaucoma, hyperthyroidism, or feelings of anxiety, tension, or agitation. (per prescriber assessment) (2)
- The prescriber will probably advise against taking this medicine if you have a heart condition or if there is a high risk that you may develop a heart condition. The label advises avoiding Adderall in patients with known structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmia, coronary artery disease, or other serious cardiac disease. (per prescriber assessment) (1) (2)
Tell your clinician about
- If you are allergic to amphetamine, dextroamphetamine, other stimulant medications such as benzphetamine, lisdexamfetamine (Vyvanse), or methamphetamine (Desoxyn), any other medications, or any of the ingredients in dextroamphetamine and amphetamine preparations.
- If you are taking or have stopped taking within the past two weeks any monoamine oxidase (MAO) inhibitors, including isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate).
- If anyone in your family has or has ever had an irregular heartbeat or has died suddenly, and if you have recently had a heart attack or have or have ever had a heart defect, high blood pressure, an irregular heartbeat, hardening of the arteries, heart or blood vessel disease, or other heart problems.
- If you or anyone in your family has or has ever had depression, bipolar disorder, mania, motor tics, verbal tics, or Tourette's syndrome, or has thought about or attempted suicide, and if you have or have ever had mental illness, seizures, an abnormal electroencephalogram (EEG), or liver or kidney disease.
- If you are pregnant, plan to become pregnant, or are breastfeeding.
- All prescription and nonprescription medicines, vitamins, minerals, and dietary supplements you take, including St. John's wort, nutritional supplements such as glutamic acid (L-glutamine), tryptophan, sodium bicarbonate, sodium phosphate, antacids and other medicines for heartburn or ulcers such as cimetidine (Tagamet), esomeprazole (Nexium), or omeprazole (Prilosec), and allergy medicines such as diphenhydramine, loratadine, fexofenadine, chlorpheniramine, or cetirizine.
- Before starting, stopping, or changing any medication while taking dextroamphetamine and amphetamine, get the advice of your doctor or pharmacist.
- If you are 65 years of age or older, talk to your doctor about the risks and benefits; older adults should not usually take this medicine because it is not as safe as other medications that can be used to treat the same condition.
Dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate dosage and how to take it
- Take the immediate-release tablet by mouth, usually 2 to 3 times daily, 4 to 6 hours apart, with or without food.
- Do not take it in the late afternoon or evening because it may cause difficulty falling asleep or staying asleep; late evening doses should be avoided because of the resulting insomnia.
- Give the first dose on awakening, with additional doses (1 or 2) at intervals of 4 to 6 hours.
- Amphetamines should be administered at the lowest effective dosage, and dosage should be individually adjusted according to the therapeutic needs and response of the patient.
- Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take it exactly as directed.
- The doctor will probably start on a low dose and increase it gradually, not more often than once every week, and may tell you to stop taking it from time to time to see if the medication is still needed; follow these directions carefully.
- For ADHD, the US label starts children aged 3 to 5 on 2.5 mg daily (raised by 2.5 mg at weekly intervals) and people aged 6 and older on 5 mg once or twice daily (raised by 5 mg at weekly intervals). For narcolepsy, the label starts ages 6 to 12 on 5 mg daily and ages 12 and older on 10 mg daily.
- Do not change the dose or schedule yourself; dose decisions are made by the prescriber.
- The medication in each dextroamphetamine and amphetamine product is absorbed differently, so one product cannot be substituted for another; if switching products, the doctor will prescribe the dose that is best for you.
- Use it as part of a total treatment programme for ADHD, which may include counselling and special education, and follow all of your doctor's and/or therapist's instructions.
- This medication may make it difficult to perform activities that require alertness or physical coordination; do not drive a car or operate machinery until you know how it affects you.
- Unless your doctor tells you otherwise, continue your normal diet.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2)
Missed dose
The supplied sources do not give missed-dose instructions for the immediate-release tablet, so ask your doctor or pharmacist what to do. Late-evening doses can cause trouble sleeping.
