Can a person with a history of myocardial infarction (heart attack) take Adderall (amphetamine and dextroamphetamine)?

From the Guidelines

People who have had a heart attack should generally avoid taking Adderall due to significant cardiovascular risks. Adderall (amphetamine/dextroamphetamine) increases heart rate and blood pressure, which can be dangerous for someone with existing heart damage or cardiovascular disease, as highlighted in the management of chronic coronary syndromes 1. This stimulant medication places additional strain on the heart and could potentially trigger another cardiac event in vulnerable individuals. The 2024 ESC guidelines for the management of chronic coronary syndromes emphasize the importance of careful management of patients with a history of myocardial infarction, recommending lifelong aspirin therapy and consideration of other antianginal drugs to reduce angina frequency and improve exercise tolerance 1.

Some key points to consider when managing a patient with a history of heart attack include:

• The use of beta-blockers, calcium channel blockers, and long-acting nitrates as first-line treatments for angina and hypertension 1
• The consideration of alternative medications for conditions such as ADHD, such as non-stimulant options like atomoxetine (Strattera), guanfacine (Intuniv), or bupropion (Wellbutrin)
• The importance of close collaboration between cardiologists and psychiatrists to develop a treatment plan that addresses mental health needs while prioritizing heart safety
• The need for careful monitoring of cardiovascular risk factors and adjustment of medications as needed to minimize the risk of another cardiac event.

Given the potential risks associated with Adderall use in patients with a history of heart attack, it is recommended to explore alternative treatment options that do not increase cardiovascular risk, such as non-stimulant medications for ADHD, under the guidance of a healthcare professional 1.

From the FDA Drug Label

WARNINGS Serious Cardiovascular Events Sudden Death in Patients with Pre-existing Structural Cardiac Abnormalities or Other Serious Heart Problems: ... Adults Sudden deaths, stroke, and myocardial infarction have been reported in adults taking stimulant drugs at usual doses for ADHD ... Adults with such abnormalities should also generally not be treated with stimulant drugs Caution is indicated in treating patients whose underlying medical conditions might be compromised by increases in blood pressure or heart rate, e.g., those with pre-existing hypertension, heart failure, recent myocardial infarction, or ventricular arrhythmia

Key Considerations:

• The drug label warns against the use of stimulant drugs, including amphetamine, in adults with serious cardiac problems, such as recent myocardial infarction.
• Caution is advised when treating patients with underlying medical conditions that may be compromised by increases in blood pressure or heart rate.
• The label recommends careful assessment of cardiovascular status before initiating treatment with stimulant medications.

Answer: A person who has had a heart attack should not take Adderall, as the FDA drug label advises against the use of stimulant drugs in adults with recent myocardial infarction due to the increased risk of serious cardiovascular events 2.

From the Research

Cardiovascular Risks and ADHD Medications

• The use of ADHD medications, such as Adderall, has been associated with increased heart rate and blood pressure, raising concerns about their cardiovascular safety 3, 4.
• However, studies have shown that the risk of serious cardiovascular events, including myocardial infarction, sudden cardiac death, and stroke, is not significantly increased in adults taking ADHD medications 5, 6.

Adderall and Heart Attack

• There is limited research specifically addressing the use of Adderall in individuals who have had a heart attack.
• A study published in 2025 found that adults with attention-deficit/hyperactivity disorder (ADHD) who had experienced a myocardial infarction had similar cardiometabolic risk profiles to those without ADHD, but poorer lifestyle behaviors and higher mortality rates 7.
• Another study published in 2011 found that current or new use of ADHD medications, including amphetamines, was not associated with an increased risk of serious cardiovascular events in young and middle-aged adults 5.

Considerations for Individuals with a History of Heart Attack

• Individuals who have had a heart attack should consult their doctor before taking Adderall or any other ADHD medication.
• The decision to prescribe Adderall or other ADHD medications should be made on a case-by-case basis, taking into account the individual's medical history, current health status, and potential risks and benefits 3, 6.
• Regular monitoring of cardiovascular health and adjustment of medication as needed may be necessary for individuals with a history of heart attack who are taking ADHD medications.