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Adderall side effects and how to avoid them

Decreased appetite, dry mouth, and trouble sleeping are common Adderall side effects, which are usually temporary. However, long-term use of Adderall could cause some more lasting side effects.
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By | Apr. 14, 2021 Medically reviewed by Gerardo Sison, Pharm.D.
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Key takeaways

  • Common side effects of Adderall include decreased appetite, dry mouth, trouble sleeping, stomach ache, headache, nervousness, weight loss, mood swings, anxiety, agitation, nausea, vomiting, dizziness, diarrhea, fast heartbeat, lack of energy, and constipation.

  • Serious side effects of Adderall can include heart-related problems, mental health issues, aggressive behavior, seizures, peripheral vasculopathy, eyesight changes, serotonin syndrome, growth suppression in children, and potentially severe allergic reactions.

  • Adderall withdrawal symptoms can occur if the drug is stopped suddenly after high doses or prolonged use. Symptoms may include depression, fatigue, increased appetite, agitation, and sleep disturbances. These symptoms typically begin within 24 hours and potentially last for about three weeks.

  • To minimize Adderall side effects, it’s recommended to take the medication as directed, avoid late doses to prevent sleeplessness, disclose all medical conditions and medications to the doctor, limit intake of other stimulants, avoid antacids, practice good sleep hygiene, and consider medication holidays under medical advice.

Adderall side effects | Serious side effects | How long do side effects last? | Warnings | Interactions | How to avoid side effects

Adderall is a central nervous system stimulant that treats the hyperactive-impulsive and inattentive symptoms of ADHD (attention deficit hyperactivity disorder) in adults and children as young as 3 years old. It is also prescribed to alleviate daytime sleepiness in adults and children 6 years and older diagnosed with narcolepsy. 

The active ingredients in Adderall are amphetamine salts. Adderall XR contains the same mixture of amphetamine salts in an extended-release oral capsule. Like all stimulants, Adderall has several side effects, warnings, restrictions, and drug interactions that patients or their caregivers should be familiar with when taking or administering this medication.

RELATED: Learn more about Adderall

Common side effects of Adderall

The most common side effects of Adderall are:

  • Decreased appetite
  • Dry mouth
  • Trouble sleeping
  • Stomach ache
  • Headache
  • Nervousness
  • Weight loss
  • Mood swings
  • Anxiety
  • Agitation
  • Nausea
  • Vomiting
  • Dizziness
  • Diarrhea
  • Fast heartbeat (tachycardia)
  • Lack of energy
  • Constipation

Weight loss

Loss of appetite and weight loss are possible side effects of Adderall. Because of these side effects, some physicians prescribe Adderall off-label for weight loss, and some people acquire the drug illegally for the same purpose. However, Adderall is not approved by the FDA as a weight-loss medication and can have serious side effects that outweigh the benefits of weight loss.

Anxiety

In Adderall XR clinical trials, anxiety was reported in 8% of adults, but not reported for children or adolescents. Anxiety is also a possible sign of Adderall abuse. Severe anxiety or panic attacks may require the discontinuation of Adderall treatment.

Serious side effects of Adderall

Because Adderall changes how the brain works, the drug can produce several serious side effects even at recommended doses. These include:

  • Heart-related problems such as increased blood pressure and heart rate, which can increase the risk of heart attacks, strokes, and sudden death (mostly in people with heart problems or heart defects)
  • Mental health problems such as the worsening or emergence of psychosis, mania, or tics
  • Aggressive behavior
  • Seizures
  • Peripheral vasculopathy (blood vessel damage), including Raynaud’s disease
  • Eyesight changes
  • Serotonin syndrome, or a rare but potentially life-threatening condition when drugs like Adderall are combined with other drugs that increase levels of serotonin in the brain
  • Growth suppression in children and adolescents
  • Potentially severe allergic reactions

Adderall withdrawal

When Adderall is taken in high doses over a prolonged period, stopping the drug suddenly can cause adverse effects such as depression, fatigue, increased appetite, agitation, slowness, sleeping too much, or trouble sleeping. Nicknamed “Adderall crash,” these symptoms are actually amphetamine withdrawal symptoms. Initial withdrawal symptoms typically begin within 24 hours of stopping amphetamines and can persist as less severe symptoms for about three weeks. To avoid withdrawal, a prescribing physician or healthcare professional may steadily reduce the Adderall dose until the drug can be safely discontinued.