Overdose
In case of overdose, call the poison control helpline at 1-800-222-1222; information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911. Overdose of CNS stimulants is characterised by sympathomimetic effects including cardiovascular effects such as tachyarrhythmias and hypertension or hypotension, with vasospasm, myocardial infarction, or aortic dissection possibly precipitating sudden cardiac death, and takotsubo cardiomyopathy; CNS effects including psychomotor agitation, confusion, and hallucinations, with serotonin syndrome, seizures, cerebral vascular accidents, and coma; and life-threatening hyperthermia (temperatures greater than 104 degrees F) and rhabdomyolysis. Symptoms of overdose may include restlessness, confusion, aggressive behavior, feelings of panic, hallucinations, fast breathing, uncontrollable shaking of a part of the body, fever, dark red or cola-colored urine, muscle weakness or aching, tiredness or weakness, depression, fast or irregular heartbeat, fainting, dizziness, blurred vision, upset stomach, vomiting, diarrhea, seizures, and coma. Consider the possibility of multiple drug ingestion. D-amphetamine is not dialyzable. Consider contacting the Poison Help line (1-800-222-1222) or a medical toxicologist for additional overdose management recommendations. (1) (2)
Dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate side effects
Adderall may cause side effects; tell your doctor if any of these symptoms are severe or do not go away. Some side effects can be serious, and some can occur at recommended doses. This medicine may also cause sudden death in children and teenagers, especially those with heart defects or serious heart problems, and may cause sudden death, heart attack, or stroke in adults, especially adults with heart defects or serious heart problems.
Nervousness
What to notice: Feeling nervous or overstimulated.
What to do: Tell your doctor if it is severe or does not go away. (2)
Headache
What to notice: Headache during treatment.
What to do: Tell your doctor if it is severe or does not go away. (2)
Changes in sex drive or ability
What to notice: Changes in libido or sexual function; the label also lists impotence and frequent or prolonged erections.
What to do: Tell your doctor if it is severe or does not go away. (1) (2)
Painful menstrual cramps
What to notice: Painful menstrual cramps.
What to do: Tell your doctor if it is severe or does not go away. (2)
Dry mouth
What to notice: Dryness of the mouth or unpleasant taste.
What to do: Tell your doctor if it is severe or does not go away. (1) (2)
Constipation or diarrhea
What to notice: Changes in bowel habit.
What to do: Tell your doctor if it is severe or does not go away. (2)
Nausea
What to notice: Feeling sick to the stomach.
What to do: Tell your doctor if it is severe or does not go away. (2)
Weight loss and loss of appetite
What to notice: Anorexia and weight loss may occur as undesirable effects.
What to do: Tell your doctor if it is severe or does not go away; in children, growth and weight gain are monitored. (1) (2)
Signs of heart problems
What to notice: Chest pain, shortness of breath, or fainting. Palpitations, tachycardia, elevation of blood pressure, sudden death, and myocardial infarction are listed as cardiovascular adverse reactions; there have been isolated reports of cardiomyopathy associated with chronic amphetamine use.
What to do: Call your or your child's doctor right away and get emergency help. (1) (2)
Serious nervous system or psychiatric symptoms
What to notice: Slow or difficult speech, dizziness, weakness or numbness of an arm or leg, seizures, motor or verbal tics, teeth grinding, depression, believing things that are not true, feeling unusually suspicious of others, hallucinating, or mania. The label also lists psychotic episodes at recommended doses, overstimulation, restlessness, irritability, euphoria, dyskinesia, dysphoria, depression, tremor, motor and verbal tics, aggression, anger, logorrhea, and dermatillomania.
What to do: Call your doctor immediately or get emergency medical treatment. (1) (2)
Serotonin syndrome
What to notice: Agitation, hallucinations, fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, nausea, vomiting, or diarrhea.
