What to Know About Adderall XR

A Stimulant Used to Treat ADHD

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Adderall XR is a central nervous system (CNS) stimulant most commonly used to treat attention-deficit/hyperactivity disorder (ADHD). Taken as an oral capsule, this medication works by altering norepinephrine and dopamine in the brain. It can increase concentration, help people stay on task longer, and manage behavioral issues associated with ADHD.

Adderall XR is the extended-release version of Adderall. Half the dose takes effect immediately, and the other half takes effect in about four hours.

The generic version is called amphetamine salt combo XR, and is made up of a combination of amphetamine and dextroamphetamine salts.

Uses

Adderall XR is only FDA-approved to treat ADHD (notably, the immediate-release version of the medication is also approved to treat narcolepsy). It may be prescribed for use in children age 6 to 12, adolescents age 13 to 17, and adults.

Off-Label Uses

While Adderall XR is only approved to treat ADHD, some research indicates it may be useful in treating children who have ADHD and oppositional defiant disorder (ODD). Stimulants, in general, may be used as an adjunct for treatment-resistant depression, though the research is not clear on their efficacy.

Due to some of its side effects, like improved focus and weight loss, Adderall and Adderall XR have gained reputations as recreational drugs. It's important to note that these medications should not be taken without a doctor's supervision, as they can be habit-forming, and they carry their own set of risks and contraindications.

Before Taking

A prescription for Adderall XR will likely involve being evaluated for ADHD. If your child is 16 years old or younger and is being examined for the condition, their doctor will look for symptoms of inattention like:

  • Failing to listen when spoken to
  • Making careless mistakes or failing to pay attention to their schoolwork or other tasks
  • Frequently losing things they need
  • Struggling to keep their attention on tasks they're working on
  • Being distracted easily
  • Struggling to follow through on instructions
  • Failing to finish schoolwork or chores
  • Frequently forgetting things
  • Avoiding or feeling reluctant to do tasks that require sustained mental effort

Your child's doctor will check for symptoms of hyperactivity and impulsivity, which can include:

  • Failing to remain seated
  • Talking excessively
  • Fidgeting, squirming, or tapping hands or feet
  • Struggling to wait
  • Blurting out answers
  • Interrupting others
  • Running or climbing at inappropriate times
  • Struggling to remain quiet while playing
  • Acting as if they're always "on the go"

Before making a diagnosis of ADHD, a doctor will also need to determine if your child:

  • Shows six or more symptoms of inattention and hyperactivity-impulsivity
  • First experienced those symptoms before age 7
  • Has had these symptoms for at least six months
  • Notices their symptoms in two or more settings (like in school and at home)
  • Is having trouble functioning in social situations or at school
  • Has another mental condition that could explain their condition

These diagnostic criteria differ for adolescents age 17 and older and in adults. In those cases, five of these symptoms are enough to make a diagnosis, and some symptoms may look very different in an adult compared to a child. Hyperactivity in an adult, for example, may involve reckless driving and fidgeting during meetings, and adults with ADHD may find themselves drawn to active jobs that don't require long periods of sitting or being still.

There isn’t a single diagnostic test for ADHD. A diagnosis requires the use of medical, psychological, educational, and social resources, and it's made based on your doctor's evaluation and on your or your child's history.

Adderall XR isn't intended to act as the sole treatment for someone with ADHD. This medication is often coupled with psychological, social, and/or educational interventions intended to help someone learn how to cope with their ADHD symptoms. In fact, your doctor may recommend trying to implement those interventions first before prescribing Adderall XR.

Patients who are taking divided doses of immediate-release Adderall (such as twice daily) may be switched to Adderall XR at the same total daily dose taken once daily. Adderall XR is titrated at weekly intervals to ensure that it’s well-tolerated. Your doctor should regularly reevaluate your prescription to ensure its long-term usefulness for reducing your symptoms.

Talk to your doctor about all medications, supplements, and vitamins that you currently take. While some drugs pose minor interaction risks, others may outright contraindicate use or prompt careful consideration as to whether the pros of treatment outweigh the cons in your case.

