The Adderall Effect on ADHD Symptoms: ADD Medication Overview

What is Adderall?

Adderall is a central nervous system stimulant ADHD medication used to treat:

• inattention
• hyperactivity
• impulsivity
• lack of focus
• disorganization
• forgetfulness
• fidgeting
• excessive talking
• frequent interrupting
• and other symptoms of attention deficit hyperactivity disorder (ADHD or ADD).

Some patients feel that Adderall has less of a drop-off effect than does Ritalin, another stimulant used for treating ADHD, which means fewer side effects as the medication wears off. Also, a dose of Adderall is typically longer lasting than a dose of Ritalin.

Adderall is FDA-approved for children, adolescents, and adults with ADHD to help them control these symptoms. Adderall should be taken only as part of a doctor-supervised treatment plan that may also include diet, exercise, supplements, behavioral therapy, parent training, and school accommodations, among other therapies. Adderall is a mixture of four different amphetamine salts – dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate. The FDA has approved a generic version of both the immediate-release (Adderall IR) and extended-release (Adderall XR) versions.

How Does Adderall work?

How Adderall improves the impairments of ADHD is not known. It was once thought that the mechanism of action involved neurotransmitters in the brain. While this is how Adderall produces its stimulating effects, it does not explain how and why the medication works for ADHD.

Doctors also sometimes prescribe Adderall for other conditions, such as narcolepsy – a sleep disorder whose symptoms include sudden attacks of daytime sleep and excessive sleepiness. Our longest surveillance of the safety of amphetamine (Adderall) comes from following people with narcolepsy for their entire lives. No problems from lifelong use have been reported.

For more information about Adderall, see the FDA Adderall Medication Guide.

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What Adderall dosage works best?

Before taking Adderall, consult with a doctor or pharmacist who can answer questions specific to your dosage or treatment plan.

Take the dosage recommended by your physician. The optimal dose changes through childhood and may go up or down over time. The American Academy of Pediatrics recommends that the dose be reviewed at least once a year. After about the age of 16, the dose usually stays the same for the rest of the person’s life.

How long does Adderall last?

The effects of Adderall XR (extended release) capsules last from seven to 12 hours, depending on a person’s individual chemistry. Most patients require two doses a day. The effects of Adderall IR (immediate release) tablets last four hours or less. Most people have to take three doses each day.

The FDA studied only a single does of XR per day, so that is all they approve taking. Insurance companies do not cover more than one dose of Adderall XR a day.

Most people are very sensitive to the dose of Adderall IR and Adderall XR. A patient can discern a 2 or 3 mg. difference in the dose. The immediate-release version comes in increments of 2.5 mg. in a range from 5 mg. to 30 mg. tablets. The extended-release formulation comes in 5 mg. increments, from 5 mg. to 30 mg.

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You should not change the dose of Adderall, or stop taking it, without talking with your doctor. If you and your clinician decide to stop Adderall, you may do so without tapering off it.

Since the FDA has not studied the use of Adderall IR in children younger than three years of age, or of Adderall XR in children younger than six years of age, the FDA does not approve the use of Adderall XR in these younger age groups.

For more information about dosage, see the National Institute of Health’s Guide.

Is Adderall safe for my child?

Amphetamine, the medication in Adderall, has been on the market for more than 80 years, so there is a lot of research and clinician experience with the use and safety of this ADHD medication for children.

• Three very large studies (more than 1 million people in each study) done by the FDA found no increased risk of cardiovascular problems in people who have taken Adderall (amphetamine) over many years.

• 40 years ago, there was some concern that the stimulant medications, including Adderall, might have the potential to stunt growth with long-term use. Multiple long-term studies that have followed children taking stimulants from age six years to adulthood have found that all of the children attained their full adult height and weight by age 21.

• The FDA lists Adderall IR and XR as Category C in pregnancy. This means that there have been no problems identified in the course of pregnancy, delivery, and post-partum period, and no increased risk of birth defects. The FDA leaves the decision to continue to take medication during pregnancy to the mother and her clinicians when the benefits clearly outweigh the risks.

What are the side effects of Adderall?

Before taking Adderall, you should tell your doctor about any personal or family or personal history of:

• Heart problems
• High blood pressure
• Vision loss
• Stroke
• Mood disorders
• BPD
• Anxiety
• Tic Disorder
• Mental health disorders

Virtually all side effects from taking Adderall are mild and pass quickly in most cases. Tolerance develops to the side effects of Adderall IR and XR in five to seven days. Side effects that persist longer than one week can be quickly managed by lowering the dose or changing to a methylphenidate stimulant. Consult your doctor for help with managing side effects.

