Side Effects of Adderall

Adderall is a brand name of a central nervous system (CNS) stimulant medication composed of four amphetamine salts, amphetamine sulfate, amphetamine aspartate, dextroamphetamine sulfate and dextroamphetamine saccharate. Adderall XR is another brand name for the same drug.

Adderall was approved by the US Food and Drug Administration (FDA) for the treatment of narcolepsy and Attention Deficit Hyperactivity Disorder (ADHD).

Narcolepsy is a sleep disorder, in which the patients experiences excessive daytime sleepiness (EDS), hypnagogic hallucinations (dream-like sensations that is seen, heard, or felt and occur near the start of sleeping or upon awakening), sleep paralysis (transient loss of speech or movement that occur near the start of sleeping or upon awakening) and cataplexy (abrupt loss of muscle tone with subsequent transient paralysis, slurred speech, or postural collapse). The above mentioned classic criteria of narcolepsy are usually referred to as the “tetrad of narcolepsy”.

ADHD is a nervous disease that usually affects children during the primary school years and characterized by inattention and abnormal behaviors, such as hyperactivity and impulsivity.

For adult patients with narcolepsy, Adderall is usually given at an initial dose of 10 mg orally every day before noon. The dose may be increased every week by 10 mg until satisfactory response is obtained. The dose can be divided at 4 to 6 hours intervals.

For ADHD in children ages 3 to 5, Adderall is usually started at 2.5 mg orally every day before noon. The dose may be increased every week by 2.5 mg until satisfactory response is obtained The dose can be divided at 4 to 6 hours intervals.

Common Adderall side effects include headache, nervousness, abdominal pain, loss of weight, nausea, vomiting, diarrhea, dry mouth, trouble sleeping and burring of vision.

Adderall should not be taken late in the evening because of the resulting insomnia (difficulty sleeping) and other sleep disorders.

Adderall is also used off-label for treatment of exogenous obesity (obesity due to over eating), altered sleep patters and depression resistant to treatment.

Black Box Warnings:
Adderall can be abused. Severe tolerance, psychological dependence and social disability have been associated with non-therapeutic use of patients who have increased their adderall dosage higher than recommended. Misuse of Adderall can lead to severe cardiovascular system (CVS) side effects and sudden death.

Common Adderall Side Effects:
Central Nervous System (CNS):
Headache
Emotional lability
Nervousness
Dyskinesia (disorders of voluntary movements of limbs, head and trunk)
Tremors (involuntary shaking movements)
Aggravation of motor and involuntary movements (tics)
Restlessness
Overstimulation

Cardiovascular System (CVS):
Hypertension (elevation of blood pressure)
Palpitations (feeling of having irregular or rapid heart beats)
Tachycardia (rapid heart beats)

Gastrointestinal Tract (GIT):
Abdominal pain
Anorexia (reduced appetite)
Loss of weight
Nausea
Vomiting
Dry mouth
Unpleasant taste
Asthenia (loss of energy and strength)
Diarrhea, or constipation
Dyspepsia (disturbed digestion)

Genital System:
Changes in libido (sexual drive)
Impotence (erectile dysfunction)

Others:
Visual disturbances, such as blurred vision
Dizziness (feeling of unsteadiness)

Serious Adderall Side Effects:
Central Nervous System (CNS):
Dependency
Psychosis (behavioral and mental disorders)
Depression
Mania (abnormal and persistent elevated or irritable mood)
With abrupt discontinuation, sudden withdrawal symptoms may occur, such as fatigue, depression, irritability, severe insomnia and personality changes.
Aggressive behavior
Tourette syndrome (neurological disorder characterized by involuntary movement “motor tics” and vocalizations “vocal or phonic tics”)
Seizures (convulsions)
Stroke (sudden death of a part of the brain cells due to reduction in the blood supply)

Cardiovascular System (CVS):
Severe hypertension (severe elevation of blood pressure)
Myocardial infarction (death of a part of the heart muscle due to sudden reduction in the blood supply)
With long-term use, cardiomyopathy may occur (weakness of the muscle of the heart)

Allergic reactions:
Anaphylaxis (life-threatening allergic reaction with rapid onset)
Angioedema (painful swelling of the blood vessels beneath the skin)
Steven-Johnson syndrome (serious inflammation of the skin and mucous membranes)
Toxic epidermal necrosis (life-threatening condition characterized by detachment of the outmost layer of the skin)

Others:
Sudden death
Long-term used in children ages 7 to 10 years may lead to growth retardation

Adderall Contraindications, Cautions, and Drug Interactions:
Adderall is absolutely contraindicated in patients with a history of hypersensitivity to it.

Adderall should be used with cautions in patients with any of the following disorders:
History of drug abuse
Cardiovascular diseases or history of cardiovascular diseases
Advanced arteriosclerosis (loss of elasticity, hardening and thickening of the arterial walls)
Anomalies of the cardiac structures
Cardiomyopathy (weakness of the muscle of the heart)
Severe arrhythmias
Moderate to severe hypertension
Hyperthyroidism (overactive thyroid gland)
Glaucoma (eye disease characterizes by elevated pressure inside the eyes and can lead to blindness)
Agitation
Bipolar disorders (mood disorder characterized by mood swings from depressive to manic)
Psychosis (behavioral and mental disorders)
Tourette syndrome or tics
Seizure or history of seizures

It is contraindicated to use Adderall with any of the following medications at the same time:
Non-selective monoamine oxidase inhibitors (MAOIs)
Anorexiants (medications that reduce appetite)
Sibutramine (medication used for treatment of obesity)

The above mentioned contraindications, cautions and interactions of Adderall are the most common ones. For a specific concern consult your pharmacist or physician and for a complete list, see the manufacturer’s prescriber guidelines.

Pharmacology:
The definitive mechanism of action of Adderall is unknown. It is thought to work through increasing release and blocking reuptake of norepinephrine and dopamine in the brain. Norepinephrine and dopamine are brain chemical responsible for elevation of mood and alertness.

Adderall is metabolized in the liver by the enzyme CYP450. Its plasma half-life ranges from 9 to 14 hours.

Adderall is excreted in the urine. Drugs that alter urinary and gastrointestinal pH levels, such as vitamin C, antacids, ammonium chloride (NH4CL) and sodium bicarbonate (NaHCO3) will cause variations in the absorption and excretion of Adderall.

Pregnancy and Lactation:
Adderall has been assigned to pregnancy category C medication by the FDA, meaning that receiving Adderall during pregnancy may not be safe. Animal studies showed that administration of Adderall to pregnant rates and mice is associated with fetal malformation and death.

Adderal is excreted in the breast milk. Safety of Adderall during breastfeeding may vary with different dosing or populations.

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