ADDERALL

DESCRIPTION / DEFINITIONS: Adderall® is a central nervous system (CNS) stimulant consisting of four stimulants: dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate. It is approved by the Food and Drug Administration (FDA) to treat Attention Deficit Hyperactivity disorders.

ABUSE: Adderal is listed as a Schedule II drug by the Drug Enforcement Administration (DEA). All schedule II drugs have a high potential for abuse.

ADDICTION / DEPENDENCE: As a schedule II drug, Adderall has a high potential for addiction and dependence, as well as abuse. See additional information, boxed warnings and half life and metabolism below.

SIDE EFFECTS: Anorexia, depression, insomnia and even severe cardiovascular events are among the many side effects that can be experienced by children, adolescents and adults. See more information below.

WITHDRAWAL SYMPTOMS: Drug cravings, anxiety and depression – which can become severe enough to lead to suicidal or violent actions – are among the withdrawal symptoms. See more information below.

TREATMENT: Treatment is dependent on how long you’ve been taking Adderall, at what dosage, and how you personally react to the drug and withdrawal. See more information below.

 

DESCRIPTION / DEFINITIONS

Adderall’s active ingredients are four different amphetamines: dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate. It increases the presence of the neurotransmitters norepinephrine, which is released by the central nervous system in times of stress, and dopamine, which is associated with the ‘reward and pleasure’ centers of the brain. Adderall was developed in 1996 to add to the drugs already on the market to treat ADHD, although it is not known exactly how Adderall works to produce a therapeutic effect on ADHD.

Adderall’s active ingredient, amphetamine, has been used as a drug for nearly 100 years, according to the U.S. National Library of Medicine. It was first used in the 1920s to help clear breathing passages for people with lung problems, asthma or colds, and in 1932 became the primary component in Benzedrine inhalers. It went on to also be used in tablet form for a variety of conditions, including types of Parkinson’s Disease, narcolepsy and depression.

But by the mid 1930s, amphetamine was already widely abused. Young people – teens and young adults – would take the amphetamine strip out of the inhalers and put it in liquid that they would drink. Or they would chew the strips and swallow them directly. Both methods gave an intense stimulant effect.

The dangers of amphetamine weren’t realized until about 1939, but instead of the dangers slowing down its use, it was used even more. It became popular among WWII soldiers, long-haul truckers, athletes, and others who needed to get more energy or stay awake for long periods of time. 

This is also when amphetamine was first used as a ‘study drug’ by students cramming for exams.

By about 1965, as the harmful and even deadly affects of amphetamine were finally being recognized, the FDA started getting it under control. Benzedrine inhalers, for example, were only available by prescription as of 1965.

Since that time the use of amphetamine for nearly all medical purposes was stopped because the dangers outweighed the benefits.

Nevertheless, in the form of Adderall – and other similar drugs – amphetamine is now used to treat the set of symptoms known as ADHD in children as young as six, as well as for teens and adults.

Students are also still using amphetamine, in the form of Adderall, as a study drug.

It is also still widely abused, and causes addiction and dependence.

 

ABUSE

As a schedule II drug, Adderall has a high potential for abuse.

 

ADDICTION / DEPENDENCE

The Adderall label warns us of addiction and dependence on the drug label:

WARNING: POTENTIAL FOR ABUSE

Amphetamines have a high potential for abuse. Administration of amphetamines for prolonged periods of time may lead to drug dependence. Pay particular attention to the possibility of subjects obtaining amphetamines for non-therapeutic use or distribution to others and the drugs should be prescribed or dispensed sparingly.

Misuse of amphetamine may cause sudden death and serious cardiovascular adverse reactions.

Amphetamines have been extensively abused. Tolerance (needing more to continue having the same effect), extreme psychological dependence, and severe social disability have occurred. There are reports of patients who have increased the dosage to levels many times higher than recommended. Abrupt cessation following prolonged high dosage administration results in extreme fatigue and mental depression; changes are also noted on the sleep EEG. Manifestations of chronic intoxication with amphetamines may include severe dermatoses, marked insomnia, irritability, hyperactivity, and personality changes. The most severe manifestation of chronic intoxication is psychosis, often clinically indistinguishable from schizophrenia.

 

HALF LIFE AND METABOLISM

The half-life of Adderall ranges from about 9 to 14 hours, depending on the weight, length of time taking it and the dosage of the person taking it.

CYP2D6, dopamine beta-hydroxylase (DBH), flavin-containing monooxygenase 3 (FMO3), butyrate-CoA ligase (XM-ligase), and glycine N-acyltransferase (GLYAT) are the enzymes known to metabolize amphetamine or its metabolites in humans.

Warning: The CYP enzymes are the major enzymes involved in drug metabolism, and since many drugs may increase or decrease the activity of various CYP isozymes, this is a major source of adverse drug interactions, since changes in CYP enzyme activity may affect the metabolism and clearance of various drugs. For example, if one drug inhibits the CYP-mediated metabolism of another drug, the second drug may accumulate within the body to toxic levels, possibly causing an overdose.

