What should I do about Adderall (amphetamine and dextroamphetamine) if planning to conceive?

From the Guidelines

If you're planning to conceive while taking Adderall, you should consult with your healthcare provider about potentially discontinuing or switching medications before trying to get pregnant, considering a trial of gradually discontinuing the medication if it's not likely to severely impact daily functioning 1.

Key Considerations

• The decision to discontinue or switch medications should be based on a risk-benefit discussion regarding the choice of medication and lowest effective dose, taking into account the potential risks of exposure to Adderall during pregnancy and the risks of untreated or inadequately treated ADHD 1.
• Adderall (amphetamine and dextroamphetamine) is associated with possible increased risks for gastroschisis, preeclampsia, and preterm birth, although these risks seem to be small 1.
• Untreated ADHD can also pose challenges during pregnancy, including increased risks for spontaneous abortion and preterm birth, highlighting the importance of finding the right balance between managing the condition and minimizing fetal exposure 1.

Recommendations

• If discontinuing Adderall is not feasible due to severe ADHD symptoms, the healthcare provider may recommend continuing with the current medication or reducing to the lowest effective dose, considering intermittent use or switching to a non-stimulant option 1.
• It is essential to monitor pregnancy carefully, including fetal growth, blood pressure checks, and ensuring appropriate weight gain, if Adderall is continued during pregnancy 1.
• Breastfeeding safety should be discussed, and considerations for intermittent use and timing feeding or pumping to achieve the lowest concentration in human milk or other feeding options should be explored 1.

From the FDA Drug Label

Dextroamphetamine has been shown to have embryotoxic and teratogenic effects when administered to A/Jax mice and C57BL mice in doses approximately 41 times the maximum human dose. Dextroamphetamine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Infants born to mothers dependent on amphetamines have an increased risk of premature delivery and low birth weight.

If planning to conceive, it is recommended to consult a doctor about the use of Adderall (amphetamine and dextroamphetamine). The drug label indicates potential embryotoxic and teratogenic effects associated with dextroamphetamine, and increased risk of premature delivery and low birth weight in infants born to mothers dependent on amphetamines. The decision to continue or stop using Adderall should be made under the guidance of a healthcare professional, weighing the potential benefits against the potential risks to the fetus 2.

From the Research

Considerations for Adderall Use When Planning to Conceive

• When planning to conceive, it's essential to consider the potential effects of Adderall (amphetamine and dextroamphetamine) on the fetus and the pregnancy itself 3.
• The US Food and Drug Administration has classified ADHD medications, including Adderall, as "pregnancy category C", implying that there is insufficient information to confirm either harm or lack of harm 3.
• Studies have shown that discontinuing ADHD treatment could put both mother and baby at risk, while continuing treatment may pose a small risk to the baby, particularly with regards to fetal malformation and cardiac malformations 3, 4.

Risks and Benefits of Continuing Adderall During Pregnancy

• Research suggests that the risk of fetal malformation associated with methylphenidate, another ADHD medication, is very low, but there is an increased risk of cardiac malformations 4.
• A study found that in utero exposure to ADHD medication, including amphetamine, was not associated with adverse long-term neurodevelopmental and growth outcomes in offspring 5.
• However, it's crucial to weigh the potential risks and benefits of continuing Adderall during pregnancy, considering the individual's specific situation and medical history 3, 6.

Communication with Healthcare Providers

• Women planning to conceive should proactively discuss their medication use, including Adderall, with their healthcare providers to make informed decisions 6.
• Healthcare providers should provide clear information about the potential risks and benefits of continuing or discontinuing Adderall during pregnancy, taking into account the individual's unique circumstances 6.

Pharmacogenetic Considerations

• The pharmacogenetic impact on the pharmacokinetics of ADHD medications, including Adderall, should be considered when choosing medications and doses 7.
• Individuals with certain genetic variants may experience different levels of enzyme activity, affecting the metabolism of ADHD medications and potentially leading to varying levels of exposure 7.