What to do: Call your doctor immediately or get emergency medical treatment. (2)
Peripheral vasculopathy, including Raynaud's phenomenon
What to notice: Paleness or blue color of fingers or toes, pain, numbness, burning, or tingling in the hands or feet, or unexplained wounds appearing on fingers or toes. Signs and symptoms are usually intermittent and mild, but sequelae include digital ulceration and/or soft tissue breakdown.
What to do: Call your doctor immediately or get emergency medical treatment; careful observation for digital changes is necessary during treatment, and further clinical evaluation such as a rheumatology referral may be appropriate. (1) (2)
Serious skin or allergic reactions
What to notice: Blistering or peeling skin, rash, hives, itching, swelling of the eyes, face, tongue, or throat, difficulty breathing or swallowing, or hoarseness. Serious skin rashes including Stevens-Johnson syndrome and toxic epidermal necrolysis have been reported, and hypersensitivity reactions including angioedema and anaphylaxis have been reported.
What to do: Call your doctor immediately or get emergency medical treatment. (1) (2)
Changes in vision
What to notice: Changes in vision or blurred vision; mydriasis is also listed.
What to do: Call your doctor immediately or get emergency medical treatment. (1) (2)
Rhabdomyolysis
What to notice: Rhabdomyolysis is listed as a musculoskeletal adverse reaction.
What to do: Seek prompt medical assessment. (1)
Slowed growth or weight gain in children
What to notice: CNS stimulants have been associated with weight loss and slowing of growth rate in pediatric patients; this medicine may slow children's growth or weight gain.
What to do: Your child's doctor will watch growth carefully; talk to your child's doctor if you have concerns about growth or weight gain, and about the risks of giving this medicine to your child. (1) (2)
Serious warnings
Abuse, misuse, and addiction (boxed warning) — emergency
Symptoms: Adderall has a high potential for abuse and misuse, which can lead to the development of a substance use disorder, including addiction. It can be diverted for non-medical use into illicit channels or distribution. Misuse and abuse of CNS stimulants, including Adderall, can result in overdose and death, and this risk is increased with higher doses or unapproved methods of administration, such as snorting or injection.
Action: Before prescribing, the prescriber assesses each patient's risk; patients and families should be educated about these risks, proper storage of the drug, and proper disposal of any unused drug. Store amphetamine sulfate in a safe place, preferably locked, and do not give Adderall to anyone else. Risk is reassessed and signs and symptoms of abuse, misuse, and addiction are monitored throughout treatment. Seek medical help for any concerns about misuse or addiction. (1)
Risks to patients with serious cardiac disease — emergency
Symptoms: Sudden death has been reported in patients with structural cardiac abnormalities or other serious cardiac disease who were treated with CNS stimulant treatment at the recommended ADHD dosages. Adderall may cause sudden death in children and teenagers, especially those with heart defects or serious heart problems, and may cause sudden death, heart attack, or stroke in adults, especially adults with heart defects or serious heart problems. Signs of heart problems include chest pain, shortness of breath, or fainting.
Action: Adderall use should be avoided in patients with known structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmia, coronary artery disease, or other serious cardiac disease. Call your or your child's doctor right away and get emergency help for any signs of heart problems. (1) (2)
Increased blood pressure and heart rate — urgent
Symptoms: CNS stimulants cause an increase in blood pressure (mean increase about 2 to 4 mm Hg) and heart rate (mean increase about 3 to 6 bpm); some patients may have larger increases.
Action: All Adderall-treated patients are monitored for potential tachycardia and hypertension; report palpitations, a racing heartbeat, or symptoms of high blood pressure to your doctor. (1)
Psychiatric adverse reactions — urgent
Symptoms: CNS stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with a pre-existing psychotic disorder, and may induce a manic or mixed episode in patients with bipolar disorder. CNS stimulants, at recommended doses, may cause psychotic or manic symptoms (for example hallucinations, delusional thinking, or mania) in patients without a prior history of psychotic illness or mania; in a pooled analysis of multiple short-term, placebo-controlled studies of CNS stimulants these occurred in approximately 0.1% of CNS stimulant-treated patients compared with 0% of placebo-treated patients.
