DEA Schedule II Control Substance means this drug has a “high potential for abuse” that “may lead to severe psychological or physical dependence,” and the federal government sets limits on the amount that may be manufactured each year.
FDA “Black Box” Warning
The Food and Drug Administration (FDA) requires the following “black box” warning on all amphetamine drugs, including Adderall, which means that medical studies indicate Adderall carries a significant risk of serious, or even life-threatening, adverse effects.
Over time, reduced level of dopamine resulting in Parkinson's-like symptoms
Damage to nerve cells, causing strokes
Effects from Withdrawal:
Fatigue and long periods of sleep
Behaviors resulting from amphetamine intoxication such as withdrawal from others, experiencing hallucinations,
paranoia, delirium perhaps occurring with violence and stereotyped behaviors such as repeatedly assembling and
dissembling electronic equipment may resemble symptoms of schizophrenia. But a skilled clinician should be able to
make the proper diagnosis.
Adderall XR (and Adderall) is a blend of four (4) amphetamines, as shown below.
Each ADDERALL XR Tablet Contains
Dextroamphetamine Sulfate USP
Amphetamine Sulfate USP
Attention deficit disorder
How Does Adderall Work?
Adderall (as with all amphetamines) works by initiating the acute stress response (“fight or flight” response). The central nervous system prepares the body for physical action by creating physiological changes as if it were stressed or under threat. These changes include:
The release of adrenaline, raises cortisol levels and other stress hormones
Increased heart rate and blood pressure
Redirected blood flow into the muscles and away from the brain
In small doses Adderall can banish tiredness and make the user feel alert and refreshed. However, the burst of energy comes at a price. A “speed crash” always follows the high and may leave the person feeling nauseous, irritable, depressed and extremely exhausted.
You have not tried other psychotherapy, have high blood pressure or any form of heart disease, are very nervous or have severe insomnia, have a history of addiction to drugs or alcohol, or have Tourette syndrome. Do not combine with monoamine oxidase inhibitors.
Common Side Effects
Loss of appetite
Difficulty falling asleep (insomnia)
Nervousness including agitation, anxiety and irritability
Less Common Side Effects
High blood pressure
Rapid pulse rate
Tolerance (constant need to raise the dose)
Feelings of suspicion and paranoia
Visual hallucinations (seeing things that are not there)
Dermatoses (infected or diseased skin)
Urinary tract infection
Infection or viral infection
Elevated ALT enzyme levels in the blood (signaling liver damage)
Overdose Side Effects
Adderall has been extensively abused. Extreme psychological dependence and severe social disability have resulted. Abuse of Adderall may cause a sudden heart attack even in those with no signs of heart disease. Symptoms of overdose that require immediate medical assistance include:
Hyperreflexia (overactive reflexes, which can include twitching or spasms)
Symptoms of depression
Seizures or abnormal EEGs
High blood pressure
Rapid heart beat
Swelling of hands/feet/ankles (for example, numbing of the fingertips)
Unexplained muscle pain
Lower abdominal pain
Rhabdomyolysis and kidney damage
Chronic abuse can manifest itself as psychosis, often indistinguishable from schizophrenia
Adderall-Induced Anxiety Disorder
The onset of amphetamine-induced anxiety disorder can occur during amphetamine use or withdrawal, according to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders as cited in the best-selling psychiatry text, Kaplan and Sadock's Synopsis of Psychiatry.
“Amphetamine, as with cocaine, can induce symptoms similar to those seen in obsessive disorder, panic disorder, and phobic disorders,” states Synopsis of Psychiatry.
Induction of schizophrenic-like states in children on prescribed doses of stimulant medications, including Adderall, have been observed, though not as well documented as with amphetamine abusers, according to The Journal of the American Board of Family Medicine in an article entitled, “Adderall-Induced Psychosis in an Adolescent.”
Adderall-Induced Sexual Dysfunction
The American Psychiatric Association’s Manual of Mental Disorders, Synopsis of Psychiatry states: “High doses and long-term use of amphetamines are associated with erectile disorder and other sexual dysfunctions.”
It is possible to build up a tolerance to amphetamines, which means the person using the drug needs to take larger doses to achieve the same effect. Over time, the body might come to depend on amphetamines just to function normally. The person craves the drug and their psychological dependence makes them panic if access is denied, even temporarily.
