Adderall 20mg Tablets
WARNING: This drug has a high risk of misuse. This can lead to alcohol or drug use disorder. Misuse or abuse of this drug can lead to overdose or death. The risk is higher with higher doses or when used in ways that are not approved like snorting or injecting it. Do not give this drug to anyone else. This drug may also be habit-forming if taken for a long time. Do not take for longer than you have been told by your doctor. Use only as you were told. Tell your doctor if you have ever had alcohol or drug use disorder. You will be watched closely while taking this drug. Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets. Throw away unused or expired drugs as you have been told. @ COMMON USES: It is used to treat attention deficit problems with hyperactivity.It is used to treat narcolepsy.It may be given to you for other reasons. Talk with the doctor.
Drug Class
Central Nervous System Stimulant
Pharmacologic Class
Sympathomimetic Amine
Pregnancy Category
Category C
FDA Approved
Jan 1996
DEA Schedule
Schedule II
Overview
What is this medicine?
Adderall is a medication that contains two types of stimulants, dextroamphetamine and amphetamine. It works by increasing certain natural chemicals in the brain that help with focus and attention. It's primarily used to treat Attention Deficit Hyperactivity Disorder (ADHD) and narcolepsy (a sleep disorder).
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. You can take this medication with or without food. However, take your last dose of the day at least 4 hours before bedtime to minimize any potential disruptions to your sleep.
Before using any over-the-counter (OTC) products, consult with your doctor, especially if they may increase your blood pressure. Examples of such products include cough or cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or aids.
Storing and Disposing of Your Medication
To maintain the effectiveness and safety of your medication, store it at room temperature, protected from light, and in a dry place. Avoid storing it in a bathroom. Keep all medications in a secure location, out of the reach of children and pets. Dispose of any unused or expired medication properly. Do not flush it down the toilet or pour it down the drain unless instructed to do so by your pharmacist. If you have questions about the best way to dispose of your medication, consult with your pharmacist, who may be aware of drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it is close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. You can take this medication with or without food. However, take your last dose of the day at least 4 hours before bedtime to minimize any potential disruptions to your sleep.
Before using any over-the-counter (OTC) products, consult with your doctor, especially if they may increase your blood pressure. Examples of such products include cough or cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or aids.
Storing and Disposing of Your Medication
To maintain the effectiveness and safety of your medication, store it at room temperature, protected from light, and in a dry place. Avoid storing it in a bathroom. Keep all medications in a secure location, out of the reach of children and pets. Dispose of any unused or expired medication properly. Do not flush it down the toilet or pour it down the drain unless instructed to do so by your pharmacist. If you have questions about the best way to dispose of your medication, consult with your pharmacist, who may be aware of drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it is close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
Lifestyle & Tips
- Take the medication exactly as prescribed by your doctor, usually in the morning to avoid sleep problems.
- Avoid taking doses late in the day to prevent insomnia.
- Maintain a healthy diet and regular exercise routine.
- Inform your doctor about all other medications, supplements, and herbal products you are taking.
- Do not share your medication with others, as it has a high potential for abuse.
- Store medication securely to prevent misuse or diversion.
Available Forms & Alternatives
Available Strengths:
- Adderall XR 30mg Capsules
- Adderall XR 20mg Capsules
- Adderall XR 10mg Capsules
- Adderall XR 15mg Capsules
- Adderall XR 5mg Capsules
- Adderall XR 25mg Capsules
- Adderall 10mg Tablets
- Adderall 30mg Tablets
- Adderall 20mg Tablets
- Adderall 15mg Tablets
- Adderall 5mg Tablets
- Adderall 12.5mg Tablets
- Adderall 7.5mg Tablets
Generic Alternatives:
Dosing & Administration
Adult Dosing
Standard Dose:
ADHD: Initial 20 mg once daily or 10 mg twice daily. Narcolepsy: Initial 10 mg once daily.
Dose Range:
5 - 60 mg
Condition-Specific Dosing:
ADHD:
Initial 20 mg once daily or 10 mg twice daily. May increase by 10 mg weekly to a maximum of 60 mg/day.
Narcolepsy:
Initial 10 mg once daily. May increase by 10 mg weekly to a maximum of 60 mg/day, given in divided doses (e.g., 10-30 mg 2-3 times daily).
