From the Guidelines
Adderall can potentially worsen pulmonary hypertension and should be used with caution in patients with this condition, as it increases heart rate and blood pressure, which can place additional strain on the pulmonary vasculature. According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1, 2, amphetamines, such as those found in Adderall, can cause elevated blood pressure and should be discontinued or decreased in dose. The medication works by increasing levels of norepinephrine and dopamine in the brain, but these same mechanisms can cause systemic and pulmonary vasoconstriction.
Key Considerations
- Patients with pulmonary hypertension who require treatment for ADHD or narcolepsy should have a thorough cardiovascular evaluation before starting Adderall, and regular monitoring of pulmonary pressures and cardiac function is essential if the medication is prescribed 3.
- Alternative non-stimulant medications for ADHD, such as atomoxetine, may be safer options for these patients.
- The severity of pulmonary hypertension, its underlying cause, and the patient's overall cardiovascular status are important factors in determining whether Adderall can be safely used.
- Any patient with pulmonary hypertension who experiences increased shortness of breath, chest pain, syncope, or worsening exercise tolerance while taking Adderall should seek immediate medical attention.
Management Strategies
- Discontinue or decrease the dose of Adderall if possible 1, 2.
- Consider alternative therapies for ADHD, such as behavioral therapies or non-stimulant medications 1, 2.
- Monitor patients closely for signs of worsening pulmonary hypertension, such as increased shortness of breath or chest pain.
- Collaborate with a center with advanced expertise in PAH care for ongoing management of patients with PAH 3.
From the Research
Adderall and Pulmonary Hypertension
- There is limited research directly linking Adderall to pulmonary hypertension.
- However, a study 4 reported a case of non-cardiogenic pulmonary edema leading to respiratory failure in a patient taking prescription Adderall.
- This study suggests that Adderall may be associated with rare but serious pulmonary complications, although the exact mechanism is unclear.
- Other studies have investigated the cardiovascular effects of Adderall and other ADHD medications, including increases in blood pressure and heart rate 5, 6.
- A study 7 found that long-term use of ADHD medications, including Adderall, was associated with an increased risk of cardiovascular diseases, including hypertension and arterial disease.
- Another study 8 discussed the efficacy and safety of atomoxetine, a non-stimulant ADHD medication, which may be a useful alternative for patients at risk of cardiovascular complications.
Cardiovascular Effects of Adderall
- Adderall has been shown to increase blood pressure and heart rate in some studies 5, 6.
- A study 5 reported a case of acute myocardial infarction in an adult taking Adderall, highlighting the potential cardiovascular risks of the medication.
- The exact mechanisms by which Adderall affects the cardiovascular system are not fully understood, but may involve increases in sympathetic nervous system activity and catecholamine release.
Monitoring and Treatment
- Clinicians should regularly monitor cardiovascular signs and symptoms in patients taking Adderall, particularly those with pre-existing cardiovascular conditions 7.
- Patients taking Adderall should be aware of the potential risks of cardiovascular complications and report any symptoms or concerns to their healthcare provider.
- Alternative treatments, such as atomoxetine, may be considered for patients at risk of cardiovascular complications or those who experience adverse effects with Adderall 8.