Diagnosing ADHD requires a variety of resources and a comprehensive patient history and evaluation, and Adderall XR should be used as part of a total treatment plan. Other treatment measures may include psychological, educational, and social support.

Precautions and Contraindications

Non-drug interventions are often helpful for people with ADHD, and medication should only be used when those interventions fail to resolve symptoms. Your doctor's willingness to consider stimulant medication may depend on how chronic and severe your symptoms are. Amphetamines carry a risk of overdosage, so the smallest amount possible should always be prescribed.

Adderall XR should not be taken by people with:

  • Advanced arteriosclerosis
  • Glaucoma
  • History of agitated states
  • History of drug abuse
  • Hypersensitivity to stimulants (which can show up as serious skin rashes, anaphylaxis, or angioedema, which is rapid swelling under the skin)
  • Hyperthyroidism
  • Moderate to severe hypertension
  • Symptomatic cardiovascular disease

Adderall XR should also be avoided if you’ve taken monoamine oxidase inhibitors (MAOIs) within the last 14 days.

Stimulant medications can increase blood pressure and average heart rate. While some people may experience larger increases, on average, this amounts to a 2 to 4 mmHg increase in blood pressure and an increased heart rate of approximately three to six beats per minute. Alone, these increases aren't likely to lead to serious consequences, but people taking stimulants should be monitored for larger changes in blood pressure and heart rate.

Extra caution may be warranted for people with certain underlying cardiovascular conditions, like:

  • Heart failure
  • Pre-existing hypertension
  • Recent heart attack
  • Ventricular arrhythmia

Before starting Adderall XR, your doctor should complete an assessment to check for any family history of sudden death or ventricular arrhythmia and conduct a thorough physical exam to check for cardiac disease.

Anyone currently taking a stimulant should undergo an immediate cardiac evaluation if they experience symptoms like:

  • Chest pain as a result of exertion
  • Unexplained fainting (known as syncope)
  • Other symptoms that could suggest cardiac problems

Stimulants may also carry risks for people with pre-existing mental health conditions. These can include:

  • A history of psychosis or a psychotic disorder, as stimulants may exacerbate symptoms
  • Bipolar disorder, as these medications could induce a manic or "mixed" episode, which includes depressive and manic symptoms simultaneously

Before beginning any stimulant, it's important that you or your child are screened thoroughly for the presence of any existing psychiatric condition, particularly psychosis and bipolar disorder.

Stimulants also carry a low risk (about 0.1%) of causing psychotic or manic symptoms in children or adolescents without a prior history of those conditions. Symptoms may include:

  • Hallucinations
  • Delusions
  • Manic episodes

If symptoms occur, discontinuation of treatment may be appropriate.

Aggressive behavior is a common symptom seen in children with ADHD. Although there is no evidence that stimulants cause aggressive behavior or hostility, patients who are starting treatment for ADHD should be monitored for increased aggression or hostility.

Adderall XR carries other risks that you should be aware of. For instance:

  • Stimulant use may impact growth in children. If your child is taking Adderall XR and isn't growing or gaining weight, you may need to check with their doctor on interrupting their treatment.
  • These medications can be problematic for people with seizures. Stimulants may increase the likelihood of a seizure for people with a prior history of them, with established electroencephalogram (EEG) abnormalities, or, very rarely, for people without a history of this condition. If seizures are present, Adderall XR shouldn't be taken.
  • Stimulant treatment can disrupt vision. Blurred vision may occur with this type of medication.
  • Stimulants may cause blood circulation problems. These medications are associated with disrupted circulation to the extremities (called peripheral vasculopathy) and with Raynaud's phenomenon, which involves decreased blood flow to certain areas of the body, like the fingers or toes.
  • Tics may worsen with stimulant usage. If you or your child has Tourette's syndrome, Adderall XR could worsen motor and vocal tics.
  • Adderall XR could impair your ability to operate machinery or vehicles. You should use caution while operating vehicles and hazardous machinery, especially if you're just beginning to take this medication.

