LATEST NEWS AND FACTS ABOUT MEDICINES YOU TAKE

The effects of amphetamines and methamphetamine are similar to cocaine, but their onset is slower and their duration is longer.—U.S. Drug Enforcement Administration (DEA) fact sheet

ABOVE: Drug Enforcement Administration, US Department of Justice. “Drug Fact Sheet: Amphetamines,” undated, retrieved January 5, 2013: www.justice.gov/dea/druginfo/drug_data_sheets/Amphetamines.pdf.
Adderall XR

Adderall XR is a powerful blend of four amphetamines that includes Dexedrine and Benzedrine.

Adderall XR Side Effects and Warnings

Schedule II Substance

Amphetamine and Dextroamphetamine Composite

  • Brand Names: ADDERALL and ADDERALL XR
  • Generic Name: AMPHETAMINE MIXED SALTS
  • Category: RESPIRATORY AND CEREBRAL STIMULANTS
Drug Enforcement Administration, Department Of Justice: Schedule II Controlled Substance

FDA “Black Box” Warning Label

The Food and Drug Administration (FDA) requires the following "black box" warning on all amphetamines, including Adderall and Adderall XR, which means that medical studies indicate these drugs carry a significant risk of serious, or even life-threatening, adverse effects.

WARNING

AMPHETAMINES HAVE A HIGH POTENTIAL FOR ABUSE. ADMINISTRATION OF AMPHETAMINES FOR PROLONGED PERIODS OF TIME MAY LEAD TO DRUG DEPENDENCE AND MUST BE AVOIDED. PARTICULAR ATTENTION SHOULD BE PAID TO THE POSSIBILITY OF SUBJECTS OBTAINING AMPHETAMINES FOR NONTHERAPEUTIC 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 EVENTS.

ABOVE: FDA black box warning label means that medical studies indicate the drug carries a significant risk of serious or even life-threatening adverse effects. The bold warning label appears on the manufacturer's wholesale packaging and is the strongest alert the FDA can require of drug-makers.

Using amphetamines once is sufficient to induce some of these symptoms:

Short-Term Effects:

  • Enhanced mood and body movement
  • Increased wakefulness, physical activity
  • Increased respiration
  • Euphoria
  • Insomnia
  • Increased heart rate
  • Increased blood pressure
  • Reduced appetite
  • Cardiovascular collapse, death
  • Dilated pupils

Long-Term Effects:

  • Damage to brain cells containing serotonin
  • Over time, reduced level of dopamine resulting in Parkinson's-like symptoms
  • Weight loss
  • Confusion
  • Tremors
  • Convulsion
  • Paranoia
  • Hallucinations
  • Damage to nerve cells, causing strokes
  • Cardiovascular collapse, death

Effects from Withdrawal:

  • Irritability
  • Anxiety
  • Paranoia
  • Aggressiveness
  • Fatigue and long periods of sleep
  • Depression

Behaviors resulting from amphetamine intoxication such as withdrawal from others, experiencing hallucinations, paranoia, delirium perhaps occurring with violence and stereotyped behaviors such as repeatedly assembling and dissembling electronic equipment may resemble symptoms of schizophrenia. But a skilled clinician should be able to make the proper diagnosis.

ABOVE: Psychology Today's Diagnosis Dictionary: Amphetamines; last reviewed by Fiery Cushman on Jan. 10, 2005; captured from www.psychologytoday.com on Jan. 8, 2008.

Description

Adderall and Adderall XR are powerful blends of four amphetamines that includes Dexedrine and Benzedrine. Each contains:

EACH ADDERALL
TABLET CONTAINS:
5 mg 7.5mg 10 mg 15 mg 20 mg 30 mg
Amphetamine Aspartate 1.25 mg 1.875 mg 2.5 mg 3.75 mg 5.0 mg 7.5 mg
Dextroamphetamine Sulfate USP 1.25 mg 1.875 mg 2.5 mg 3.75 mg 5.0 mg 7.5 mg
Amphetamine Sulfate USP 1.25 mg 1.875 mg 2.5 mg 3.75 mg 5.0 mg 7.5 mg
Dextroamphetamine Saccharate 1.25 mg 1.875 mg 2.5 mg 3.75 mg 5.0 mg 7.5 mg
TOTAL AMPHETAMINES 3.1 mg 4.7 mg 6.3 mg 9.4 mg 12.6mg 18.8 mg
EACH ADDERALL XR
CAPSULE CONTAINS:
5 mg 10 mg 15 mg 20 mg 25 mg 30 mg
Amphetamine Aspartate 1.25 mg 2.5 mg 3.75 mg 5.0 mg 6.25 mg 7.5 mg
Dextroamphetamine Sulfate USP 1.25 mg 2.5 mg 3.75 mg 5.0 mg 6.25 mg 7.5 mg
Amphetamine Sulfate USP 1.25 mg 2.5 mg 3.75 mg 5.0 mg 6.25 mg 7.5 mg
Dextroamphetamine Saccharate 1.25 mg 2.5 mg 3.75 mg 5.0 mg 6.25 mg 7.5 mg
TOTAL AMPHETAMINES 3.1 mg 6.3 mg 9.4 mg 12.5 mg 15.6 mg 18.8 mg

