Adderall (a combination of dextroamphetamine and amphetamine) is a psychostimulant medication belonging to the phenethylamine class of drugs. Adderall is used in the treatment of attention-deficit hyperactivity (ADHD) and narcolepsy. Unfortunately, Adderall has become popular among students and young professionals seeking to enhance cognitive and physical performance. Like many other stimulants, this medication has a high potential for recreational misuse and abuse.
- What is a safe dose of this drug?
This medication is available in an immediate release and extended release formula.
- ADHD: In immediate release form, a 5 mg oral dose is administered each day and can be increased by 5 mg to 10 mg per day every week. Maximum dose should not exceed 40 mg per day. For the extended release version of this drug, a 20 mg oral dose is administered in the morning. Dose can be increased as required but the maximum dose should not exceed 30 mg per day without consulting your doctor.
- Narcolepsy: Doctors typically only prescribe the immediate release version of this drug for narcolepsy. It is administered orally in doses ranging from 5 mg to 60 mg per day. The dose can be increased by 10 mg per day every week. Dosage should not exceed 60 mg per day.
- Does dosage for this drug change for children?
Adderall is not recommended for children under three years of age. Additionally, narcolepsy is rare in children under 12 years of age, so treatment options should be thoroughly discussed with your physician for the best treatment recommendation. The following ADHD treatment doses are recommended for children:
- Children three to six years old: A 2.5 mg per day dose may be administered. The dose can be increased by 2.5 mg per week. The maximum dose should not exceed 40 mg per day. It can be administered in a divided dose three times a day with intervals of four to six hours between additional doses. In the extended release formula, an initial 5 mg to 10 mg dose should be given in the morning and may be increased weekly. However, dosage should not exceed 30 mg per day.
- Children over six years old: A 5 mg dose can be administered once or twice each day with about four to six hours between doses. The dose can be increased by 5 mg per week but should not exceed 40 mg per day. In the extended release format, this medication should be given as a 10 mg dose in the morning and may be increased weekly. Dosage should not exceed 30 mg per day without a doctor’s consultation.
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Adderall is well-absorbed in the gastrointestinal tract. The bioavailability is typically over 75% for dextroamphetamine. The absorption of Adderall depends upon the pH of the individual’s gastrointestinal tract. Basic pH increases its absorption through the lipid-rich cell membranes of the gut. Acidic pH changes the drug in its water soluble cationic (salt) form, and less is absorbed. The drug is metabolized in the liver which results in a variety of excreted metabolic products.
- How can I get the most out of my treatment with this medication?
This drug is primarily prescribed to treat ADHD, which is a condition also regularly addressed with various types of psychotherapy—most notably behavioral modification. Finding a therapist or counselor that is trained in behavioral therapy may help you better regulate your emotional and behavioral responses to symptoms associated with ADHD. Additionally, a therapist can help you develop a safe plan to gain control over symptoms, help you develop important coping strategies, and they can help you learn to stay more focused and manage impulses.
Adderall, like many other stimulants, can cause a range of side effects. Consult with your health care provider if you experience any of the following as dosage may need adjusted or treatment discontinued:
- Cardiovascular side effects, such as palpitations, especially after chronic use
- Overstimulation leading to discomfort if there is a change in the level of stimulation
- Increased irritability
- Involuntary movements
- Excessive skin picking
- Tingling or burning skin
- Teeth grinding
- Blurred vision
- Abdominal pain, nausea, diarrhea, or constipation
- Impotency, changes in the libido, or prolonged erections
- Loss of appetite
If you are prescribed this drug, ensure that you disclose all medications, supplements, and vitamins you regularly take with your doctor and pharmacist. Be aware of the following drug interactions:
- Acetazolamide, sodium bicarbonate, and hydrochlorothiazide: These drugs may cause an increase in side effects by decreasing urinary excretion of Adderall.
- Entacapone: The effects of dopamine, noradrenaline, and adrenaline are increased when administered with this drug.
- Guanethidine: The hypotensive effects of guanethidine are decreased when taken with this medication.
- Antihistamines (diphenhydramine): The sedative effects of diphenhydramine are decreased when taken with this medication.
- Tricyclic antidepressants: Adderall, when administered with desipramine, protriptyline, or other tricyclic antidepressants, causes a sustained increase in the concentration of Adderall in the brain. This can also cause arrhythmias and hypertension.
- Phenobarbital: Mixing these medication can cause an increase in the concentration of phenobarbital in the body.
- Phenytoin: When taken with this medication, the absorption of phenytoin decreases in the intestine. Concomitant administration can also cause an increase in anticonvulsant activity of phenytoin due to synergistic effect of Adderall.
- Chlorpromazine: Adderall antagonizes the antipsychotic effects of chlorpromazine.
- Propoxyphene: Fatal convulsions can occur if this medication is taken with propoxyphene.
People experiencing hyperthyroidism, glaucoma, hypertension, advanced arteriosclerosis, symptomatic cardiovascular disease, and moderate-to-severe hypertension should not use this medication. Additionally, individuals in agitated states and those history of drug abuse should discuss all possible treatment options before taking Adderall.
The U.S. Food and Drug Administration (FDA) has placed this medication in pregnancy category C, which indicates that animal studies have shown negative effects on the fetus when this drug is introduced. All possible alternative treatments should be discussed by you and your doctor before taking this drug if you are pregnant.
This medication has a high risk for abuse and dependency. If you are prescribed this drug and need to stop treatment, consult with your doctor to develop a safe plan for withdrawal. Some individuals are able to stop this drug “cold turkey” while others experience debilitating withdrawal symptoms. Your doctor should be able to help you develop the safest plan for you, especially if you need to taper down your dosage. Abruptly discontinuing this drug following chronic use may lead to:
- Depression sometimes accompanied by suicidal ideation
- Sleep issues
- Abdominal pain
- Changes in appetite
- Millichap JG (2010). "Chapter 3: Medications for ADHD". In Millichap JG. Attention Deficit Hyperactivity Disorder Handbook: A Physician's Guide to ADHD (2nd ed.). New York, USA: Springer. pp. 111–113. ISBN 9781441913968.
- Huang YS, Tsai MH (July 2011). "Long-term outcomes with medications for attention-deficit hyperactivity disorder: current status of knowledge". CNS Drugs 25 (7): 539–554. doi:10.2165/11589380-000000000-00000. PMID 21699268.
- "Adderall IR Prescribing Information". United States Food and Drug Administration. Barr Laboratories, Inc. March 2007. pp. 4–5. Retrieved 2 November 2013.
- Heal DJ, Smith SL, Gosden J, Nutt DJ (June 2013). "Amphetamine, past and present – a pharmacological and clinical perspective". Journal of Psychopharmacology 27 (6): 479–496. doi:10.1177/0269881113482532. PMC 3666194. PMID 23539642. Mixed enantiomers/mixed salts amphetamine (3:1 d:l isomers)
Page content reviewed by James Pendleton, ND.