Action: Before starting, patients are screened for risk factors for developing a manic episode (for example comorbid or history of depressive symptoms or a family history of suicide, bipolar disorder, or depression). If such symptoms occur, the prescriber considers discontinuing Adderall; contact your doctor promptly. (1)
Long-term suppression of growth in pediatric patients — urgent
Symptoms: CNS stimulants have been associated with weight loss and slowing of growth rate in pediatric patients.
Action: Growth (weight and height) is closely monitored in Adderall-treated pediatric patients; pediatric patients who are not growing or gaining weight as expected may need to have their treatment interrupted. Talk to your child's doctor about any concerns. (1) (2)
Seizures — urgent
Symptoms: There is some clinical evidence that stimulants may lower the convulsive threshold in patients with prior history of seizure, in patients with prior EEG abnormalities in absence of seizures, and very rarely, in patients without a history of seizures and no prior EEG evidence of seizures.
Action: In the presence of seizures, the drug should be discontinued; seek medical attention promptly and let the clinician you see advise on whether to continue or stop. (1)
Peripheral vasculopathy, including Raynaud's phenomenon — urgent
Symptoms: Signs and symptoms are usually intermittent and mild; however, sequelae include digital ulceration and/or soft tissue breakdown. Effects were observed in postmarketing reports and at the therapeutic dosage of CNS stimulants in all age groups throughout the course of treatment. Signs and symptoms generally improved after dosage reduction or discontinuation of the CNS stimulant.
Action: Careful observation for digital changes is necessary during treatment. Further clinical evaluation (for example rheumatology referral) may be appropriate for patients who develop signs or symptoms of peripheral vasculopathy; report paleness or blue color of fingers or toes, pain, numbness, burning, or tingling in the hands or feet, or unexplained wounds on fingers or toes. (1) (2)
Serotonin syndrome — emergency
Symptoms: Serotonin syndrome, a potentially life-threatening reaction, may occur when amphetamines are used in combination with other drugs that affect the serotonergic neurotransmitter systems such as MAOIs, SSRIs, SNRIs, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, and St. John's wort. Symptoms include agitation, hallucinations, fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, nausea, vomiting, or diarrhea.
Action: Serotonergic treatment is initiated with lower doses and patients are monitored for signs and symptoms of serotonin syndrome, particularly during Adderall initiation or dosage increase. If serotonin syndrome occurs, the prescriber discontinues Adderall and the concomitant serotonergic drug(s); call your doctor immediately or get emergency medical treatment. (1) (2)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| MAO inhibitors (including linezolid and intravenous methylene blue) | Concomitant use of MAOIs and CNS stimulants can cause hypertensive crisis; potential outcomes include death, stroke, myocardial infarction, aortic dissection, ophthalmological complications, eclampsia, pulmonary edema, and renal failure. | Do not administer Adderall concomitantly or within 14 days after discontinuing an MAOI. Tell your doctor or pharmacist if you are taking or have stopped taking an MAOI within the past two weeks. (1) (2) |
| Serotonergic drugs (including SSRIs, SNRIs, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, and St. John's wort) | Concomitant use increases the risk of serotonin syndrome. | Treatment is initiated with lower doses and patients are monitored for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, the prescriber discontinues Adderall and the concomitant serotonergic drug(s). Give your doctor and pharmacist a complete medicine list. (1) (2) |
| CYP2D6 inhibitors | Concomitant use may increase the exposure of Adderall compared to use of the drug alone and increase the risk of serotonin syndrome. | Treatment is initiated with lower doses and patients are monitored for signs and symptoms of serotonin syndrome, particularly during Adderall initiation and after a dosage increase. If serotonin syndrome occurs, the prescriber discontinues Adderall and the CYP2D6 inhibitor. (1) |
