Learn the short- and long-term effects of Adderall on the body

If you have attention-deficit/hyperactivity disorder (ADHD), your healthcare provider may recommend or prescribe the stimulant medication Adderall to help minimize your symptoms. Adderall can be an essential tool for improving the daily executive functioning of people with ADHD. It helps with thinking more clearly, focusing energy on singular projects, and coping better with everyday challenges like impulsivity and hyperactivity. 

But it’s understandable if you have concerns about taking Adderall due to possible adverse side effects. To better understand this medication, we spoke with two experts about how Adderall works and its short-term and long-term effects on the body.

What is Adderall?

Adderall is a brand-name drug; its generic is amphetamine-dextroamphetamine. Both are a combination of amphetamine salts: dextroamphetamine and amphetamine, according to Alex Dimitriu, MD, founder of Menlo Park Psychiatry & Sleep Medicine. It’s FDA approved for the treatment of ADHD and narcolepsy, but it’s sometimes prescribed off-label as a weight loss drug. The drug works by stimulating the central nervous system thereby increasing the amounts of certain neurotransmitters (norepinephrine and dopamine) in the brain. 

The effects of Adderall on the body

No two people taking Adderall will have the same response to the drug. Dr. Dimitriu notes this is especially true for people with ADHD versus people without ADHD (i.e., people taking Adderall for narcolepsy or off-label uses). 

“Generally speaking, the side effects of Adderall are more problematic in non-ADHD users,” Dr. Dimitriu says. However, he explains that anyone taking Adderall may experience common side effects, such as increased energy, alertness, elevated heart rate and blood pressure, dry mouth, and decreased appetite.

Short-term effects of Adderall on the body

According to a 2018 review, “the primary pharmacologic effect of both amphetamine and methylphenidate is to increase central dopamine and norepinephrine activity, which impacts executive and attentional function.” The impacts Adderall has on your nervous system and your body when a dose is active in your system are known as short-term effects, and they include:

• Improved energy
• Enhanced focus
• Better impulse control
• Loss of appetite
• Dry mouth
• Increased heart rate and blood pressure
• Constipation

“Adderall [narrows your] focus, so you are more likely to keep doing whatever you are doing,” Dr. Dimitriu says. “This can be good when the task ahead is clear.” 

Since Adderall affects people differently, the effects can sometimes be challenging for people with ADHD. Dr. Dimitriu explains that singular concentration “can also lead to ‘railroading,’ or getting stuck on a wrong path, solution, or creative direction without seeing alternatives.”

Once the Adderall passes through your system, you’re likely to see these effects quickly wear off. You may start noticing an inability to focus or concentrate and an increase in impulsivity or irritability while suddenly feeling hungry, less motivated, or even sluggish. 

Long-term effects of Adderall on the body

Regularly taking Adderall is not a cure for ADHD. It won’t have any long-lasting effects on your cognition; its cognitive benefits (like improved focus and better impulse control) will wear off as the medication does. The long-term effects of taking Adderall over an extended period are primarily physical, says Erika Gray, Pharm.D., chief medical officer and co-founder of Toolbox Genomics. They include:

• Nervousness or restlessness
• Difficulty sleeping
• Nausea or vomiting
• Hypertension, or high blood pressure 
• Weight loss due to loss of appetite
• Tolerance of the medication
• Adderall addiction

Many of these effects are usually seen with Adderall abuse; this is when it is taken recreationally or without the supervision of a healthcare provider, especially at too-high doses. Taking unknown or high doses can be dangerous, says Dr. Dimitriu. It can lead to serious side effects like agitation, impaired focus, anxiety, panic attacks, or even psychosis (in extreme cases).

High doses of Adderall may cause cardiovascular issues like a heart attack. However, there’s still a lot that experts don’t know about the relationship between Adderall and heart problems since much of the evidence relates to drug abuse rather than the proper use of prescription stimulants. The risks also seem to be higher for people with existing heart conditions like arrhythmias, which is noted in the medication’s black box warning. 

