Amphetamines (Adderall/Vyvanse)

What amphetamines are

Amphetamines are a group of medications sold under brand names such as Adderall, Adderall XR, Vyvanse (lisdexamfetamine), Dexedrine, and Mydayis, along with their generic versions. They work mainly by boosting the activity of two of the brain's chemical messengers, dopamine and norepinephrine, which help with focus, attention, and alertness. Because they rev up that signaling, they are often called stimulants. They come in several forms, including tablets, capsules, and longer-acting versions that release over the day. They are controlled medicines, so they are used thoughtfully and with regular follow-up.

What it treats

Your clinician might suggest an amphetamine for one of these, among other possible off-label uses:

• Attention-deficit/hyperactivity disorder (ADHD)
• Narcolepsy, a condition that causes overwhelming daytime sleepiness
• Binge eating disorder in adults (for lisdexamfetamine, sold as Vyvanse, specifically)

Whether it is a good fit depends on several factors, including your heart health, your history, and your other medications. As with everything in psychiatry, that is decided case by case.

How it works

Honestly, no one knows with complete certainty how amphetamines produce their benefit. What robust research supports is that they increase the activity of dopamine and norepinephrine in the brain, which can make it easier to focus, sustain attention, and stay alert. The biology is only part of the picture: how much a medication helps, and how it feels, is individual. Two people on the same medication can have very different experiences.

How to take it

There is no single right way to take an amphetamine; it depends on you and your clinician, and a medicine in this group calls for more care than most. The plan you and your clinician make together is the one to follow, not a number you read online. A few points matter here:

• Take it exactly as you and your clinician agreed, and do not increase the amount on your own.
• Expect regular check-ins on things like blood pressure, heart rate, sleep, appetite, and mood, especially early on.
• Store it securely and do not share it. These medicines are controlled, and giving them away or selling them can harm others and is against the law.
• If you miss a dose, ask your clinician or pharmacist what to do rather than doubling up.
• Do not stop abruptly after taking it regularly. Stopping suddenly can leave you drained, low, or very tired for a stretch, and your clinician can step it down more gently when the time comes.

A word on dependence, plainly: amphetamines are Schedule II medicines, the category with a high potential for misuse and dependence. With steady use the body and brain can come to rely on them, so misusing them or stopping suddenly can feel bad. Taken as prescribed and monitored, many people use them safely for years. Being thoughtful about this is not a judgment of you; it is exactly why we plan the dose together, follow up regularly, and store the medicine safely.

What to expect

This varies from person to person. Unlike some medications that take weeks to help, an amphetamine often has a noticeable effect the same day, which is part of how it is used. Any side effects, if they happen, also tend to show up early, and many ease over the first weeks or can be eased by adjusting the timing. The right plan for you may change over time, and that is something you and your clinician revisit together. If it does not turn out to be the right fit, that is useful information, not a dead end, and there are other options. As always, this is case by case.

Side effects

Not everyone gets side effects, and many that do happen ease over the first weeks. The lists below are possibilities, not certainties.

Possible more common side effects:

• Reduced appetite, and in children some slowing of growth, which your clinician monitors
• Trouble sleeping
• Headache, dry mouth, or an upset stomach
• Feeling jittery, anxious, or irritable
• A faster heartbeat
• A let-down or low feeling as a dose wears off

If any of these stick around or bother you, send a non-urgent message through the patient portal or bring it up at your next visit; often a small change in timing or plan helps.

Less common, but concerning side effects that could require emergency care:

• Chest pain, shortness of breath, or fainting
• Signs of a serious change in thinking: hearing or seeing things that others do not, severe agitation, or feeling abnormally high, wired, or irritable with racing thoughts and far less need for sleep than usual
• Serotonin syndrome: agitation, confusion, a racing heart, fever, heavy sweating, or stiff or twitching muscles, especially after another medication is added
• Fingers or toes that feel numb, cool, or painful, or that change color from pale to blue to red
• A painful erection, or one lasting more than a few hours
• A seizure
• Signs of an allergic reaction: rash, hives, or swelling of the face, lips, or throat
• Any new or worsening thoughts of harming yourself

For any of these, use the help options at the top of this page: call 911 or go to the nearest emergency department for a medical emergency or severe reaction, or call or text 988 for a mental health crisis.