| Acidifying agents (including gastrointestinal and urinary acidifying agents, and methenamine therapy) | Acidifying agents lower blood levels and efficacy of amphetamines; urinary excretion of amphetamines is increased and efficacy is reduced by acidifying agents used in methenamine therapy. | The label states to increase dose based on clinical response; dose changes must be made by the prescriber. (1) |
| Alkalinizing agents (including gastrointestinal and urinary alkalinizing agents, such as sodium bicarbonate) | Alkalinizing agents increase blood levels and potentiate the action of amphetamine. | Co-administration of Adderall and gastrointestinal alkalinizing agents should be avoided. (1) (2) |
| Adrenergic blockers | Adrenergic blockers are inhibited by amphetamines. | Tell your doctor and pharmacist about all medicines you take so this can be managed. (1) |
| Tricyclic antidepressants | May enhance the activity of tricyclic or sympathomimetic agents causing striking and sustained increases in the concentration of d-amphetamine in the brain; cardiovascular effects can be potentiated. | Monitor frequently and adjust or use alternative therapy based on clinical response; decisions are made by the prescriber. (1) |
| Antihistamines (including diphenhydramine, loratadine, fexofenadine, chlorpheniramine, and cetirizine) | Amphetamines may counteract the sedative effect of antihistamines. | Tell your doctor and pharmacist that you take these products before starting Adderall. (1) (2) |
| Antihypertensives | Amphetamines may antagonize the hypotensive effects of antihypertensives. | Tell your doctor and pharmacist about all medicines you take. (1) |
| Chlorpromazine | Chlorpromazine blocks dopamine and norepinephrine receptors, thus inhibiting the central stimulant effects of amphetamines, and can be used to treat amphetamine poisoning. | Tell your doctor and pharmacist about all medicines you take. (1) |
| Ethosuximide | Amphetamines may delay intestinal absorption of ethosuximide. | Tell your doctor and pharmacist about all medicines you take. (1) |
| Haloperidol | Haloperidol blocks dopamine receptors, thus inhibiting the central stimulant effects of amphetamines. | Tell your doctor and pharmacist about all medicines you take. (1) |
| Lithium carbonate | The anorectic and stimulatory effects of amphetamines may be inhibited by lithium carbonate. | Tell your doctor and pharmacist about all medicines you take. (1) |
| Meperidine | Amphetamines potentiate the analgesic effect of meperidine. | Tell your doctor and pharmacist about all medicines you take. (1) |
| Norepinephrine | Amphetamines enhance the adrenergic effect of norepinephrine. | Tell your doctor and pharmacist about all medicines you take. (1) |
| Phenobarbital | Amphetamines may delay intestinal absorption of phenobarbital; coadministration of phenobarbital may produce a synergistic anticonvulsant action. | Tell your doctor and pharmacist about all medicines you take. (1) |
| Phenytoin | Amphetamines may delay intestinal absorption of phenytoin; coadministration of phenytoin may produce a synergistic anticonvulsant action. | Tell your doctor and pharmacist about all medicines you take. (1) |
| Propoxyphene | In cases of propoxyphene overdosage, amphetamine CNS stimulation is potentiated and fatal convulsions can occur. | Tell your doctor and pharmacist about all medicines you take. (1) |
| Proton pump inhibitors (for example omeprazole; also listed as esomeprazole and cimetidine among heartburn or ulcer medicines) | Time to maximum concentration (Tmax) of amphetamine is decreased compared to when administered alone. | Monitor patients for changes in clinical effect and adjust therapy based on clinical response; dose changes are made by the prescriber. (1) (2) |
| Veratrum alkaloids | Amphetamines inhibit the hypotensive effect of veratrum alkaloids. | Tell your doctor and pharmacist about all medicines you take. (1) |
| Drug/laboratory test interactions | Amphetamines can cause a significant elevation in plasma corticosteroid levels; this increase is greatest in the evening. Amphetamines may interfere with urinary steroid determinations. | Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking dextroamphetamine and amphetamine. (1) (2) |
Pregnancy, breastfeeding, kidney/liver function, age
Children and adolescents