 

SIDE EFFECTS

The side effects of Adderall are extensive. They include:

  • agitation
  • anxiety
  • blurred vision
  • constipation
  • diarrhea
  • difficulty having an orgasm
  • dizziness
  • dry mouth or unpleasant taste in the mouth
  • emotional lability (rapid, often exaggerated changes in mood, involving strong emotions or feelings like uncontrollable laughing or crying, or heightened irritability or temper)
  • excitability
  • fear
  • fever
  • hair loss
  • headache
  • heart palpitations
  • impotence
  • increased blood pressure
  • increased heart rate
  • irritability
  • loss of appetite
  • loss of interest in sex
  • nausea
  • nervousness
  • restlessness
  • sleep problems (insomnia)
  • stomach pain
  • tremor
  • vomiting
  • weakness
  • weight loss

 

Adderall can also have serious and even deadly side effects for people with certain pre-existing conditions, such as: 

  • advanced arteriosclerosis
  • symptomatic cardiovascular disease
  • moderate to severe hypertension
  • hyperthyroidism
  • hypersensitivity – which may or may not be known about – to amphetamine or anything else in Adderall. Taking amphetamines could result in anaphylactic reactions. These can be life-threatening and can include flushing of the skin, hives, a sense of impending doom, swelling of throat and mouth, difficulty in swallowing or speaking, alterations in heart rate, severe asthma, abdominal pain, nausea and vomiting, sudden feeling of weakness (drop in blood pressure), collapse and unconsciousness. It can also cause angiodema – similar to hives, but it affects the deeper layers of tissue, including the dermis, subcutaneous tissue, the mucosa, and submucosal tissues.
  • glaucoma
  • agitated states such as anxiety and nervousness
  • on or recently having taken any kind of anti-depressant.

 

The label also warns against other potential effects of Adderall: 

  • Serious Cardiovascular Events – those who have cardiovascular problems can experience heart attack, strokes, and sudden death.
  • Mental and Emotional Adverse Events – With someone who has no pre-existing behavioral conditions, Adderall, at usual doses, can cause hallucinations, delusional thinking, mania, aggression and hostility. Anyone with pre-existing mental or emotional problems risks their symptoms becoming worse when taking Adderall. Even at usual doses, manic or depressive episodes can be induced. 
  • Long-Term Suppression of Growth – children have to be monitored regularly to ensure they are developing properly. 
  • Seizures – in both those who have and do not have a history of seizures.
  • Peripheral Vasculopathy, including Raynaud’s phenomenon – a slow and progressive disorder that may affect any blood vessel outside of the heart including the arteries, veins, or lymphatic vessels and cause the brain, other organs, and the legs to not get enough blood flow to properly function. Raynaud’s phenomenon is characterized by cold and numb fingers, toes and other areas of the body in response to cold temperatures and stress.
  • Serotonin Syndrome – a potentially life-threatening condition that can occur when Adderall is mixed with certain other drugs. Symptoms of Serotonin Syndrome include agitation, hallucination, delirium, coma, tachycardia, labile (quickly vacillating up and down) blood pressure, dizziness, extreme sweating, hyperthermia, neuromuscular symptoms like tremor, rigidity, spasmodic jerking of muscles, hyperreflexia (sudden onset of excessively  high blood pressure), incoordination, seizures, and/or gastrointestinal symptoms such as nausea, vomiting, and diarrhea.
  • Visual disturbance – Adderall can cause symptoms such as blurred vision and difficulty focusing.
  • Tics – Adderall can exacerbate problems like Tourette’s Syndrome or any kind of tics.

 

WITHDRAWAL SYMPTOMS

Adderal can be a difficult drug to stop taking, especially if you’ve been abusing it by taking too much, or taking it for too long. 

Symptoms may include: depression, anxiety, and drug cravings, all of which can make it hard to stay off the drug once you’ve decided to quit. Also, the depression and anxiety induced by amphetamine withdrawal can lead to suicidal or violent actions.

Other withdrawal symptoms include:

  • extreme fatigue
  • sleep disturbances
  • insomnia, followed by hypersomnia
  • intense and vivid drug-related dreams
  • hunger
  • memory impairment
  • anhedonia (loss of interest in pleasurable activities).

These, as well as the anxiety and depression, will generally go away within a week or two, although feeling like yourself again can take many additional weeks or months and even years.

Symptoms of withdrawal from Adderall or other stimulants can begin anytime from hours or days after the last use.

 

TREATMENT

While stopping taking stimulants on your own is not usually life threatening, the withdrawal symptoms may be too uncomfortable, distressing, painful or even dangerous to successfully become drug-free without help.  A medically-controlled detox may help alleviate the pain and discomfort of coming off stimulants. Call us for more information.