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
ADHD (6-12 years): Initial 5 mg once or twice daily. May increase by 5-10 mg weekly to a maximum of 40 mg/day. Narcolepsy (6-12 years): Initial 5 mg once daily. May increase by 5 mg weekly to a maximum of 60 mg/day, given in divided doses.
Adolescent:
ADHD (13-17 years): Initial 10 mg once daily. May increase by 10 mg weekly to a maximum of 40 mg/day.
Dose Adjustments
Renal Impairment:
Mild:
No specific dose adjustment recommended, but monitor for adverse effects.
Moderate:
Consider lower doses and monitor for adverse effects due to reduced excretion.
Severe:
Use with caution; consider significant dose reduction (e.g., 50% of usual dose) or avoid. Monitor closely for toxicity.
Dialysis:
Not well studied; amphetamines are not significantly removed by hemodialysis. Avoid or use with extreme caution.
Hepatic Impairment:
Mild:
No specific dose adjustment recommended.
Moderate:
No specific dose adjustment recommended, but monitor for adverse effects.
Severe:
Use with caution; consider lower doses due to potential for altered metabolism.
Pharmacology
Mechanism of Action
Dextroamphetamine and amphetamine are non-catecholamine sympathomimetic amines that exert their therapeutic effect by increasing the release of norepinephrine and dopamine from presynaptic nerve terminals in the brain. They also block the reuptake of these monoamines into the presynaptic neuron, leading to increased concentrations in the synaptic cleft. The exact mechanism in ADHD and narcolepsy is not fully understood but is thought to involve stimulation of the CNS.
Pharmacokinetics
Absorption:
Bioavailability:
Approximately 75% (oral)
Tmax:
2-4 hours (for individual amphetamine salts)
FoodEffect:
Food can delay Tmax by approximately 2.5 hours but does not significantly affect the extent of absorption (AUC).
Distribution:
Vd:
3-5 L/kg
ProteinBinding:
Approximately 15-26%
CnssPenetration:
Yes
Elimination:
HalfLife:
Dextroamphetamine: 10-13 hours; Amphetamine (levo-isomer): 9-11 hours
Clearance:
Highly dependent on urinary pH; increased in acidic urine, decreased in alkaline urine.
ExcretionRoute:
Renal
Unchanged:
Approximately 30-50% (amphetamine), 45-60% (dextroamphetamine) excreted unchanged in urine, highly dependent on urinary pH.
Pharmacodynamics
OnsetOfAction:
30-60 minutes
PeakEffect:
2-4 hours
DurationOfAction:
4-6 hours (immediate release)
Confidence:
High
Safety & Warnings
BLACK BOX WARNING
Amphetamines have a high potential for abuse. Administration of amphetamines for prolonged periods of time may lead to drug dependence. Misuse of amphetamines may cause sudden death and serious cardiovascular adverse events.
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of high blood pressure, including:
+ Severe headache
+ Dizziness
+ Passing out
+ Changes in eyesight
Signs of a urinary tract infection (UTI), such as:
+ Blood in the urine
+ Burning or pain while urinating
+ Frequent or urgent need to urinate
+ Fever
+ Lower stomach pain
+ Pelvic pain
Other severe side effects, including:
+ Erectile dysfunction
+ Changes in sex interest
+ Seizures
+ Trouble controlling body movements
+ Trouble controlling sounds, such as humming, throat clearing, yelling, or making loud noises
+ Restlessness
+ Changes in eyesight
+ Prolonged or frequent erections
+ Changes in skin color, such as pale, blue, gray, purple, or red discoloration
+ Numbness, pain, tingling, or cold feeling in the hands or feet
+ Sores or wounds on the fingers or toes
+ Muscle pain or weakness
+ Dark urine
+ Trouble passing urine
Heart problems, including:
+ Sudden death (rarely occurs in people with pre-existing heart problems or defects)
+ Chest pain
+ Abnormal heartbeat
+ Shortness of breath
+ Severe dizziness or passing out
If you have a heart condition or defect, or if a family member has an abnormal heartbeat or died suddenly, inform your doctor. Seek immediate medical attention if you experience any signs of heart problems.