Amphetamines are not recommended for use in children under 3 years of age with ADHD. Long-term effects of amphetamines in children have not been well established. Adderall is used to treat ADHD in adults and children 3 years of age and older, and narcolepsy. The US label notes that narcolepsy is rare in children under 12 and gives a starting dose for ages 6 to 12. It may cause sudden death in children and teenagers, especially those with heart defects or serious heart problems, and may slow children's growth or weight gain; the child's doctor will watch growth carefully. The label directs that, prior to treating patients, the prescriber assesses for the presence of cardiac disease and evaluates family history and the patient for motor or verbal tics or Tourette's syndrome. (1) (2)
Pregnancy
There are no adequate and well-controlled studies in pregnant women. Amphetamine, in the enantiomer ratio present in Adderall (d- to l- ratio of 3:1), had no apparent effects on embryofetal morphological development or survival when orally administered to pregnant rats and rabbits throughout the period of organogenesis at doses of up to 6 and 16 mg/kg/day, respectively, approximately 1.5 and 8 times the maximum recommended human dose of 30 mg/day [child] on a mg/m2 body surface area basis. Fetal malformations and death have been reported in mice following parenteral administration of d-amphetamine doses of 50 mg/kg/day or greater (approximately 6 times a human dose of 30 mg/day [child] on a mg/m2 basis), also associated with severe maternal toxicity. A number of studies in rodents indicate that prenatal or early postnatal exposure to amphetamine at doses similar to those used clinically can result in long-term neurochemical and behavioral alterations, with reported behavioral effects including learning and memory deficits, altered locomotor activity, and changes in sexual function. There has been one report of severe congenital bony deformity, tracheo-esophageal fistula, and anal atresia (vater association) in a baby born to a woman who took dextroamphetamine sulfate with lovastatin during the first trimester of pregnancy. Amphetamines should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Infants born to mothers dependent on amphetamines have an increased risk of premature delivery and low birth weight, and may experience withdrawal symptoms demonstrated by dysphoria, including agitation, and significant lassitude. Tell your doctor if you are pregnant or plan to become pregnant; if you become pregnant while taking this medicine, call your doctor. (1) (2)
Breastfeeding
Amphetamines are excreted in human milk. Mothers taking amphetamines should be advised to refrain from nursing; do not breastfeed while taking dextroamphetamine and amphetamine. (1) (2)
Older adults
Adderall has not been studied in the geriatric population. Talk to your doctor about the risks and benefits of taking it if you are 65 years of age or older; older adults should not usually take it because it is not as safe as other medications that can be used to treat the same condition. (1) (2)
Monitoring
Before starting
- Assess each patient's risk for abuse, misuse, and addiction.
- Assess for the presence of cardiac disease: perform a careful history, family history of sudden death or ventricular arrhythmia, and physical exam.
- Assess the family history and clinically evaluate patients for motor or verbal tics or Tourette's syndrome.
- Screen patients for risk factors for developing a manic episode (for example comorbid or history of depressive symptoms or a family history of suicide, bipolar disorder, or depression).
- Discuss glaucoma, hyperthyroidism, anxiety, tension, agitation, liver or kidney disease, seizures, abnormal EEG, and mental illness history with the prescriber.
- Educate patients and their families about the risks of abuse, misuse, and addiction, proper storage of the drug, and proper disposal of any unused drug.
During treatment
- Reassess each patient's risk of abuse, misuse, and addiction and frequently monitor for signs and symptoms of abuse, misuse, and addiction.
- Monitor all Adderall-treated patients for potential tachycardia and hypertension.
- Closely monitor growth (weight and height) in Adderall-treated pediatric patients; pediatric patients who are not growing or gaining weight as expected may need to have their treatment interrupted.
- Careful observation for digital changes is necessary during treatment because of the risk of peripheral vasculopathy, including Raynaud's phenomenon.
- The doctor may order certain lab tests to check the body's response to dextroamphetamine and amphetamine; keep all appointments with your doctor and the laboratory.