Anxiety

In Adderall XR clinical trials, anxiety was reported in 8% of adults, but not reported for children or adolescents. Anxiety is also a possible sign of Adderall abuse. Severe anxiety or panic attacks may require the discontinuation of Adderall treatment.

Other side effects

Sexual side effects

Amphetamines can decrease sex drive and even cause impotence (erectile dysfunction). Both effects were reported by 2% to 4% of adults participating in Adderall XR clinical trials. Alternative medications, such as Ritalin (methylphenidate) for ADHD and the narcolepsy drugs modafinil and armodafinil may be less likely to cause a decrease in libido. Vyvanse (lisdexamfetamine dimesylate) can cause similar sexual side effects as Adderall, and Strattera (atomoxetine), another ADHD drug, may also cause sexual side effects. 

Dependency, abuse, and misuse

Adderall and Adderall XR are both Schedule II controlled substances because of their potential for drug abuse and dependency. Adderall is sometimes misused as a weight loss aid or “study drug” by high-school and college students. Prolonged high doses of Adderall can cause dependency and withdrawal symptoms when withdrawn suddenly.

How long do Adderall side effects last?

Side effects of Adderall are usually temporary, and they often go away with consistent use of the medication or when the medicine is discontinued. Some severe side effects such as heart-related problems could lead to life-threatening events like heart attacks and strokes. Although rare, the effects of growth suppression in children and adolescents could last a lifetime if the drug is not discontinued.

The long-term use of Adderall may lead to heart muscle disease (cardiomyopathy), brain chemistry changes, or drug abuse. Heart and brain damage have been well-documented in people abusing amphetamines over a prolonged period but have not been well-studied in people taking amphetamines at therapeutic doses. There is some concern that long-term therapeutic use of amphetamines may be a “gateway” to illicit drug use, but the evidence is not conclusive. Taking Adderall under the supervision of a doctor and with a valid prescription generally does not result in brain damage or substance abuse. 

Adderall contraindications & warnings

Like all prescription drugs, Adderall and Adderall XR are not appropriate or safe for everyone. The amphetamines in Adderall can worsen existing medical conditions such as high blood pressure, heart problems, and psychotic disorders, such as bipolar disorder or Tourette’s syndrome. For these reasons, Adderall and Adderall XR are contraindicated for people with:

  • Advanced arteriosclerosis
  • Moderate to severe high blood pressure
  • Symptomatic cardiovascular disease
  • Glaucoma
  • Hyperthyroidism (overactive thyroid)
  • Agitated states
  • Patients with a history of drug abuse 
  • Know hypersensitivity to amphetamines

Adderall should be used with caution in people with:

  • A history of seizures or who have had an abnormal brain wave test (EEG)
  • Mental health conditions such as psychosis, bipolar disorder, or Tourette syndrome
  • High blood pressure
  • Kidney problems
  • A history of circulation problems in the fingers and toes

Adderall withdrawal

When Adderall is taken in high doses over a prolonged period, stopping the drug suddenly can cause adverse effects such as depression, fatigue, increased appetite, agitation, slowness, sleeping too much, or trouble sleeping. Nicknamed “Adderall crash,” these symptoms are actually amphetamine withdrawal symptoms. Initial withdrawal symptoms typically begin within 24 hours of stopping amphetamines and can persist as less severe symptoms for about three weeks. To avoid withdrawal, a prescribing physician or healthcare professional may steadily reduce the Adderall dose until the drug can be safely discontinued.