Adderall can cause the following side effects:

• Suppressed appetite resulting in weight loss
• Dry mouth
• Irritability
• Stomachaches
• Sleeplessness
• Nervousness
• Agitation
• Dizziness
• Headaches
• Sexual dysfunction in males
• Tremor
• Emotional problems, or restlessness
• Weakness
• Dizziness

Less common side effects include:

• Euphoria
• Cold or flu-like symptoms
• Cough or hoarseness
• Fever or chills
• Unpleasant “metallic” taste
• Fast, pounding, or uneven heartbeats
• Pain or burning during urination
• Talking more than usual
• Mood changes
• Numbness or tingling of skin
• Numbness or pain in fingers and toes
• Tremors or muscle twitches
• Seeing things or exhibiting unusual behavior
• Constipation

This is not a complete list of side effects and considerations. If you notice a possible adverse reaction, contact your doctor or pharmacist.

For more information about potential side effects, see the National Institute of Health’s Guide.

What do I need to know about Adderall abuse and diversion?

People with a history of substance abuse should be careful when taking Adderall. It can be habit-forming. Because Adderall is a stimulant, it is abused by some people who do not need the drug to treat ADHD symptoms. Some people crush the pills and sniff them to achieve a high from the dopamine released. When Adderall is abused, it is almost always an immediate-release formulation. As a result, most clinicians favor the extended-release format when there is concern about either abuse or diversion. Others may use the appetite-suppressing side effect to help lose weight. These abuses can lead to serious health risks, such as heart problems.

To read user reviews and experiences with Adderall, visit our treatment forums.

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Adderall FAQs

Adderall is a “Schedule II Stimulant.” What does that mean?

“Schedule II” is the classification used by the Drug Enforcement Agency (DEA) to indicate drugs with a high potential for abuse. All of the first-line stimulant medications for ADHD are Schedule II drugs because of a concern of potential abuse. These medications were Schedule 4 medications until 1978. Several national organizations have petitioned the DEA to group them under this less-restrictive category without success.

Can I develop a tolerance to Adderall that would lead to an increase in dosage?

While it is possible to develop a tolerance to your current dose of Adderall, it is very uncommon. Usually there are other factors at work. There is no such thing as a high dose or low dose of Adderall. There is only the right dose for each individual at this point in his or her development.

The most important factor is how efficiently the medication is absorbed from the GI tract into the body and how quickly it is eliminated in the urine. Foods that contain large amounts of citric acid and ascorbic acid (vitamin C) will prevent the absorption of both Adderall IR and XR into the body. Fruit juices high in vitamin C, soda drinks, and food with high levels of preservatives should be avoided an hour before and after taking Adderall. High doses of vitamin C (1000 mg., or supplements like Airborne and EmergenC, which contain high amounts of the vitamin) act as an “off” switch by causing virtually all of the amphetamine in the body to be excreted in the urine.

If your current dose is no longer effective as it once was, work with your doctor to discover why. For children under 16, it may be that a higher dose is needed. You may also need to take the medication more than once a day. Discuss these options with your physician.

Can I take Adderall while pregnant or breast feeding?

The U.S. Food and Drug Administration classifies drugs for use in pregnancy into several categories. They are grouped based on information available from human and/or animal studies, and whether that information shows the drug is harmful. Adderall falls into “Pregnancy Category C.” This means that while problems have not been identified with Adderall, there is still not enough information to say, with absolute certainty, that Adderall will or will not harm an unborn child. Category C medications should only be used if the benefits to the mother are greater than any potential risk to the unborn child. Your doctor can help you determine if this is the right choice for you. You should consult with your physician right away before taking any medication – existing or new – during pregnancy.

Adderall is passed through breast milk. The American Academy of Pediatrics recommends that nursing mothers not take any ADHD medication while nursing. They also add that this recommendation is based “on an abundance of caution” because it has never been studied. Your physician can help you decide how to best manage your situation.

For more information, see the National Institute of Health Guide.

Can I take Adderall with other medications?

When managed properly, certain medications can be taken alongside Adderall. You should keep a list of all supplements, prescription, and over-the-counter-products you take, and discuss your treatment plan with your physician and pharmacist to prevent any dangerous drug interactions. Drug interactions can either change the effectiveness of the medication, or put you at risk for dangerous side effects.

You should not take MAO inhibitors while taking Adderall, or two weeks before treatment with Adderall, due to a serious and sometimes fatal interaction.

Amphetamine in Adderall originally came on the market as an over-the-counter decongestant. Certain cough medicines or diet pills contain ingredients that may increase heart rate or blood pressure when taken in combination with Adderall. Additionally, large amounts of caffeine can cause a higher incidence of side effects whether consumed via a beverage, chocolate, or from other over-the-counter medications.

Adderall can cause false test results in certain laboratory tests, such as blood and urine steroid-level tests, or brain scans for Parkinson’s disease. If you are having medical tests, be sure that all physicians and staff are aware of your medication history.

