By Ioana Cozma

Last updated: 04 December 2023 & medically reviewed by Dr. Kimberly Langdon

Though an effective stimulant prescribed for ADHD and narcolepsy, Adderall has some potentially harmful side effects. This article delves into different Adderall side effects, from common reactions to severe complications, Adderall side effects in women, and drug interactions.

Key takeaways:

  • Adderall can cause significant cardiovascular issues.

  • Severe mental and mood changes, like aggressive behavior and worsening of bipolar disorder, can occur from prolonged Adderall use.

  • Adderall use might result in dependency.

  • Adderall's interaction with other substances can amplify its risks, leading to life-threatening conditions.

Adderall Side Effects

What is Adderall?

Adderall is a prescription drug based on a combination of amphetamine salts that has shown promising results in treating Attention Deficit Hyperactivity Disorder (ADHD).[1] The primary ingredients, dextroamphetamine and amphetamine, are classed as central nervous system stimulants because they increase the levels of two neurotransmitters, dopamine, and norepinephrine.

Adderall stimulates these neurotransmitters’ release and simultaneously blocks their reuptake, leading to heightened alertness and focus.[2] Therefore, Adderall improves concentration, attention span, and impulse control in people with ADHD.

Common Adderall side effects with regular use

Adderall, like many prescription medications, has adverse reactions. When taken as prescribed, Adderall side effects are manageable.

Physical Adderall side effects

  • Elevated heart rate

  • Hypertension

  • Difficulty falling or staying asleep

  • Reduced saliva production resulting in dry mouth

  • Decreased appetite

  • Prolonged or painful erection

  • Stomachaches or other digestive issues

  • Headaches

  • Involuntary shaking or twitching[3]

Psychological Adderall side effects

  • Anxiety

  • Rapid changes in mood

  • A general state of restlessness or unease

  • Paranoia

  • Depressive episodes[3]

Behavioral Adderall side effects

  • Increased irritability leading to hostile behavior

  • Restlessness

  • Impulsive behavior[3]

Common side effects of Adderall when abused

Adderall side effects are more poignant when the substance is abused.

Physical Adderall side effects

  • Rapid heart rate

  • Elevated blood pressure

  • Heart palpitations

  • Tremors

  • Dilated pupils

  • Chest pain

  • Difficulty in breathing or feelings of being "winded"

  • Nausea and vomiting

  • Overheating[3]

Psychological Adderall side effects

  • Paranoia

  • Hallucinations

  • Panic attacks

  • Aggravated anxiety

  • Depressive episodes[3]

  • Impairment in cognitive functioning when taken non-medically[4]

Behavioral Adderall side effects

  • Aggressive behavior

  • Compulsive behaviors, such as engaging repeatedly in specific actions or rituals

  • Neglecting basic self-care routines

  • Social withdrawal[3]

Severe side effects of Adderall

Adderall side effects may become severe, particularly in the case of prolonged Adderall addiction and consumption. However, some individuals may be allergic to the mix of amphetamine salts, so they might experience severe adverse events even if taking the medicine as prescribed.

Mood/behavioral changes

Overstimulation of neurotransmitters like dopamine can disrupt the brain's natural equilibrium, leading to pronounced mood disturbances.

Symptoms might include severe depression, suicidal ideation, aggressive behavior, hostility, paranoia, or psychosis.[3] These Adverse side effects may lead to harmful actions towards oneself or others.

Cardiovascular problems

As a stimulant, Adderall increases heart rate and blood pressure. Excessive abuse can overwork the cardiovascular system,[2] leading to elevated heart rate (tachycardia), increased blood pressure (hypertension), chest pain, arrhythmias (irregular heartbeats), and in extreme cases, heart attack or stroke.

These issues might be life-threatening, particularly for people with pre-existing heart conditions.

Gastrointestinal issues

The body's central nervous system (CNS) communicates with the gastrointestinal system. CNS overstimulation due to Adderall can disrupt this communication and lead to severe abdominal pain, nausea, vomiting, diarrhea, and constipation.[5]

While not typically life-threatening, these side effects may be profoundly discomforting and disrupt daily activities.

Dependence and addiction

Over time and with consistent misuse, the brain becomes reliant on Adderall to maintain certain levels of neurotransmitters.[2] This dependency can lead to a physical need for the drug and a psychological craving for its effects.