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to contact your doctor if you notice any of the following:
Feeling nervous and excitable
Headache
Trouble sleeping
Constipation
Diarrhea
Stomach pain
Upset stomach
Nausea or vomiting
Decreased appetite
Dizziness
Fatigue
Weakness
Dry mouth
Bad taste in the mouth
Weight loss
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of high blood pressure, including:
+ Severe headache
+ Dizziness
+ Passing out
+ Changes in eyesight
Signs of a urinary tract infection (UTI), such as:
+ Blood in the urine
+ Burning or pain while urinating
+ Frequent or urgent need to urinate
+ Fever
+ Lower stomach pain
+ Pelvic pain
Other severe side effects, including:
+ Erectile dysfunction
+ Changes in sex interest
+ Seizures
+ Trouble controlling body movements
+ Trouble controlling sounds, such as humming, throat clearing, yelling, or making loud noises
+ Restlessness
+ Changes in eyesight
+ Prolonged or frequent erections
+ Changes in skin color, such as pale, blue, gray, purple, or red discoloration
+ Numbness, pain, tingling, or cold feeling in the hands or feet
+ Sores or wounds on the fingers or toes
+ Muscle pain or weakness
+ Dark urine
+ Trouble passing urine
Heart problems, including:
+ Sudden death (rarely occurs in people with pre-existing heart problems or defects)
+ Chest pain
+ Abnormal heartbeat
+ Shortness of breath
+ Severe dizziness or passing out
If you have a heart condition or defect, or if a family member has an abnormal heartbeat or died suddenly, inform your doctor. Seek immediate medical attention if you experience any signs of heart problems.
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to contact your doctor if you notice any of the following:
Feeling nervous and excitable
Headache
Trouble sleeping
Constipation
Diarrhea
Stomach pain
Upset stomach
Nausea or vomiting
Decreased appetite
Dizziness
Fatigue
Weakness
Dry mouth
Bad taste in the mouth
Weight loss
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Chest pain, shortness of breath, or fainting (seek immediate medical attention)
- New or worsening aggression or hostility
- New or worsening psychotic symptoms (e.g., hearing voices, paranoia, delusions)
- New or worsening manic symptoms (e.g., extreme energy, racing thoughts, decreased need for sleep)
- Unexplained wounds on fingers or toes (rare, but can indicate circulation problems)
- Blurred vision or other vision changes
- Severe headache
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following conditions to ensure safe treatment:
Any allergies you have, including allergies to this medication, its components, or other substances. Describe the allergic reaction and its symptoms.
A family history of certain health conditions, such as:
+ Blood vessel disease
+ High blood pressure
+ Heart structure problems or other heart-related issues
+ Tourette's syndrome or tics
Your medical history, including:
+ Glaucoma
+ Agitation
+ Anxiety
+ Overactive thyroid
+ Previous instances of drug abuse or stroke
Existing kidney disease
Current medications, including:
+ Acetazolamide
+ Sodium bicarbonate
+ Recent use (within the last 14 days) of certain depression or Parkinson's disease medications, such as:
- Isocarboxazid
- Phenelzine
- Tranylcypromine
- Selegiline
- Rasagiline (note: combining these medications can lead to very high blood pressure)
+ Concomitant use of:
- Linezolid
- Methylene blue
If you are breast-feeding, as you should not breast-feed while taking this medication
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist to ensure safe treatment. Do not initiate, terminate, or modify any medication regimen without consulting your doctor.
It is essential to inform your doctor about the following conditions to ensure safe treatment:
Any allergies you have, including allergies to this medication, its components, or other substances. Describe the allergic reaction and its symptoms.
A family history of certain health conditions, such as:
+ Blood vessel disease
+ High blood pressure
+ Heart structure problems or other heart-related issues
+ Tourette's syndrome or tics
Your medical history, including:
+ Glaucoma
+ Agitation
+ Anxiety
+ Overactive thyroid
+ Previous instances of drug abuse or stroke
Existing kidney disease
Current medications, including:
+ Acetazolamide
+ Sodium bicarbonate
+ Recent use (within the last 14 days) of certain depression or Parkinson's disease medications, such as:
- Isocarboxazid
- Phenelzine
- Tranylcypromine
- Selegiline
- Rasagiline (note: combining these medications can lead to very high blood pressure)
+ Concomitant use of:
- Linezolid
- Methylene blue
If you are breast-feeding, as you should not breast-feed while taking this medication
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist to ensure safe treatment. Do not initiate, terminate, or modify any medication regimen without consulting your doctor.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. This will help ensure your safety and prevent any potential interactions with other treatments.
