Amphetamine (Adderall): Uses, Dosage, Side Effects, and What to Expect

Mixed amphetamine salts (75% d-amphetamine, 25% l-amphetamine) (brand name: Adderall, Adderall XR) is a central nervous system stimulant (mixed amphetamine salts). Amphetamine has a dual mechanism of action: it both blocks the reuptake of dopamine and norepinephrine (like methylphenidate) AND actively promotes their release from presynaptic nerve terminals. It also inhibits monoamine oxidase (MAO) to a small degree. This dual action produces more robust dopaminergic and noradrenergic enhancement compared to methylphenidate, which may explain why some patients who don't respond to one stimulant respond to the other. The mixed salts formulation (Adderall) contains four amphetamine salts that provide both rapid and sustained release.

• Attention-Deficit/Hyperactivity Disorder (ADHD) in children age 3+ and adults
• Narcolepsy

Common off-label uses:

• Treatment-resistant depression (augmentation)
• Binge eating disorder (lisdexamfetamine/Vyvanse is FDA-approved for this)
• Cognitive enhancement in neurological conditions
• Excessive daytime sleepiness

Immediate-release: start 5-10 mg 1-2 times daily, max 40 mg/day for ADHD. Extended-release (XR): 10-20 mg once daily, max 30 mg for children, 40 mg for adults (some clinicians prescribe higher). Take in the morning (IR may add afternoon dose). Avoid late-day dosing due to insomnia risk.

Immediate-release: 30-60 minutes, lasts 4-6 hours. Extended-release: 1-2 hours, lasts 10-12 hours. Most patients notice effects from the first dose.

• Decreased appetite (often more pronounced than methylphenidate)
• Insomnia
• Dry mouth
• Increased heart rate and blood pressure
• Headache
• Weight loss
• Irritability and mood changes
• Restlessness or anxiety

• Cardiovascular risk (sudden death in patients with structural heart abnormalities — screen before starting)
• Growth suppression in children
• Psychosis or mania (new onset or exacerbation)
• Serotonin syndrome (rare, when combined with serotonergic drugs)
• Misuse and dependence potential (Schedule II controlled substance)
• Peripheral vasculopathy

MAOIs contraindicated. Use caution with serotonergic drugs. Acidifying agents (vitamin C, fruit juices) decrease absorption. Alkalinizing agents increase absorption. Avoid with antihypertensives (opposing effects). CYP2D6 inhibitors may increase cardiovascular effects.

Category C. Amphetamines cross the placenta. Associated with increased risk of premature birth and low birth weight. Neonatal withdrawal symptoms possible.

No dangerous physical withdrawal, but stimulant discontinuation can cause a 'crash' — fatigue, increased appetite, depressed mood, hypersomnia lasting days to weeks. ADHD symptoms return immediately.