Used For

  • Attention deficit disorder
  • Narcolepsy
  • Depression
  • Obesity

How Amphetamines Work

When we are stressed or under threat, the central nervous system prepares us for physical action by creating particular physiological changes. Amphetamines prompt the brain to initiate this 'fight or flight' response. These changes include:

  • The release of adrenalin and other stress hormones
  • Increased heart rate and blood pressure
  • Redirected blood flow into the muscles and away from the gut

In small doses amphetamines can banish tiredness and make the user feel alert and refreshed. However, the burst of energy comes at a price. A "speed crash" always follows the high and may leave the person feeling nauseous, irritable, depressed and extremely exhausted.

Do Not Use If

You have not tried other psychotherapy, have high blood pressure or any form of heart disease, are very nervous or have severe insomnia, have a history of addiction to drugs or alcohol, or have Tourette syndrome. Do not combine with monoamine oxidase inhibitors.

Common Side Effects

  • Dry Mouth
  • Loss of appetite
  • Headache
  • Difficulty falling asleep (insomnia)
  • Nervousness including agitation, anxiety and irritability
  • Addiction

Less Common Side Effects

  • High blood pressure
  • Rapid pulse rate
  • Tolerance (constant need to raise the dose)
  • Feelings of suspicion and paranoia
  • Visual hallucinations (seeing things that are not there)
  • Depression
  • Cocaine craving
  • Dermatoses (infected or diseased skin)
  • Urinary tract infection
  • Infection or viral infection
  • Elevated ALT enzyme levels in the blood (signaling liver damage)

Overdose Side Effects

Amphetamines have been extensively abused. Extreme psychological dependence and severe social disability have resulted. Abuse of amphetamines may cause a sudden heart attack even in those with no signs of heart disease. Symptoms of overdose that require immediate medical assistance include:

  • Restlessness
  • Tremor
  • Aggression
  • Hallucinations
  • Panic states
  • Hyperreflexia (overactive reflexes, which can include twitching or spasms)
  • Personality changes
  • Symptoms of depression
  • Seizures or abnormal EEGs
  • High blood pressure
  • Rapid heart beat
  • Swelling of hands/feet/ankles (for example, numbing of the fingertips)
  • Delusions
  • Sweating
  • Vomiting
  • Dehydration
  • Unexplained muscle pain
  • Lower abdominal pain
  • Rhabdomyolysis and kidney damage
  • Chronic abuse can manifest itself as psychosis, often indistinguishable from schizophrenia

Amphetamine-Induced Anxiety Disorder

The onset of amphetamine-induced anxiety disorder can occur during amphetamine use or withdrawal, according to best-selling psychiatry text, Kaplan and Sadock's Synopsis of Psychiatry citing American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

"Amphetamine, as with cocaine, can induce symptoms similar to those seen in obsessive disorder, panic disorder, and phobic disorders," states Synopsis of Psychiatry.

Adderall-Induced Psychosis

Induction of schizophrenic-like states in children on prescribed doses of stimulant medications, including Adderall, have been observed, though not as well documented as with amphetamine abusers, according to The Journal of the American Board of Family Medicine in an article entitled, "Adderall-Induced Psychosis in an Adolescent."

Amphetamine-Induced Sexual Dysfunction

Referring again to American Psychiatric Association's Manual of Mental Disorders, Synopsis of Psychiatry states: "High doses and long-term use of amphetamines are associated with erectile disorder and other sexual dysfunctions."

Adderall and Adderall XR are Schedule II Substances, which means that Adderall and Adderall XR have a "high potential for abuse" that "may lead to severe psychological or physical dependence," and the federal government sets limits on the amount of these amphetamine drugs that may be manufactured each year.

ABOVE: 21 USC Sec. 812 01/22/02. Drug Enforcement Administration, US Department of Justice. www.dea.gov/pubs/csa/812.htm.

“Amphetamine, as with cocaine, can induce symptoms similar to those seen in obsessive disorder, panic disorder, and phobic disorders.”