For the most part, Adderall can be safely used to minimize ADHD symptoms in patients who have no contraindications. It’s a Schedule II controlled substance, so it can lead to a substance use disorder if it’s misused, but that’s rarely seen in people using therapeutic doses of the drug for ADHD as prescribed by a provider. In fact, correctly medicating with Adderall may decrease the likelihood of substance abuse later in life since there is less need to self-medicate with illegal substances.

While you can build up a tolerance to Adderall, there’s not much consistency in the studies looking at tolerance rates, notes Dr. Dimitriu. He adds that the lower the dose, the more likely you’ll have positive Adderall side effects rather than negative ones. The prescribing information for amphetamines says that they should be prescribed at the lowest effective dose.

How long does Adderall stay in the body?

According to Dr. Gray, Adderall has a half-life of 12 hours (which means half of the initial dose you took will still be in your system after 12 hours), and after about 60 hours, it will have fully “washed out” or cleared from your system. 

“The half-life of Adderall XR is the same as the immediate release capsules,” Dr. Gray says. “The way the XR capsules are designed, they release the medication in a two-step process, which mimics twice-a-day dosing.”

That said, Dr. Gray says certain circumstances can change how long the drug lasts in your body. The liver and kidneys break down Adderall, so anyone with liver or kidney dysfunction may have a longer half-life. Additionally, as you get older and if you take higher doses, your body can take longer to metabolize the medication. 

Another (unexpected) factor that can affect how quickly Adderall leaves your body is the pH level of your urine. High-alkaline urine decreases how much Adderall is excreted from your system, while urine high in acidity increases excretion, according to Dr. Gray.

How to avoid Adderall withdrawal

If you plan to discontinue Adderall entirely, you need to work with your practitioner to slowly taper your dose. Because Adderall blocks dopamine transport in the brain (which leads to increased dopamine levels), stopping the medication all at once may make your brain feel like it needs more dopamine than usual, Dr. Gray explains. This can cause unpleasant withdrawal symptoms such as mood changes, problems with concentration and motivation, irritability, and trouble sleeping.

Dopamine levels will eventually normalize, but it takes time. “Some people feel better in one to two weeks, while others may struggle for several months,” she says.

But it’s also worth noting that you don’t have to stop taking Adderall at any particular point—there’s no age when you must stop using it. Some young children and adolescents can discontinue it as they age, but many adults require Adderall and other ADHD treatments throughout their lives. 

For some people, taking a break from Adderall (i.e., planning to skip or lower a dose over the weekend) is a happy medium versus stopping it entirely. 

“Occasional breaks or days of lower dosage are generally beneficial and can allow the body to re-sensitize to the effect of stimulants,” Dr. Dimitriu says. However, you must weigh the pros against the cons. “For some people, the impact of being unmedicated with stimulants can be substantial and costly,” he says. “[You] should make this decision together [with your healthcare provider], reviewing interpersonal, career, or academic impacts.”

How to switch to another medication

If Adderall is no longer the best stimulant medication for you, Dr. Dimitriu says you can work with your provider to switch between the two main classes of stimulant medication: an amphetamine drug, such as Adderall, or a methylphenidate drug, such as Ritalin. 

Several other prescription drugs fall into these categories, such as brand-name Vyvanse (in the amphetamine class) and Jornay (in the methylphenidate class). However, Dr. Dimitriu warns the doses may not be the same across these drugs, so your provider will have to work out the equivalent dose. Your healthcare provider should also advise you on whether or not you need to taper or discontinue your initial drug before starting your new drug. This will depend on the dose you have previously taken and the new dose being prescribed to you. 

One other easy thing you can do to optimize the effect of any stimulant drug is to prioritize sleep. “Sleep is essential to making ADHD symptoms and medications work,” Dr. Dimitriu says. “I have seen numerous patients report diminished or no effect from stimulants [when they are] consistently sleeping less than six to seven hours per night.” 

Dr. Dimitriu recommends getting extra sleep before any dose increases to prevent sleep from interfering with your medication changes.