For more information about Adderall and drug interactions, see the FDA Adderall Medication Guide.

Does Adderall cause changes in menstrual cycles, like missed periods?

The published literature on side effects of Ritalin, Dexedrine, and Adderall does not suggest a relationship between Adderall and the menstrual cycle.

However, many women find that their ADHD medication is not as effective in the four to five days before their menstrual flow. Raising the dose of Adderall does not increase its level of benefits. Talk with your doctor about how to measure this loss of effectiveness.

For more information, see our expert response.

How can I convince my children to eat, when appetite-loss is a common side effect?

Suppression of appetite is a side effect of Adderall, and people taking it often lose weight. This side effect is not necessarily dose-related. Loss of appetite is much more common in children who were already thin or picky eaters before taking Adderall.

Strategies for combating appetite-suppression weight loss include:

• Feed your child nutrient-dense foods, like yogurt and peanut butter.
• Fill up on breakfast before medication takes effect. This also helps to moderate blood sugar.
• Serve liquid meals such as high-protein, healthy smoothies.
• Encourage grazing on healthy snacks.
• Give a daily multi-vitamin.
• Limit juice intake.
• Schedule outdoor play before meals to boost appetite.
• Try different foods and new recipes to raise her interest in eating.

For more strategies, see When Meds Suppress Appetite.

How long does it take for Adderall to kick in and start working?

Typically, people will see effects from immediate-release stimulants in just one hour. The medication is effective as soon as it crosses the blood-brain barrier. Since citric and ascorbic acid (vitamin C), in either supplements, juices, or foods can prevent absorption of ADHD stimulant medication, try taking the medication on an empty stomach, and avoid vitamin C an hour before and after taking medication.

For more information about Adderall and drug interactions, see the FDA Adderall Medication Guide.

Why am I not seeing results from taking Adderall?

Only about 70 percent of people get a clear benefit from amphetamine. You may need to increase the dosage. When both amphetamine and methylphenidate are tried, the response rate rises to 88 percent. That means that one in every 12 people will not get the dramatic benefits that are usually seen with first-line ADHD medications. Before you give up hope and try alternative medications, you need to give the standard medications a full try.

If you are not seeing results, your doctor may need to increase the dosage. Generally, adults can change the dose of medication daily until they find the optimal amount. Younger children, however, often lack the ability to tell the physician how the medication is affecting their mood and functioning. For patients under the age of 16, the medication dose should only be raised once a week to allow time for parents and teachers to assess the medication’s effect on symptoms.

Is Adderall habit forming?

Adderall has a high potential for abuse and over-reliance, especially among people who do not have ADHD. The likelihood of physiological dependence for people with ADHD is very minimal when used properly and monitored by a physician.

Once you learn how much these medications help, it might be possible to be psychologically worried that you’ll have problems if you go off the medication. You should discuss your concerns more with your physician.

People with a history of substance abuse should discuss this with their doctors before taking any ADHD medication.

My 17-year old son isn’t taking his Adderall, and is giving it out to friends without ADHD. What should I do?

There is a serious problem of Adderall misuse in high schools and colleges throughout the country. If an individual without ADHD takes this medication, he or she feels a boost of psychological energy and alertness. Students find that they can pull “all-nighters,” whether to study or spend time with friends. This boost is similar to the boost you would get from consuming a lot of caffeine. People may develop magical beliefs about what the ADHD medication does for them and may decide that they “need” the medication, and go to great lengths to get pills.

The first thing to do is to switch to an extended release formulation of Adderall. There is little market for Adderall XR because its onset if gradual and smooth. The “buzz” that abusers seek is directly related to how quickly the medication level rises in the blood. This is why abusers crush Adderall IR and sniff it. When ground up, Adderall XR turns into a paste that does not give much of a buzz.

Sharing or selling prescription medications, especially a controlled substance, is a serious criminal offense, no matter the innocent intent of the adolescent. If the understanding and cooperation of the adolescent cannot be obtained, the only two choices are to 1) have the parent hold and distribute the medication or 2) stop the medication altogether and switch to a non-stimulant medication.

For more information about Adderall and drug abuse, see the FDA Adderall Medication Guide.

Why would someone take Adderall instead of Ritalin?

An individual will almost always have a clear preference for one stimulant over the other, but a doctor cannot tell this in advance. A person has to try each medication to see what each has to offer him. Preference for one medication over the other does not run in families. Because one person in the family responds optimally to Adderall does not mean another family member will respond the same way.

Some patients feel that Adderall has less of a drop-off effect than Ritalin, which means fewer rebound side effects as the medication wears off. Some people experience less or different side effects and drug interactions from different medications. They might experience side effects with Ritalin, and none with Adderall or vice versa.

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William Dodson, M.D., is a member of the ADDitude ADHD Medical Review Panel.

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