ABOVE: Kaplan and Sadock's Synopsis of Psychiatry (2007) citing American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

Dependence, Tolerance and Withdrawal

It is possible to build up a tolerance to amphetamines, which means the person using the drug needs to take larger doses to achieve the same effect. Over time, the body might come to depend on amphetamines just to function normally. The person craves the drug and their psychological dependence makes them panic if access is denied, even temporarily.

Withdrawal symptoms can include tiredness, panic attacks, crankiness, extreme hunger, depression and nightmares. Some people experience a pattern of "binge crash" characterized by using continuously for several days without sleep, followed by a period of heavy sleeping.

If It Doesn't Work

The drug should be stopped gradually. Withdrawal symptoms are psychological and stopping suddenly can cause extreme fatigue and severe, even suicidal, depression in adult patients.

Abrupt cessation of Adderall and Adderall XR can cause extreme fatigue and severe, even suicidal, depression in adult patients.

ABOVE: The Essential Guide to Psychiatric Drugs—Rev. and updated (2007).

If It Does Work

"In the treatment of ADHD for children and young adults, Adderall XR is now prescribed frequently, often as a first-line drug. This is, in my opinion, a very serious mistake," states Jack M. Gorman, M.D., professor of psychiatry at Columbia University and deputy director of the New York State Psychiatric Institute. "Adderall is now abused throughout college campuses, where it is bought, sold, stolen, borrowed, snorted and injected. It is a very powerful drug that undoubtedly works for ADHD, but there are alternatives with less abuse potential that should be tried first."

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“High doses and long-term use of amphetamines are associated with erectile disorder and other sexual dysfunctions.”

ABOVE: Kaplan and Sadock's Synopsis of Psychiatry (2007) citing American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.
Emergency Paul Hart

Study finds more than triple the risk of developing a tear in the aorta, the huge artery carrying blood out of the heart. An emergency with high potential for fatality.

Young Abusers Risk Fatal Heart Vessel Condition

In a study published in the American Heart Journal, researchers scanned the medical records of nearly 31 million patients nationwide, ages 18 to 49, and found amphetamine abusers faced 3.3 times the risk of developing a torn aorta.

An aortic tear (a tear in the largest artery in the body, also called aortic dissection) is a medical emergency and can quickly lead to death, even with optimal treatment. Complications include rupture, heart attack, permanent kidney failure, stroke and death, according to the National Library of Medicine at the National Institutes of Health. If torn completely open, there is massive and rapid blood loss and an 80 percent mortality rate. Half of patients die before they even reach the hospital.

The torn heart vessel brings on "the most horrible chest pain imaginable," states a cardiologist at San Francisco General Hospital and the University of California, San Francisco, David Waters, in Science News, reporting on the Journal's study. "Patients say, 'I think I'm going to die,' and they're right," he said.

Adderall XR Matt Jeacock

14 of the 20 dead were children. None were associated with misuse or abuse. Initially Canada pulled the psychostimulant off the market, but then withdrew its ban.

20 Sudden Deaths Linked to Adderall XR

Adderall XR, a widely used drug for attention deficit hyperactivity disorder, was pulled off the market in Canada after regulators linked the drug to 20 sudden deaths and 12 strokes. Fourteen of the deaths and two of the 12 strokes were in children.

The adverse reactions were not associated with overdose, misuse or abuse of Adderall XR, Canadian regulators said.

The U.S. Food and Drug Administration issued a public health advisory to alert providers to the withdrawal. But the agency also said it had evaluated the same reports as Canadian regulators and did not think the data warranted pulling the drug from the U.S. market.

ADDERALL (a Schedule II controlled substance) is the new name for a Dextroamphetamine/Amphetamine composite medication that has been around for more than 30 years. This formula was also used in a medication known as Obetrol, made in the past by Rexar and developed for weight loss. As a medication for ADHD, Adderall was approved for unrestricted use for treatment of ADHD by the FDA in March 1996.

All amphetamines (amphetamine, dextroamphetamine and methamphetamine) have essentially the same chemical properties and their actions are so alike that even experienced users may not feel a difference between them, according to a 2005 report by the Drug Enforcement Agency (DEA).

ABOVE: Drug Enforcement Administration, US Department of Justice. “Amphetamines,” Drugs of Abuse Publication. National Drug Intelligence Center, 2005 ed. www.usdoj.gov/dea/pubs/abuse.
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The Fear of Withdrawal

Once addicted, most people find that stopping is more easily said than done. Rates of relapse, even after treatment, are very high. One of the biggest reasons is the fear of drug withdrawal. Addiction to Adderall means the body is physically dependent on the substance. Take it away and there is a violent physical reaction. Without the drug, the addict may develop severe depression and a drug craving so powerful that they will do almost anything--including commit violent crimes--to get more drugs.