Withdrawal symptoms can include tiredness, panic attacks, crankiness, extreme hunger, depression and nightmares. Some people experience a pattern of “binge crash” characterized by using continuously for several days without sleep, followed by a period of heavy sleeping.
If It Doesn't Work
The drug should be stopped gradually. Withdrawal symptoms are psychological and stopping suddenly can cause extreme fatigue and severe, even suicidal, depression in adult patients.
If It Does Work
“In the treatment of ADHD for children and young adults, Adderall XR is now prescribed frequently, often as a first-line drug. This is, in my opinion, a very serious mistake,” states Jack M. Gorman, M.D., professor of psychiatry at Columbia University and deputy director of the New York State Psychiatric Institute. “Adderall is now abused throughout college campuses, where it is bought, sold, stolen, borrowed, snorted and injected. It is a very powerful drug that undoubtedly works for ADHD, but there are alternatives with less abuse potential that should be tried first.”
20 Sudden Deaths Linked to Adderall XR
as reported by Associated Press (February 10, 2005)
Adderall XR, a widely used drug for attention deficit hyperactivity disorder, was pulled off the market in Canada after regulators linked the drug to 20 sudden deaths and 12 strokes. Fourteen of the deaths and two of the 12 strokes were in children.
The adverse reactions were not associated with overdose, misuse or abuse of Adderall XR, Canadian regulators said.
The U.S. Food and Drug Administration issued a public health advisory to alert providers to the withdrawal. But the agency also said it had evaluated the same reports as Canadian regulators and did not think the data warranted pulling the drug from the U.S. market.
NY Times: Children's A.D.D. Drugs Don't Work Long-Term
The NY Times, in an op-ed article by L. Alan Sroufe, a professor emeritus of psychology at the University of Minnesota's Institute of Child Development, stated the following:
“Attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams. But when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects... Many parents who take their children off the drugs find that behavior worsens, which most likely confirms their belief that the drugs work. But the behavior worsens because the children's bodies have become adapted to the drug. Adults may have similar reactions if they suddenly cut back on coffee, or stop smoking.”
Parents might want to consider another approach.
ABOVE: L. Alan Sroufe, “Ritalin Gone Wrong: Children's A.D.D. Drugs Don't Work Long-Term,” New York Times, pg SR1, NY ed, 1/28/2012.
What are the differences between the various Amphetamines?
What is the most important information I should know about ADDERALL XR?
The following have been reported with use of ADDERALL XR and other stimulant medicines.
1. Heart-related problems:
sudden death in patients who have heart problems or heart defects
stroke and heart attack in adults
increased blood pressure and heart rate
Tell your doctor if you or your child have any heart problems, heart defects, high
blood pressure, or a family history of these problems.
Your doctor should check you or your child carefully for heart problems before
starting ADDERALL XR.
Your doctor should check you or your child's blood pressure and heart rate
regularly during treatment with ADDERALL XR.
Call your doctor right away if you or your child has any signs of heart
problems such as chest pain, shortness of breath, or fainting while
taking ADDERALL XR.
2. Mental (Psychiatric) problems:
new or worse behavior and thought problems
new or worse bipolar illness
new or worse aggressive behavior or hostility
Children and Teenagers
new psychotic symptoms (such as hearing voices, believing things that
are not true, are suspicious) or new manic symptoms
Tell your doctor about any mental problems you or your child have, or about a
family history of suicide, bipolar illness, or depression.
Call your doctor right away if you or your child have any new or
worsening mental symptoms or problems while taking ADDERALL XR, especially seeing or hearing things that are not real, believing things that
are not real, or are suspicious.
Stimulant drugs may have subtle impacts on cognitive and intellectual processes. Both parents and researchers have noticed that children taking Ritalin sometimes answer questions
in ways that seem overly compliant or narrow, suggesting the drug might restrict creative thinking. One study found hyperactive children taking Ritalin offered less varied answers to open-ended questions.
How much do the “neuro-enhancing” drugs really help? And there's the question of what we mean by “smarter.”
The psycho-stimulants help students bear down on their work, but with odd effects. One college student says he spends “too much time researching a paper rather than actually writing it.” Another student looked back at papers he'd written while on Adderall and found them verbose: “I'd produce two pages on something that could be said in a couple of sentences.”