Individuals may feel a strong compulsion to continue taking Adderall, even if they face negative consequences. They might increase their dosage without medical guidance, experience withdrawal symptoms without Adderall, or engage in risky behaviors to obtain more Adderall.

Does Adderall affect women differently?

Adderall side effects in females may be different because of hormonal fluctuations throughout a woman’s menstrual cycle.[6]

One of these hormones, estrogen, is actively involved in dopamine modulation, which Adderall also increases. When estrogen levels are high during the follicular phase of the menstrual cycle (the first half), Adderall side effects might be augmented.[6]

Estrogen also influences the metabolism and excretion of drugs, so women may metabolize Adderall faster or slower at different times of their menstrual cycles.

Progesterone, another female hormone that peaks during the luteal phase (the second half) of the menstrual cycle, may counteract some of estrogen's effects on dopamine.[6]

Hormonal fluctuations may also affect mood and emotional well-being in some females. When combined with Adderall, which itself can cause mood swings or anxiety as side effects, these emotional reactions are heightened.

Due to these interactions, some women might need dose adjustments at different points in their menstrual cycle, such as a lower dose during the follicular phase and higher dosages in the luteal phase.[6]

Adderall interactions

Adderall interacts with various medications and substances, altering its potency or triggering harmful side effects. Common interactions with Adderall include

  • MAO inhibitors (Monoamine Oxidase Inhibitors): Combining Adderall with antidepressants such as phenelzine and tranylcypromine may generate a hypertensive crisis (a severe increase in blood pressure) or serotonin syndrome.[3]

  • Antihypertensive drugs: Adderall can decrease the effect of medications designed to lower blood pressure, such as beta-blockers or ACE inhibitors.[7]

  • Acidifying agents: Drugs like ascorbic acid (vitamin C) or certain urinary acidifying agents may lower Adderall absorption, reducing its effectiveness.[7]

  • Alkalinizing agents: Some antacids or urinary alkalinizing medicines may increase Adderall absorption, intensifying its effects and adverse reactions.[7]

  • Antipsychotics: Drugs like haloperidol or chlorpromazine may counteract the effects of Adderall.[7]

  • Antidepressants: Serotonergic drugs, such as SSRIs or SNRIs, may increase the risk of serotonin syndrome when taken with Adderall.[3]

  • Narcotic pain medications: Combining opioids with Adderall may also augment the risk of serotonin syndrome.[8]

  • Lithium: The mood stabilizer might decrease the effectiveness of Adderall.[9]

  • Certain common cold drugs: Over-the-counter medications containing decongestants (like pseudoephedrine or phenylephrine) may intensify the cardiovascular effects of Adderall.[3]

  • Alcohol: Combining Adderall with alcohol may increase the risk of cardiovascular side effects, exacerbate impaired judgment, or increase the risk of substance abuse.[10]

Warnings and health risks for Adderall

  • Cardiovascular risks: Sudden death in patients with heart problems or defects, stroke, heart attack, increased blood pressure and heart rate[7]

  • Mental risks: Worsening behavior and thought disturbances in patients with a history of psychosis, along with new or worsening bipolar disorder, and aggressive behavior[7]

  • Misuse and dependency: Adderall is a Schedule II controlled substance, with a high risk of substance abuse[10]

  • Serotonin syndrome: Risk when used in combination with serotonergic agents (SSRIs, SNRIs, triptans), or with drugs that impair serotonin metabolism (e.g., MAOIs) [7]

  • Circulatory issues: Peripheral vasculopathy, including Raynaud’s phenomenon[7]

  • Long-term growth suppression: Particularly in children[7]

  • Neurological effects: Motor and vocal tics can occur or worsen in patients with Tourette's syndrome[11]

What to do if you experience severe Adderall side effects

If you experience severe side effects from Adderall, you should address the situation promptly:

  • Go to the nearest emergency room or call emergency services immediately at 1-800-222-1222.[1][3] Severe symptoms include chest pain, difficulty breathing, fainting, or a significant change in mental status.

  • Maintain a detailed record of the side effects experienced, including the onset, duration, and any other factors.

  • Unless otherwise directed by a medical professional, cease taking Adderall if you're experiencing severe side effects.

  • Do not dispose of the remaining medication, as it might be needed for reference or assessment.

  • Until you've consulted with your doctor, avoid combining Adderall with alcohol, caffeine, or any other medications or supplements.

  • Notify your healthcare provider about any severe side effects so they can adjust the dosage or change to another medication.

  • Report the adverse effects on FDA’s MedWatch.[12]