Yet many addicts who get past the withdrawal period still relapse in time. Unfortunately, we do not know why. Animal studies have shown that addiction to most substances changes the way genes in the brain function.

ABOVE: The Essential Guide to Psychiatric Drugs—Rev. and updated (2007).

Generic Adderall Recall

The FDA and Barr Laboratories, Inc. announced a recall for generic Adderall tablets that may have been "super-potent" and posed a risk of serious side effects among users of the drug. (August 13, 2009)

ABOVE: FDA: Barr Laboratories, Inc. issues a voluntary nationwide recall of Dextroamphetamine/Amphetamine 20mg Tablets, Lot number 311756; 8/13/2009: www.fda.gov/Safety/Recalls/ucm177321.htm

Generic Adderall Problems

A number of people have reported feeling really bad when taking generic Adderall XR.

“I am freaking out. This is my first day on it [generic Adderall XR] and I am a mess. I can feel my concrentration is better but my anxiety level has risen and I feel so depressed. Thank God I don't have to work today...I feel horrible..”

“I took the pill an hour ago and within half an hour of taking it, it just HIT me. I was hit with this HORRIBLE anxiety and depression. From a 0 to a 10 within minutes and it feels horrible... If anything, the generic made my ADHD worse, on top of giving me depression and anxiety. I kept getting lost in the middle of my sentences when I spoke, I kept forgetting what I was trying to say. I felt so dumb. Then I could not sleep at all last night... If you google it, many, many people write about these problems... Today I didn't take it, and I was a new person. It was such a relief to not have that garbage in my system.”

Adderall May Cause 60% Increase in Risk of Parkinson's Disease

Users of amphetamines, like Adderall, may be nearly 60 percent more likely to develop Parkinson's disease than those who don't take the drugs, suggests a 31-year study, presented at the American Academy of Neurology's 63rd Annual Meeting.

The study involved 66,348 volunteers in California. The average age at the start of the study was 36. By 1995, according to the researchers, 1,154 of the amphetamine-users had been diagnosed with Parkinson's disease.

The study's author stated: “If further studies confirm these findings, the potential risk of developing Parkinson's disease from these types of amphetamines would need to be considered by doctors before prescribing these drugs as well as be incorporated into amphetamine abuse programs, including illicit use.”

Amphetamines are now often prescribed to increase wakefulness and focus for people with attention deficit hyperactivity disorder, narcolepsy, and traumatic brain injuries. But when this study was conducted, between 1964 and 1973, amphetamines (Dexedrine and Benzedrine) were commonly used for weight-loss. Adderall is a blend of four amphetamines that includes Dexedrine and Benzedrine.

ABOVE: PR Newswire, “Using Amphetamines May Increase Risk of Parkinson's Disease,” St. Paul, Minn., 2/22/2011. (The study was supported by Kaiser Permanente Northern California.) www.prnewswire.com/news-releases/using-amphetamines-may-increase-risk-of-parkinsons-disease-116660444.html

“All major classes of psychiatric drugs—antipsychotics, antidepressants, benzodiazepines, and stimulants for ADHD—can trigger new and more severe psychiatric symptoms in a significant percentage of patients.”

ABOVE: Whitaker, R. Anatomy of an Epidemic: “Psychiatric Drugs and the Astonishing Rise of Mental Illness in America,” Ethical Human Psychology and Psychiatry, Vol. 7 No. 1, 2005.

What do Amphetamines Include?

BRAND NAME GENERIC NAME
Adderall amphetamine plus dextroamphetamine
[instant release]
Adderall XR amphetamine plus dextroamphetamine
[extended release]
Benzedrine amphetamine
[instant release]
Biphetamine amphetamine plus dextroamphetamine
Desoxyn methamphetamine
[instant release]
Dexedrine dextroamphetamine
[instant release]
Dexedrine SR dextroamphetamine
[extended release]
Dexedrine Spansule dextroamphetamine
[extended release]
Dextrostat dextroamphetamine
[instant release]
ProCentra dextroamphetamine
[immediate release, bubblegum flavor]
Vyvanse dextroamphetamine
with lysine (lisdexamfetamine)
[extended release]
  • ALTERNATE NAMES:
  • amphetamine = amfetamine = dl-amphetamine
  • dextroamphetamine = dexamfetamine
    = dexamphetamine = d-amphetamine
  • methamphetamine = d-methamphetamine

All amphetamines have essentially the same chemical properties and actions, states a 2005 published report by the Drug Enforcement Agency (DEA). Amphetamine, dextroamphetamine and methamphetamine are so alike, according to the DEA report, that even experienced users may not feel a difference between them.