Before operating a vehicle or engaging in activities that require alertness and clear vision, wait until you understand how this medication affects you. If you experience any changes in your ability to focus or react, avoid these activities until you have adjusted to the medication.
Long-term or high-dose use of this medication can lead to tolerance, where the drug becomes less effective, and you may need higher doses to achieve the same effect. If you notice that the medication is not working as well as it previously did, contact your doctor. Do not take more than the prescribed dose, as this can increase the risk of adverse effects.
Prolonged or regular use of this medication may cause dependence, and stopping it abruptly can lead to withdrawal symptoms. If you need to reduce the dose or stop taking the medication, consult your doctor first, and follow their instructions carefully. Report any adverse effects to your doctor promptly.
Before starting this medication, your doctor may recommend heart tests to ensure your safety. If you have any questions or concerns, discuss them with your doctor.
This medication may cause an increase in blood pressure. Monitor your blood pressure and heart rate as directed by your doctor, and report any changes or concerns. Additionally, your doctor may order regular blood tests to monitor your condition; be sure to follow their instructions and discuss any results with them.
It is crucial to inform all your healthcare providers and laboratory personnel that you are taking this medication, as it may affect certain lab tests. Do not take antacids while using this medication, as they may interact with it.
Some individuals may experience behavioral or mood changes, such as altered thinking, anger, or hallucinations, while taking this medication. If you or a family member have a history of mental or mood disorders, such as depression or bipolar illness, or if a family member has committed suicide, inform your doctor. Seek immediate medical attention if you experience hallucinations, changes in behavior, or mood changes, including depression, suicidal thoughts, nervousness, emotional instability, abnormal thinking, anxiety, or loss of interest in life.
This medication may increase the risk of seizures in some individuals, particularly those with a history of seizure disorders. Discuss your risk with your doctor to determine the best course of action.
A rare but potentially life-threatening condition called serotonin syndrome can occur if you take this medication with certain other drugs. Seek immediate medical attention if you experience agitation, balance changes, confusion, hallucinations, fever, abnormal heartbeat, flushing, muscle twitching or stiffness, seizures, shivering or shaking, excessive sweating, severe diarrhea, stomach upset, or vomiting, or severe headache.
In some cases, this medication may affect growth in children and adolescents. Regular growth checks may be necessary, and your doctor will discuss the potential risks and benefits with you. Different brands of this medication may be suitable for different age groups, so consult your doctor before giving it to a child.
Before consuming alcohol, discuss the potential risks and benefits with your doctor. If you are pregnant or plan to become pregnant, inform your doctor to discuss the benefits and risks of using this medication during pregnancy.
Before operating a vehicle or engaging in activities that require alertness and clear vision, wait until you understand how this medication affects you. If you experience any changes in your ability to focus or react, avoid these activities until you have adjusted to the medication.
Long-term or high-dose use of this medication can lead to tolerance, where the drug becomes less effective, and you may need higher doses to achieve the same effect. If you notice that the medication is not working as well as it previously did, contact your doctor. Do not take more than the prescribed dose, as this can increase the risk of adverse effects.
Prolonged or regular use of this medication may cause dependence, and stopping it abruptly can lead to withdrawal symptoms. If you need to reduce the dose or stop taking the medication, consult your doctor first, and follow their instructions carefully. Report any adverse effects to your doctor promptly.
Before starting this medication, your doctor may recommend heart tests to ensure your safety. If you have any questions or concerns, discuss them with your doctor.
This medication may cause an increase in blood pressure. Monitor your blood pressure and heart rate as directed by your doctor, and report any changes or concerns. Additionally, your doctor may order regular blood tests to monitor your condition; be sure to follow their instructions and discuss any results with them.
It is crucial to inform all your healthcare providers and laboratory personnel that you are taking this medication, as it may affect certain lab tests. Do not take antacids while using this medication, as they may interact with it.
Some individuals may experience behavioral or mood changes, such as altered thinking, anger, or hallucinations, while taking this medication. If you or a family member have a history of mental or mood disorders, such as depression or bipolar illness, or if a family member has committed suicide, inform your doctor. Seek immediate medical attention if you experience hallucinations, changes in behavior, or mood changes, including depression, suicidal thoughts, nervousness, emotional instability, abnormal thinking, anxiety, or loss of interest in life.