Other Stimulants

Together with the immediate-release version of Adderall, other common stimulants used to treat ADHD include:

  • Aptensio XR, Concerta, and Metadate ER (methylphenidate extended release)
  • Daytrana
  • Desoxyn (methamphetamine)
  • Dexedrine (dextroamphetamine)
  • Dyanavel XR (amphetamine)
  • Evekeo (amphetamine sulfate)
  • Focalin XR (dexmethylphenidate extended release)
  • Methylin (methylphenidate chewable tablets and solution)
  • ProCentra (dextroamphetamine sulfate oral solution)
  • Quillivant XR (methylphenidate extended release oral suspension)
  • Ritalin (methylphenidate) and Ritalin SR (methylphenidate SR) 
  • Vynase (lisdexamfetamine)

Dosage

Adderall XR is administered at the lowest effective dose, and dosages depend on the therapeutic needs and response of each individual.

All listed dosages are according to the manufacturer. Check your prescription, and talk to your doctor to make sure you are taking the right dose for you.

In children who are between the ages of 6 and 12, medication is often started at 10 milligrams (mg) once daily in the morning. The dosage may be adjusted in increments of 5 or 10 mg at weekly intervals. There may be times when a physician decides to start the dose at 5 mg once in the morning.

The maximum recommended dose for children 6 to 12 years of age is 30 mg per day. Doses greater than 30 mg per day have not been studied in children, and Adderall XR has not been studied in children under 6 years of age.

In adolescents with ADHD who are between the ages of 13 and 17, the recommended starting dose is 10 mg per day. The dose may be increased to 20 mg per day after one week if their ADHD symptoms are not adequately controlled.

In adults, the recommended dose is 20 mg per day.

Adderall XR comes in capsules with several dosage options, each with differentiating color combinations:

  • 5 mg capsules (clear and blue)
  • 10 mg capsules (blue and blue)
  • 15 mg capsules (blue and white)
  • 20 mg capsules (orange and orange)
  • 25 mg capsules (orange and white)
  • 30 mg capsules (natural and orange)

Capsules should be taken by mouth and swallowed whole. They should not be chewed or crushed, as this could release all the medication at once and increase the risk of side effects.

Modifications

The entire contents of a capsule may be sprinkled on a small amount of applesauce just before taking. The mixture should be swallowed immediately and should not be chewed. This may be particularly helpful for young children who are resistant to taking the medication.

How to Take and Store

Adderall XR can be taken with or without food as directed by your physician. It is usually taken once in the morning and should be taken the same way with every dose (such as with or without food). Drink a glass of liquid after each dose.

If you forget to take your medication, take it as soon as possible. Take caution when taking it in the afternoon, however, as it may interfere with sleep when it's taken too close to bedtime. You should also avoid doubling up on this medication—if it's almost time for your next dose, skip the one you missed and go back to your normal schedule.

Overdoses are possible with this medication, and they can be fatal. Symptoms include:

  • Abdominal cramps
  • Aggressiveness
  • Arrhythmias
  • Circulatory collapse
  • Confusion
  • Convulsions and coma
  • Diarrhea
  • Fatigue and depression after the stimulant wears off
  • Hallucinations
  • High fever over 106 F (known as hyperpyrexia)
  • Hypertension or hypotension
  • Nausea
  • Overactive reflexes (known as hyperreflexia)
  • Panic
  • Rapid breathing
  • Restlessness
  • Rhabdomyolysis, a condition where the muscles break down
  • Tremors
  • Vomiting

If you believe that you or a loved one has overdosed on Adderall XR, seek help immediately. In the United States, you can contact the Poison Control Center at 1-800-222-1222 or call 911 right away for help.

Store Adderall XR at room temperature (59 F to 86 F). This medication is a controlled substance and should be kept in a secure, safe place in a tightly closed container.