ABOVE: Drug Enforcement Administration, US Department of Justice. “Amphetamines,” Drugs of Abuse Publication. National Drug Intelligence Center, 2005 ed. www.usdoj.gov/dea/pubs/abuse.

What is the most important information I should know about ADDERALL XR?

ADDERALL XR is a stimulant medicine. The following have been reported with use of stimulant medicines [AMPHETAMINES].

1. Heart-related problems:

  • sudden death in patients who have heart problems or heart defects
  • stroke and heart attack in adults
  • increased blood pressure and heart rate

Tell your doctor if you or your child have any heart problems, heart defects, high blood pressure, or a family history of these problems. Your doctor should check you or your child carefully for heart problems before starting ADDERALL XR

Your doctor should check you or your child's blood pressure and heart rate regularly during treatment with ADDERALL XR.

Call your doctor right away if you or your child has any signs of heart problems such as chest pain, shortness of breath, or fainting while taking ADDERALL XR.

2. Mental (Psychiatric) problems:

All Patients

  • new or worse behavior and thought problems
  • new or worse bipolar illness
  • new or worse aggressive behavior or hostility

Children and Teenagers

  • new psychotic symptoms (such as hearing voices, believing things that are not true, are suspicious) or new manic symptoms

Tell your doctor about any mental problems you or your child have, or about a family history of suicide, bipolar illness, or depression.

Call your doctor right away if you or your child have any new or worsening mental symptoms or problems while taking ADDERALL XR, especially seeing or hearing things that are not real, believing things that are not real, or are suspicious.

ABOVE: Adderall XR Medication Guide, Rev. 03/2009.

How Safe is Ritalin?

Many think methylphenidate (Ritalin) is safe, or mild, because so many children use it. However, the government classifies the psychoactive drug with cocaine and morphine because it is highly addictive. [More]

Strattera Side Effects

Most people may not know that Strattera (atomoxetine) appears to cause unsatisfactory sexual function (decreased libido, ejaculatory problems and impotence). [More]

Focalin Side Effects and Warnings

Focalin is a chemical variant of methylphenidate, dextro- or dexmethylphenidate, and also comes in an XR version. Naturally, the manufacturer claims it is better than other versions of methylphenidate, but that claim is met with skepticism by many psychopharmacologists. [More]

ProCentra: Liquid “Dexedrine”

ProCentra is a new name for what used to be a popular diet drug, Dexedrine. Now sold for children in bubblegum-flavored liquid and advertised as “easier to swallow.” [More]

What is Your Adderall IQ?

Amphetamine Advantage or Dangerous Delusion?

Like athletes who use steroids, students who use Adderall to enhance academic performance are in many ways victims. [More]

High-Fructose Corn Syrup May Hurt Cognition and Memory

Los Angeles, CA -- A recent study from the University of California Los Angeles (UCLA) brings new evidence about how high-fructose corn syrup (HFCS) may effect the brain. Researchers measured HFCS influence on insulin signaling, synaptic plasticity in the brain, and behavior. They concluded that HFCS consumption impaired cognitive ability and provided evidence of how HFCS may have more of an effect than previously known on cognition and memory.

Do psycho-stimulants impair creativity?

Stimulant drugs may have subtle impacts on cognitive and intellectual processes. Both parents and researchers have noticed that children taking Ritalin sometimes answer questions in ways that seem overly compliant or narrow, suggesting the drug might restrict creative thinking. One study found hyperactive children taking Ritalin offered less varied answers to open-ended questions.

How much do the “neuro-enhancing” drugs really help? And there's the question of what we mean by “smarter.”

The psycho-stimulants help students bear down on their work, but with odd effects. One college student says he spends “too much time researching a paper rather than actually writing it.” Another student looked back at papers he'd written while on Adderall and found them verbose: “I'd produce two pages on something that could be said in a couple of sentences.”

Could enhancing one kind of thinking exact a toll on others?

All these questions need proper scientific answers, but for now much of the discussion is taking place furtively, among an increasing number of Americans who are performing daily experiments on their own brains (or their children's brains).

ABOVE: Diller, L.H. Running on Ritalin: A Physician Reflects on Children, Society, and Performance in a Pill; Bantam Doubleday Dell Pub. Group, Inc. (1998); citing Feidler, N.L., et al., "The effects of stimulant drugs on curiosity behaviors of hyperactive boys," Journal of Abnormal Child Psychology, 11:193-206 (1983). Talbot, M. "Brain Gain: The underground world of 'neuroenhancing' drugs," The New Yorker, 4/2009.
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