This medication may increase the risk of seizures in some individuals, particularly those with a history of seizure disorders. Discuss your risk with your doctor to determine the best course of action.
A rare but potentially life-threatening condition called serotonin syndrome can occur if you take this medication with certain other drugs. Seek immediate medical attention if you experience agitation, balance changes, confusion, hallucinations, fever, abnormal heartbeat, flushing, muscle twitching or stiffness, seizures, shivering or shaking, excessive sweating, severe diarrhea, stomach upset, or vomiting, or severe headache.
In some cases, this medication may affect growth in children and adolescents. Regular growth checks may be necessary, and your doctor will discuss the potential risks and benefits with you. Different brands of this medication may be suitable for different age groups, so consult your doctor before giving it to a child.
Before consuming alcohol, discuss the potential risks and benefits with your doctor. If you are pregnant or plan to become pregnant, inform your doctor to discuss the benefits and risks of using this medication during pregnancy.
Overdose Information
Overdose Symptoms:
- Restlessness
- Tremor
- Hyperreflexia (overactive reflexes)
- Rapid respiration
- Confusion
- Hallucinations
- Panic states
- Hyperpyrexia (very high fever)
- Rhabdomyolysis (muscle breakdown)
- Arrhythmias (irregular heartbeats)
- Hypertension (high blood pressure) or Hypotension (low blood pressure)
- Circulatory collapse
- Convulsions
- Coma
What to Do:
Seek immediate medical attention. Call 911 or Poison Control at 1-800-222-1222. Management is primarily symptomatic and supportive, including gastric lavage, activated charcoal, and acidification of urine to enhance excretion.
Drug Interactions
Contraindicated Interactions
- Monoamine Oxidase Inhibitors (MAOIs) - concurrent use or within 14 days of MAOI discontinuation (risk of hypertensive crisis)
Major Interactions
- Serotonergic drugs (e.g., SSRIs, SNRIs, triptans, fentanyl, lithium, tramadol, St. John's Wort) - risk of serotonin syndrome
- Tricyclic Antidepressants (TCAs) - increased stimulant effect, risk of cardiovascular effects
- Urinary alkalinizers (e.g., sodium bicarbonate, acetazolamide, thiazide diuretics) - decreased amphetamine excretion, increased plasma levels and effects
- Antihypertensives - amphetamines may antagonize the hypotensive effects of guanethidine and other adrenergic blocking agents
Moderate Interactions
- Urinary acidifiers (e.g., ammonium chloride, ascorbic acid) - increased amphetamine excretion, decreased plasma levels and effects
- Antacids (e.g., aluminum hydroxide, magnesium hydroxide) - increased amphetamine absorption, increased plasma levels
- Proton Pump Inhibitors (PPIs) - may increase amphetamine absorption
- CYP2D6 inhibitors (e.g., quinidine, ritonavir, fluoxetine, paroxetine) - increased amphetamine exposure, increased risk of adverse effects
- Phenothiazines (e.g., chlorpromazine) - may inhibit amphetamine effects
- Haloperidol - may inhibit amphetamine effects
Minor Interactions
- Not many commonly cited minor interactions with significant clinical impact.
Monitoring
Baseline Monitoring
Cardiovascular assessment (BP, HR, ECG if clinically indicated)
Rationale: To identify pre-existing cardiac conditions that may contraindicate stimulant use or require close monitoring.
Timing: Prior to initiation of therapy
Height and Weight (especially in pediatric patients)
Rationale: To establish baseline for growth monitoring, as stimulants can cause growth suppression.
Timing: Prior to initiation of therapy
Psychiatric history (e.g., bipolar disorder, psychosis, tics)
Rationale: To assess risk of stimulant-induced psychiatric adverse events or exacerbation of pre-existing conditions.
Timing: Prior to initiation of therapy
Routine Monitoring
Blood Pressure (BP) and Heart Rate (HR)
Frequency: At each visit (e.g., every 3-6 months or as clinically indicated)
Target: Within normal limits for age; monitor for sustained increases
Action Threshold: Sustained clinically significant increases (e.g., >10-20 mmHg systolic/diastolic or >15-20 bpm HR) warrant investigation and potential dose adjustment or discontinuation.