Overdose

Adderall carries the risk for overdose in part because of its potential for drug abuse or misuse. The maximum recommended daily dose of Adderall is 40 mg a day for ADHD and 60 mg a day for narcolepsy, but symptoms of an overdose can occur at lower doses. These symptoms include:

  • Restlessness
  • Tremor
  • Fast breathing
  • Overactive reflexes
  • Confusion
  • Aggression
  • Hallucinations
  • Panic
  • High fever
  • Nausea and vomiting
  • Abdominal cramps
  • Muscle pain 
  • High or low blood pressure
  • Irregular heartbeat

A fatal overdose is often preceded by convulsions and coma. If an overdose is suspected, call a poison helpline or go to an emergency room.

Children

Adderall has been FDA approved for children between the ages of 3 and 17 for the treatment of ADHD and for children older than 6 diagnosed with narcolepsy. Adderall XR, however, is only approved for children between the ages of 6 and older. Unfortunately, the long-term effects of the pediatric use of amphetamines have not been well-studied. 

One significant and common side effect of Adderall is the suppression of growth in children. Over time, children taking Adderall may gain less weight and height than other children. Falling behind on growth is one reason Adderall may be discontinued in children.

Pregnancy

The safety of Adderall in pregnant women has not been fully established, but the drug may cause premature birth, low birth weight, and amphetamine withdrawal symptoms in a newborn. Women who are pregnant or considering pregnancy should discuss the benefits and possible risks of taking Adderall during pregnancy. Pregnant women taking Adderall or Adderall XR may choose to join the National Pregnancy Registry for Psychiatric Medications to help track Adderall’s effects on pregnancy.

Breastfeeding

Nursing women should avoid taking Adderall or Adderall XR while breastfeeding. The amphetamines in Adderall can be present in breast milk at anywhere from 2% to 14% of the dose taken. Adverse effects on nursing babies have not been well-documented, but there is a possibility the infant may experience serious cardiovascular side effects or other adverse effects.

Senior citizens

The use of Adderall in people older than 65 has not been studied.

Adderall interactions

Adderall has several drug interactions patients or caregivers should review before taking or administering Adderall.

  • Monoamine oxidase inhibitors (MAOIs)—CONTRAINDICATED: MAO inhibitors are a small family of prescription medications that treat depression (isocarboxazid, tranylcypromine, and phenelzine), bacterial infections (linezolid or tedizolid), cancer (procarbazine), Parkinson’s disease (selegiline and safinamide), or are used for medical imaging (methylene blue). Adderall should never be taken within 14 days of the last dose of an MAO inhibitor. The combination can cause a potentially fatal rise in blood pressure or result in serotonin syndrome, a potentially hazardous drug reaction that occurs when too much serotonin persists in the brain. 
  • Serotonergic drugs: Serotonergic drugs raise serotonin levels in the brain. Adderall is a serotonergic drug. Combining two or more serotonergic drugs raises the risk of serotonin syndrome. Serotonergic drugs that should be avoided or used cautiously with Adderall include certain antidepressants, antipsychotic medications, mood stabilizers, other stimulants, opioids, migraine medications, antinausea drugs, seizure medications, and drugs that treat the symptoms of Parkinson’s disease. Some of these drugs, when combined with Adderall, may increase the risk of seizures.
  • Stimulants: The amphetamines in Adderall are classified as stimulants. They “speed up” the brain, causing possible side effects such as high blood pressure, fast heartbeat, and anxiety. Combining Adderall with other stimulants, such as caffeine, amphetamines, nasal decongestants, bronchodilators, and appetite suppressants may increase the likelihood or severity of side effects. 
  • Sympathomimetics: The amphetamines in Adderall are also sympathomimetic drugs, which stimulate sympathetic nerves responsible for regulating blood pressure, heart rate, and sweating. Taking Adderall with other sympathomimetic medications such as other amphetamines, decongestants, and weight loss medications (including phentermine, phendimetrazine, diethylpropion, and benzphetamine all of which are contraindicated) can increase the risk of cardiovascular side effects. 
  • Tricyclic antidepressants: Tricyclic antidepressants can cause a sharp increase in the concentration of dextroamphetamine in the brain, raising the risk of cardiovascular events.
  • Blood pressure medications (antihypertensives): Because one of the side effects of Adderall is high blood pressure, Adderall can reduce the beneficial effects of blood pressure lowering medications.
  • Glaucoma medications: The amphetamines in Adderall also increase pressure in the eye, blunting the positive effects of glaucoma medications. 
  • Adrenergic blockers: Sometimes called alpha blockers and beta blockers, adrenergic blockers interfere with nerve signals to muscles in the heart and blood vessels. They are used to treat high blood pressure, chest pain, and irregular heartbeats. The amphetamines in Adderall can counteract the action of these drugs, reducing their important and life-saving benefits.
  • CYP2D6 inhibitors: Several types of drugs, called CYP2D6 inhibitors, block the liver enzyme (CYP2D6) the body uses to break down Adderall. The most potent include some selective serotonin reuptake inhibitors (SSRIs), certain antiviral drugs, and quinidine. Healthcare professionals are well-versed in these drugs, so always tell a doctor, pharmacist, or other healthcare provider about any medications being taken when getting a prescription.
  • Acidifying agents: Drugs or foods that increase stomach acid or urinary acid can decrease the concentration of Adderall in the blood. While not strictly forbidden, acidifiers may make Adderall less effective as a therapy.
  • Alkalinizing agents: Drugs that decrease stomach acid or urinary acid can increase the concentration of Adderall in the blood, raising the risk of side effects. Certain alkalinizing drugs, like antacids, some thiazides, and urinary alkalinizing agents, should be avoided when taking Adderall.