Since Adderall XR is a controlled substance, you should consider planning ahead if you need to travel. While Adderall XR is approved for use across the United States, you may need to comply with different drug labeling requirements while traveling from state to state. Your safest option may be to keep your medication in its original, prescribed container and ensure that you travel with roughly the amount you need—don't bring a large number of extra doses. If you plan to fly, you should keep your medication with you in a carry-on bag or purse, rather than checking it.

Traveling internationally with Adderall XR presents different problems, as this medication is not legal in certain countries. Check with the foreign embassy in your destination to determine if your medication is restricted in any way; if so, you'll likely need to comply with strict requirements for documentation. You should also speak with your doctor about what to do if you run out of medication while abroad.

Side Effects 

Adderall XR has a number of possible side effects, which can range from mild to severe. It is important to talk to your doctor about what to expect while taking Adderall XR, and you should always keep them informed about any new or unexpected reactions you experience.

Common

Side effects can vary depending on age. For children age 6 to 12, the most common are:

  • Abdominal pain
  • Emotional lability, or rapid mood changes
  • Fever
  • Insomnia
  • Loss of appetite
  • Nausea
  • Nervousness
  • Vomiting

In adolescents age 13 to 17, the most common side effects include:

  • Abdominal pain
  • Insomnia
  • Loss of appetite
  • Nervousness
  • Weight loss

Common side effects for adults are:

  • Agitation
  • Anxiety
  • Diarrhea
  • Dizziness
  • Dry mouth
  • Feeling weak
  • Headache
  • Insomnia
  • Loss of appetite
  • Nausea
  • Tachycardia (rapid heartbeat)
  • Urinary tract infection
  • Weight loss

Severe

Severe side effects of Adderall XR can include:

  • Allergic reactions 
  • Depression
  • Eyesight changes or blurred vision
  • Heart attack
  • Impotence
  • Increased blood pressure
  • Psychotic episodes
  • Seizures
  • Slowing of growth or height in children
  • Stroke
  • Sudden death due to existing heart problems
  • Trouble operating vehicles or machinery

If you are taking too high of a dosage of Adderall XR, you might experience symptoms like:

  • Hyperactivity
  • Irritability
  • Marked insomnia
  • Personality changes
  • Psychosis that's indistinguishable from schizophrenia
  • Severe skin issues, like lesions

Warnings and Interactions

Adderall XR is a Schedule II drug (meaning it has a high potential for abuse) and a controlled substance. It carries risks of abuse and dependence, and these risks may be higher if you’ve experienced a substance use disorder in the past. It's important that you follow your doctor's orders and do not increase the dose, take it more often, or use it for a longer period of time than is prescribed.

If you decide to stop taking Adderall XR, you should work closely with your doctor. Quitting cold turkey may lead to withdrawal symptoms (such as severe tiredness, sleep problems, or mental/mood changes like depression). Withdrawal symptoms are more likely if you have used this medication for a long time or in high doses. You should only decrease your dose or discontinue your medication under the supervision of your physician.

Adderall XR may interact with other medications and cause serious side effects, so it’s important to talk to your doctor about any prescription and non-prescription medicines, vitamins, and herbal supplements that you or your child take. Tell your doctor if you or your child takes:

  • Antidepressants
  • Antihistamines
  • Antipsychotics
  • Blood pressure medicines
  • Blood thinners
  • Lithium
  • MAOIs
  • Medication for seizures
  • Opioid pain medication
  • Stomach acid medicines

Adderall XR has not been evaluated for use in children under 6 years of age or in older adults.

If you are pregnant or are trying to become pregnant, discuss your options with your doctor. While it's not clear if Adderall XR is safe to take during pregnancy, data from animal testing show that there is a possible danger to the fetus, and there are well-established side effects for infants born to mothers with a dependency on amphetamines.

That said, Adderall XR may be used during pregnancy if the benefit to the mother outweighs those potential risks. Nursing mothers, however, should not breastfeed while taking this medication, as amphetamines can travel through the breastmilk.

It's important to remain under the care of a physician while taking Adderall XR. Your doctor can ensure you remain safe and free from serious side effects while evaluating your dosage and long-term treatment plan.

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