- The doctor may tell you to stop taking the medicine from time to time to see if it is still needed; follow these directions carefully.
Storage
Store at 20 degrees to 25 degrees C (68 degrees to 77 degrees F) [see USP Controlled Room Temperature]. Dispense in a tight, light-resistant container as defined in the USP, with a child-resistant closure (as required). Keep this and all medications out of the reach of children. Keep the medication in the container it came in, tightly closed, and out of reach of children; store it at room temperature, away from light and excess heat and moisture (not in the bathroom). Store it in a safe place, preferably locked, and do not give Adderall to anyone else. Ask the prescriber or pharmacist how to dispose of any unused drug.
Professional information
Clinician-facing context only. Use the current US prescribing information, the indication-specific dosing directions, cardiac and psychiatric assessments, abuse-risk monitoring, and interaction guidance.
United States
Indication: Attention Deficit Hyperactivity Disorder (ADHD)
Dose summary: Not recommended for children under 3 years of age. In children 3 to 5 years of age, start with 2.5 mg daily; daily dosage may be raised in increments of 2.5 mg at weekly intervals until optimal response is obtained. In children 6 years of age and older, start with 5 mg once or twice daily; daily dosage may be raised in increments of 5 mg at weekly intervals until optimal response is obtained. Only in rare cases will it be necessary to exceed a total of 40 mg per day. Give the first dose on awakening; additional doses (1 or 2) at intervals of 4 to 6 hours. Regardless of indication, amphetamines should be administered at the lowest effective dosage, and dosage should be individually adjusted according to the therapeutic needs and response of the patient; late evening doses should be avoided because of the resulting insomnia.
Renal context: Renal or hepatic impairment dosing is not addressed in the supplied sources; this page does not provide impairment-specific dosing. (1)
United States
Indication: Narcolepsy
Dose summary: Usual dose 5 mg to 60 mg per day in divided doses, depending on the individual patient response. Narcolepsy seldom occurs in children under 12 years of age; however, when it does, dextroamphetamine sulfate may be used. The suggested initial dose for patients aged 6 to 12 is 5 mg daily; daily dose may be raised in increments of 5 mg at weekly intervals until optimal response is obtained. In patients 12 years of age and older, start with 10 mg daily; daily dosage may be raised in increments of 10 mg at weekly intervals until optimal response is obtained. If bothersome adverse reactions appear (for example insomnia or anorexia), dosage should be reduced. Give the first dose on awakening; additional doses (1 or 2) at intervals of 4 to 6 hours.
Renal context: Renal or hepatic impairment dosing is not addressed in the supplied sources; this page does not provide impairment-specific dosing. (1)
Hepatic guidance
The supplied sources do not provide hepatic impairment-specific dosing; the MedlinePlus patient information advises telling your doctor if you have or have ever had liver or kidney disease. Use the current local product information and specialist judgement.
Overdose note
D-amphetamine is not dialyzable. Consider contacting the Poison Help line (1-800-222-1222) or a medical toxicologist for additional overdose management recommendations. (1) (2)
Frequently asked questions
What is Adderall used for?
Adderall is indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) and narcolepsy. MedlinePlus states Adderall is used to treat ADHD in adults and children 3 years of age and older, and the US label gives narcolepsy starting doses from age 6. It is used as part of a treatment programme that may include counselling and special education. (1) (2)
Can Adderall be used to treat ordinary tiredness?
No. The combination of dextroamphetamine and amphetamine should not be used to treat excessive tiredness that is not caused by narcolepsy. (2)
How often is the immediate-release tablet taken?
The immediate-release tablet is usually taken 2 to 3 times daily, 4 to 6 hours apart, with or without food, with the first dose on awakening. It should not be taken in the late afternoon or evening because it may cause difficulty falling asleep or staying asleep. (1) (2)
Is Adderall addictive?