Height and Weight (pediatric patients)
Frequency: Every 3-6 months
Target: Maintain growth percentile; monitor for significant deceleration
Action Threshold: Significant growth deceleration (e.g., crossing two major percentile lines) warrants evaluation and consideration of drug holiday or alternative therapy.
Psychiatric symptoms (e.g., agitation, anxiety, psychosis, mania, aggression, tics)
Frequency: At each visit
Target: Absence of new or worsening symptoms
Action Threshold: Emergence of new psychotic or manic symptoms, severe agitation, or significant tics warrants immediate evaluation and potential discontinuation.
Abuse/Diversion potential
Frequency: At each visit
Target: Not applicable
Action Threshold: Signs of abuse or diversion warrant intervention and re-evaluation of treatment plan.
Symptom Monitoring
- Chest pain
- Shortness of breath
- Syncope (fainting)
- Unexplained wounds (due to compulsive picking)
- New or worsening aggression/hostility
- New or worsening psychotic symptoms (e.g., hallucinations, delusions)
- New or worsening manic symptoms (e.g., elevated mood, decreased need for sleep, racing thoughts)
- Severe anxiety or agitation
- Muscle twitching or tics
- Blurred vision
Special Patient Groups
Pregnancy
Generally not recommended during pregnancy unless the potential benefit justifies the potential risk to the fetus. Amphetamines can cause adverse pregnancy outcomes.
Trimester-Specific Risks:
First Trimester:
Limited data, but potential for increased risk of congenital malformations cannot be ruled out.
Second Trimester:
Potential for premature birth and low birth weight.
Third Trimester:
Risk of premature birth, low birth weight, and withdrawal symptoms (e.g., agitation, feeding difficulties, tremor, hypotonia) in the neonate if used near term.
Lactation
Amphetamines are excreted into breast milk. Due to the potential for serious adverse reactions in breastfed infants (e.g., irritability, poor feeding, sleep disturbances, weight loss), breastfeeding is generally not recommended or should be done with extreme caution and close infant monitoring.
Infant Risk:
High (L4 - Possibly Hazardous)
Pediatric Use
Use in children under 6 years of age for ADHD or narcolepsy is not recommended. Monitor growth (height and weight) closely due to potential for growth suppression. Monitor for emergence or worsening of psychiatric symptoms (e.g., psychosis, mania, aggression, tics).
Geriatric Use
Use with caution in elderly patients. Start with lower doses and titrate slowly due to increased sensitivity to adverse effects, particularly cardiovascular and psychiatric effects. Monitor renal function.
Clinical Information
Clinical Pearls
- Adderall has a high potential for abuse and dependence; prescribe and dispense with caution.
- Careful cardiovascular assessment is crucial before initiating therapy and throughout treatment, especially in patients with pre-existing cardiac conditions.
- Monitor growth parameters (height and weight) in pediatric patients regularly, as growth suppression can occur.
- Be vigilant for the emergence of new or worsening psychiatric symptoms, including psychosis, mania, aggression, or tics.
- Advise patients to take the last dose early in the day to minimize the risk of insomnia.
- Educate patients and caregivers on the signs of overdose and the importance of secure storage to prevent diversion.
Alternative Therapies
- Methylphenidate (e.g., Ritalin, Concerta, Focalin)
- Lisdexamfetamine (Vyvanse)
- Atomoxetine (Strattera)
- Guanfacine extended-release (Intuniv)
- Clonidine extended-release (Kapvay)
- Bupropion (Wellbutrin - off-label for ADHD)
Cost & Coverage
Average Cost:
$50 - $200 per 30 tablets (generic 20mg)
Generic Available:
Yes
Insurance Coverage:
Tier 2 or Tier 3 (for generic formulations); Tier 4 or higher (for brand-name)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication.
This medication is accompanied by a Medication Guide, which provides crucial information about its use. Please read this guide carefully and review it again whenever you receive a refill. If you have any questions or concerns about this medication, don't hesitate to discuss them with your doctor, pharmacist, or other healthcare provider.
In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When reporting the incident, be prepared to provide details about the medication taken, the amount, and the time it occurred.
This medication is accompanied by a Medication Guide, which provides crucial information about its use. Please read this guide carefully and review it again whenever you receive a refill. If you have any questions or concerns about this medication, don't hesitate to discuss them with your doctor, pharmacist, or other healthcare provider.
In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When reporting the incident, be prepared to provide details about the medication taken, the amount, and the time it occurred.