Pregnancy and breastfeeding

A note on scope first. Everything below is specifically about Adderall, the mixed amphetamine salts. The other medications covered on this page, including lisdexamfetamine (Vyvanse), have been studied separately and less, and it should not be assumed that the same findings carry over to them. If you take one of those, that is worth asking about directly.

If you are pregnant, thinking about it, or breastfeeding, this is worth going through together rather than settling from a page. Tell your clinician before changing anything, and do not stop suddenly on your own.

In pregnancy

Taking it as prescribed does not appear to make it harder to get pregnant. Studies of people taking prescribed amphetamines have not shown an increased chance of birth defects, and findings on miscarriage have not been consistent: some report a small increase, and others find no clear difference once maternal ADHD and other factors are accounted for. FDA labeling states that the published studies and post-market reports available have not identified a drug-associated risk of major birth defects or miscarriage.

Child development is the best studied part, and the news is reassuring. Three large studies, covering millions of pregnancies between them, looked at whether children exposed before birth were more likely to develop autism, ADHD, or other neurodevelopmental conditions. In each one, an apparent increase disappeared once the comparison accounted for the fact that ADHD runs in families. Two of the studies also compared siblings, which is a stringent test, and found the same. One of them pooled its results with another and landed exactly at no difference.

Pregnancy and birth outcomes are less settled. Some studies suggest higher chances of poor growth, low birth weight, or preterm delivery; one found a higher chance of preterm delivery and two did not. Some found higher rates of high blood pressure and preeclampsia. ADHD itself is associated with preterm delivery and with blood pressure problems in pregnancy, which makes these hard to separate.

Taking more than prescribed is a different situation. Studies of use above the prescribed amount, or without a prescription, show higher chances of poor growth, low birth weight, and preterm delivery, along with temporary newborn symptoms including jitteriness, sleepiness, and trouble breathing at birth. Withdrawal has not been reported in newborns of people who took it as prescribed.

While breastfeeding

This is the thinnest evidence anywhere on this page, and the sources do not agree with each other. You should know both things before you decide.

Roughly 20 mother and infant pairs appear in the entire published literature. In those reports, babies grew normally and development was normal where it was measured; some parents reported sleepiness, crying or restlessness, and colic or constipation. There are no studies of the combination product specifically in breastfeeding.

The disagreement is this. FDA labeling for Adderall XR advises that breastfeeding is not recommended while taking it. LactMed, the National Institutes of Health lactation database, records that position and adds that some experts hold that doses in the range used to treat a medical condition can be used while nursing, with the baby watched for irritability, trouble sleeping, and feeding difficulty. MotherToBaby likewise notes the label position and says the benefit may outweigh the possible risks. All three are current. This is a real split rather than one source being out of date, and it is the reason this particular decision belongs in a conversation rather than on a page.

Both LactMed and the FDA state plainly that the long-term effects on a baby's development are unknown. That is a genuine gap in what has been studied. It is neither a reassurance nor a warning, and anyone telling you it is one of those is going beyond the evidence.

One practical point: large doses might interfere with milk production, particularly before breastfeeding is well established, though MotherToBaby notes there are no clear reports of this actually happening in patients.

Separately, and this is a different situation again, breastfeeding is generally discouraged where amphetamines are being used outside a prescription.

If you are a man taking Adderall

One study suggested that amphetamine medication may lower sperm production, which would affect fertility. Whether it changes the chance of birth defects has not been studied.

Registries

There is a national registry that follows pregnancy outcomes for people taking medications for ADHD, and you can enroll yourself rather than waiting to be asked. It is listed in the references at the bottom of this page.

When to reach out, and where

For routine questions, side effects that can wait, or how things are going, send your clinician a message through the patient portal. These are part of your ongoing care and are answered in the normal course of a few business days, so they are best for things that are not urgent.

If something feels urgent, you do not need to wait for a reply. The help options at the top of this page are the fastest way to get care: 911 or the nearest emergency department for a medical emergency or severe reaction, or 988 any time for a mental health crisis or thoughts of self-harm.

Questions to ask your clinician

• What are you hoping this medication will help with in my case?
• How and when will we know if it is working?
• What should we watch for given my heart health and history?
• What should I do about appetite, sleep, or mood changes if they come up?
• If pregnancy is possible for me, or I am breastfeeding, what should we talk through?
• What is the plan if this one turns out not to be the right fit?
• How will we handle stopping it, if and when we get there?