This may not be a complete list of possible drug interactions with Adderall. 

How to avoid Adderall side effects

People taking Adderall commonly experience side effects, particularly loss of appetite, dry mouth, and trouble sleeping. There are, however, potentially more worrisome but rare side effects such as elevated blood pressure or fast heartbeats patients or caregivers may be concerned about. A few tips can help reduce or prevent side effects:

1.  Take Adderall as directed

Take the dose as prescribed and read the medication guide or patient instructions that come with the medicine. For maximum benefit, take Adderall daily unless directed otherwise. Adderall can be taken with or without food. However, foods that increase stomach acid, such as citrus juice, may decrease the body’s absorption of the drug, decreasing its effectiveness. Above all, do not increase the dose or use the medication for another purpose, such as weight loss or studying. 

2.  Take the first dose of Adderall right after waking up in the morning

The first Adderall dose should be taken upon waking in the morning. Adderall XR should only be taken in the morning.

3.  Do not take a late dose of Adderall

To prevent sleeplessness, a common complaint of Adderall users, avoid taking doses late in the afternoon or early evening. Adderall XR should not be taken in the afternoon.

4.  Tell your doctor about all medical conditions and medications

Because of the risk of side effects, you should tell your prescribing doctor or healthcare provider about:

  • Any medical conditions, such as heart, circulation, or blood pressure problems, as well as an overactive thyroid or a history of seizures
  • Psychiatric conditions, especially schizophrenia, bipolar disorder, or Tourette’s syndrome
  • Any history of substance abuse 
  • All medications, over-the-counter medications, supplements, and remedies being taken

5.  Avoid taking other stimulants

Other types of stimulants, like caffeine and nasal decongestants, may worsen Adderall’s side effects, so use them conservatively.

6.  Avoid antacids and other alkalinizing agents

Substances that reduce stomach or urinary acid can increase the risk of Adderall’s side effects. The most common alkalinizing agents are antacids. They should be avoided outright when taking Adderall.

7.  Practice good sleep hygiene

Insomnia is one of the most common side effects of Adderall. One area to consider in overcoming amphetamine-induced sleeplessness is good sleep hygiene—go to bed at the same time each night, relax before bedtime, avoid overstimulation, take a break from devices immediately before bed, exercise every day, and maintain a sleep log to track what works and what doesn’t.

8.  Take a medication holiday

When Adderall side effects become a problem, many healthcare providers suggest taking a “medication holiday” when the medication is discontinued or the dose reduced for a few days, a few weeks, or even a few months. However, get professional medical advice first. Taking a medication holiday may not be appropriate for some people. 

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