The label carries a boxed warning that Adderall has a high potential for abuse and misuse, which can lead to the development of a substance use disorder, including addiction, and that misuse and abuse of CNS stimulants can result in overdose and death. Risk is assessed before prescribing and reassessed throughout treatment, and patients and families are educated about these risks and about proper storage and disposal. (1)
Can I switch between different dextroamphetamine and amphetamine products?
No. The medication in each product is absorbed differently by the body, so one dextroamphetamine and amphetamine product cannot be substituted for another product. If you are switching from one product to another, your doctor will prescribe a dose that is best for you. (2)
Can I drive while taking Adderall?
This medication may make it difficult for you to perform activities that require alertness or physical coordination. Do not drive a car or operate machinery until you know how this medication affects you. (2)
Can I drink alcohol or take other medicines with Adderall?
The supplied sources do not address alcohol. Many medicines interact with Adderall, including MAO inhibitors, serotonergic drugs, CYP2D6 inhibitors, acidifying and alkalinizing agents, tricyclic antidepressants, antihistamines, and others. Before starting, stopping, or changing any medications while taking dextroamphetamine and amphetamine, get the advice of your doctor or pharmacist. (1) (2)
What is the mechanism of action of dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate (mixed salts of a single-entity amphetamine product)?
Amphetamines are non-catecholamine sympathomimetic amines with CNS stimulant activity. The mode of therapeutic action in ADHD is not known; amphetamines are thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space. Adderall tablets contain d-amphetamine and l-amphetamine salts in the ratio of 3:1. Following a single 10 or 30 mg dose in healthy volunteers under fasted conditions, peak plasma concentrations occurred approximately 3 hours post-dose for both d-amphetamine and l-amphetamine. Mean elimination half-life for d-amphetamine was shorter than for the l-isomer (9.77 to 11 hours vs. 11.5 to 13.8 hours). PK parameters (Cmax, AUC 0-inf) of d- and l-amphetamine increased approximately three-fold from 10 mg to 30 mg, indicating dose-proportional pharmacokinetics. The effect of food on the bioavailability of Adderall has not been studied. Amphetamine is reported to be oxidized at the 4 position of the benzene ring to form 4-hydroxyamphetamine, or on the side chain alpha or beta carbons to form alpha-hydroxy-amphetamine or norephedrine, respectively; norephedrine and 4-hydroxy-amphetamine are both active and each is subsequently oxidized to form 4-hydroxy-norephedrine, and alpha-hydroxy-amphetamine undergoes deamination to form phenylacetone, which ultimately forms benzoic acid and its glucuronide and the glycine conjugate hippuric acid. Although the enzymes involved in amphetamine metabolism have not been clearly defined, CYP2D6 is known to be involved with formation of 4-hydroxy-amphetamine; since CYP2D6 is genetically polymorphic, population variations in amphetamine metabolism are a possibility. Amphetamine is known to inhibit monoamine oxidase, whereas the ability of amphetamine and its metabolites to inhibit various P450 isozymes and other enzymes has not been adequately elucidated; in vitro experiments with human microsomes indicate minor inhibition of CYP2D6 by amphetamine. (1) (2)
What is the generic name of Adderall?
The generic name is dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate (mixed salts of a single-entity amphetamine product). It is sold under brand names including Adderall. (1) (2)
What class of drug is dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate (mixed salts of a single-entity amphetamine product)?
Adderall is classed as: Central nervous system (CNS) stimulant; non-catecholamine sympathomimetic amine (amphetamine mixed salts). (1) (2)
References
- Adderall (dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate and amphetamine sulfate tablets) — full prescribing informationDailyMed, U.S. National Library of Medicine (Adderall tablets full prescribing information, Teva) · United States · accessed 2026-10-13 · source 1
- Dextroamphetamine and Amphetamine: MedlinePlus Drug InformationMedlinePlus, U.S. National Library of Medicine · United States · accessed 2026-10-13 · source 2
Brand names by country
Single-ingredient dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate (mixed salts of a single-entity amphetamine product) names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.