What to Know About Adderall XR

Adderall XR: Uses, Side Effects, Dosages, Precautions

Adderall XR can improve your focus.

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Adderall XR is a central nervous system stimulant most commonly used to treat ADHD. It’s a Schedule II drug that works by altering certain natural chemicals 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 four hours.

Amphetamine salt combo XR (amphetamine and dextroamphetamine salts) is the generic version.

Uses

Adderall XR is FDA approved to treat ADHD and narcolepsy.

Off-Label Uses

Adderall XR may be used as an adjunct for treatment-resistant depression.  

Before Taking

A diagnosis of ADHD can only be made if an individual experienced symptoms of hyperactivity/impulsivity or inattention prior to the age of 7. The symptoms must have caused social, occupational, or academic impairment, and this impairment must have been present in two or more settings.

There isn’t a single diagnostic test for ADHD. A diagnosis requires the use of medical, psychological, educational, and social resources. A diagnosis is made based on the history and evaluation of the patient.

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.

Adderall XR should be used as part of a total treatment plan for ADHD. Other treatment measures may include psychological, educational, and social support.

Precautions and Contraindications

Stimulants are not intended for use in patients who exhibit symptoms due to environmental factors or those who have other psychiatric disorders, such as psychosis.

Psychosocial and educational interventions are often helpful, and medication should only be used when those interventions fail to resolve the symptoms. A physician’s willingness to consider stimulant medication depends on the chronicity and severity of symptoms when remedial measures alone are insufficient.

Stimulant medications cause a modest increase in blood pressure (about 2 to 4 mmHg) and a slight increase in average heart rate (about 3 to 6 beats per minute). Some individuals may experience larger increases. These changes wouldn’t be expected to result in short-term consequences, but all patients should be monitored for larger changes in blood pressure and heart rate.

Caution should be taken in patients whose underlying conditions might be compromised by increases in heart rate and blood pressure, such as the following:

  • pre-existing hypertension
  • heart failure
  • recent myocardial infarction
  • ventricular arrhythmia.

Prior to starting Adderall XR, individuals being considered for treatment should have a careful history (including assessment for family history of sudden death or ventricular arrhythmia) and physical exam to assess for the presence of cardiac disease and should receive further cardiac evaluation if there is any evidence of disease. Patients who experience symptoms such as exertional chest pain, unexplained fainting, or other symptoms that may indicate cardiac problems should undergo a prompt cardiac evaluation.

Stimulants may exacerbate symptoms in anyone with pre-existing psychotic disorder.

Particular care should be taken in using stimulants to treat ADHD patients with comorbid bipolar disorder due to concern that the medication may induce mixed/manic episodes. Prior to starting any stimulant, patients should be screened for the risk of bipolar disorder.

Treatment-emergent psychotic or manic symptoms in children or adolescents without a prior history of mania or psychosis may be caused by stimulants, even at the usual doses. Symptoms may include hallucinations, delusions, or manic episodes. If symptoms occur, discontinuation of treatment may be appropriate. In short-term, placebo-controlled studies, such symptoms occurred in about 0.1% of patients being treated with stimulants.

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.

Other Drug Class Names

Other ADHD medications that contain a dextroamphetamine/modified amphetamine mixture include:

  • Adderall–lasts four hours
  • Adzenys ER–extended-release oral suspension
  • Adzenys XR-ODT–orally-disintegrating tablet that is immediate and delayed release
  • Dexedrine Spansule–immediate relief flowed by gradual release
  • Dyanavel XR–liquid extended release
  • Evekeo–immediate-release tablet
  • ProCentra–immediate-release liquid
  • Mydayis–long-acting capsule
  • Vyvanse–capsule and chewable tablet
  • Zenzedi–immediate-release tablet

Dosage

Adderall XR is administered at the lowest effective dose. Dosages depend on therapeutic needs and response of the patient.

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 10mg once daily in the morning. The dosage may be adjusted in increments of 5mg or 10mg at weekly intervals. There may be times when a physician decides to start the dose at 5mg once in the morning. The maximum recommended dose for children 6 to 12 years of age is 30mg/day. Doses greater than 30mg/day have not been studied in children. 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 10mg/day. The dose may be increased to 20mg/day after one week if ADHD symptoms are not adequately controlled.

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

Adderall XR comes in capsules. It should be taken by mouth.

Capsules should be 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.

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 is taken too close to bedtime.

Store Adderall XR in a safe place at room temperature (50 to 86 degrees F).

Side Effects 

It is important to talk to your doctor about what to expect in terms of side effects.

Common

  • Headache
  • Decreased appetite
  • Nervousness
  • Mood swings
  • Dizziness
  • Stomach ache
  • Trouble sleeping
  • Weight loss
  • Dry mouth
  • Fast heartbeat

 Severe

  • Seizures
  • Slowing of growth or height in children
  • Eyesight changes or blurred vision 

Warnings and Interactions

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

  • Antidepressants
  • Antipsychotics
  • Lithium
  • Narcotic pain medication
  • Blood thinners
  • Blood pressure medicines
  • Stomach acid medicines

You may need to be weaned off Adderall XR slowly if you and your physician decide to discontinue the medication. Quitting cold turkey may lead to withdrawal symptoms (such as severe tiredness, sleep problems, or mental/mood changes such as 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 sometimes cause addiction. This risk may be higher if you’ve had a substance use disorder. Do not increase the dose, take it more often, or use it for a longer time than is prescribed. Properly discontinue the medication when directed to do so by a physician.

Adderall XR may affect you or your child’s ability to drive or do other dangerous activities.

The use of stimulant medications has been associated with:

  • Heart-related problems – sudden death in patients who have heart problems, stroke or heart attack in adults, and increased blood pressure and heart rate
  • Mental problems – new or worse behavior or thought problems, new or worse bipolar symptoms, new or worse aggression and hostility, and new psychotic symptoms in teens
  • Circulation problems in fingers and toes – fingers or toes may feel numb, cool, or painful, or they may change from pale to blue or red

It should not be taken by anyone who:

  • Has heart disease or hardening of the arteries
  • Has moderate or severe high blood pressure
  • Has hyperthyroidism
  • Has glaucoma
  • Is very anxious, agitated, or tense
  • Has a history of drug abuse
  • Is taking or has taken an antidepressant medication called a monoamine oxidase inhibitor or MAOI within the past 14 days
  • Is sensitive to, allergic to, or had a reaction to other stimulant medications

Adderall XR should not be taken by breastfeeding mothers. Patients who become pregnant or intend to become pregnant should notify their physician.

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  1. Anderson KN, Dutton AC, Broussard CS, et al. ADHD Medication Use During Pregnancy and Risk for Selected Birth Defects: National Birth Defects Prevention Study, 1998-2011. Journal of Attention Disorders. September 2018:108705471875975.

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