Could enhancing one kind of thinking exact a toll on others?
All these questions need proper scientific answers, but for now much of the discussion is taking place furtively, among an increasing number of Americans who are performing daily experiments on their own brains (or their children's brains).
ABOVE: Diller, L.H. Running on Ritalin: A Physician Reflects on Children, Society, and Performance in a Pill; Bantam Doubleday Dell Pub. Group, Inc. (1998); citing
Feidler, N.L., et al., “The effects of stimulant drugs on curiosity behaviors of hyperactive boys,” Journal of Abnormal Child Psychology, 11:193-206 (1983). Talbot, M. “Brain Gain: The underground world of
‘neuroenhancing’ drugs,” The New Yorker, 4/2009.
Although Vyvanse is referred to as “pro-drug” of dextroamphetamine, it's still an amphetamine, meaning that it's easily abused and can cause insomnia, agitation, anxiety and sometimes psychotic symptoms like seeing things or becoming paranoid. [More]
Many think methylphenidate (Ritalin) is safe, or mild, because so many children use it. However, the government classifies the psychoactive drug with cocaine and morphine because it's highly addictive. [More]
Drug Enforcement Administration, US Department of Justice. “Amphetamines,” Drugs of Abuse Publication. National Drug Intelligence Center, 2005 ed.
Drug Enforcement Administration, US Department of Justice. “Drug Fact Sheet: Amphetamines,” undated, retrieved January 5, 2013: justice .gov/dea/ druginfo/ drug_data_sheets/ Amphetamines.pdf.
National Institute of Mental Health. Medications. Bethesda, MD: National Institute of Mental Health,
National Institutes of Health, US Department of Health and Human Services; NIH Publication No. 02-3929, 2007 ed.
Australian Drug Foundation, Victorian Minister for Health. “Amphetamines Fact Sheet,” 2007 ed.: betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf /pages/Amphetamines.
Johns Hopkins Medicine, Health Alerts, “Heart Attack: Symptoms and Remedies”: johnshopkinshealthalerts.com/symptoms_remedies/ heart_attack/83-1.html#3 (2008).
U.S. Food and Drug Association, Center for Drug Evaluation and Research. “Public Health Advisory for Adderall and Adderall XR,” 02/09/2005.
Adderall XR Medication Guide, Rev. 03/2009.
Sadock, B.J., et al. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry (Synopsis of Psychiatry), 10th ed. Philadelphia, PA; Lippincott Williams & Wilkins, 2007.
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC, 2000, as cited above.
S., L.K., et al. “Adderall-Induced Psychosis in an Adolescent,” The Journal of the American Board of Family Medicine. Vol. 15 No. 6, Nov-Dec 02.
Gorman, Jack M. The Essential Guide to Psychiatric Drugs—Rev. and updated, 4th ed. New York, NY: St. Martin's Press, 2007.
Westover AN, Nakonezny PA. “Aortic dissection in young adults who abuse amphetamines.” Am Heart J 2010; 160:315-321.
Seppa N. “Amphetamine abusers face blood vessel risk,” Science News, Web ed. Aug. 23, 2010: sciencenews .org.
National Institutes of Health. “Aortic dissection: Aortic aneurysm - dissecting” PubMed Health, produced by the National Center for Biotechnology Information, a division of the National Library of Medicine at the National Institutes of Health, dated 5/4/2010: ncbi.nlm.nih.gov/pubmedhealth/ PMH0001233/
Isselbacher, EM; Eagle KA, Zipes DP, et al. “Diseases of the aorta”. In Braunwald. Heart disease: a textbook of cardiovascular medicine (5th ed.). Philadelphia: WB Saunders, pp. 1546:81, 1997.
Abreu BE, et al. Influence of amphetamine sulfate on cerebral metabolism and blood flow in man. J Pharm Sci, 1949;38:186–188.
Lombard J, et al. The Brain Wellness Plan; Kensington Pub. Corp., 1998.
Mazza M, et al. Primary cerebral blood flow deficiency and Alzheimer's disease: shadows and lights. Journal of Alzheimer's Disease 2011;23(3):375-89.
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