Can Adderall (amphetamine and dextroamphetamine) cause abdominal pain with ingestion of food and water in a patient with a history of gastric bypass surgery?

From the Guidelines

Adderall can potentially cause abdominal pain in someone who has had gastric bypass surgery, especially when taken with food and water, due to its stimulant properties and the altered digestive anatomy of the patient. This medication, which contains amphetamine salts, is known to cause gastrointestinal side effects including stomach pain, nausea, decreased appetite, and constipation in many patients 1. For individuals with altered digestive anatomy from gastric bypass, these effects may be more pronounced due to changes in how medications are absorbed and how the digestive system processes food. The stimulant properties of Adderall can increase stomach acid production and slow gastric emptying, which might exacerbate discomfort in a surgically modified digestive tract.

Some key considerations for patients with a history of gastric bypass surgery include:

• Eating habits: planning and arranging frequent small meals throughout the day, eating slowly and methodically chewing food, and avoiding foods that can form phytobezoars 1
• Fluid intake: drinking sufficient amounts of fluids to maintain adequate hydration, separating liquids from solids, and avoiding carbonated beverages 1
• Preventing nutritional deficiencies: eating an adequate amount of protein, making an effort to eat a balanced diet, and limiting consumption of calorie-dense food and drinks 1

If you're experiencing abdominal pain when taking Adderall after gastric bypass, consult your healthcare provider immediately. They might recommend taking the medication at different times relative to meals, adjusting the dosage, switching to an extended-release formulation that might be gentler on your system, or considering alternative treatments altogether. It's also important to follow the nutritional recommendations for bariatric surgery patients, such as avoiding simple sugars and foods with a high glycemic index, combining complex carbohydrates, protein, and fiber in meals, and separating liquids from solid foods 1.

From the FDA Drug Label

Gastrointestinal symptoms include nausea, vomiting, diarrhea and abdominal cramps. The FDA drug label mentions abdominal cramps as a potential gastrointestinal symptom of amphetamine overdosage, but it does not specifically address the question of whether Adderall can cause abdominal pain with ingestion of food and water in a patient with a history of gastric bypass surgery.

• The label does not provide information on the interaction between amphetamine and gastric bypass surgery.
• It does not discuss the effects of amphetamine on the gastrointestinal system in the context of food and water ingestion in patients with a history of gastric bypass surgery. Therefore, no conclusion can be drawn regarding the specific question, and a conservative clinical decision would be to exercise caution and consider consulting with a healthcare professional or a Certified Poison Control Center for guidance 2.

From the Research

Abdominal Pain after Gastric Bypass Surgery

• Abdominal pain is a common symptom reported by patients after Roux-en-Y gastric bypass surgery, with up to 30% of patients experiencing recurrent abdominal pain in the long term 3.
• The etiology of abdominal pain after gastric bypass surgery is heterogeneous and includes gallstone-related disease, intestinal obstruction, anastomotic ulcerations and strictures, intestinal dysmotility, dysfunctional eating, and food intolerance 3, 4.
• Internal hernia, marginal ulcer, biliary disease, and jejunojejunal anastomotic issues are among the most common causes of abdominal pain after Roux-en-Y gastric bypass 4.

Effect of Bariatric Surgery on Drug Absorption

• Bariatric surgery may alter the absorption of orally administered medications, including those used to treat attention-deficit/hyperactivity disorder (ADHD) 5, 6.
• Changes in gastrointestinal physiology after bariatric surgery can affect the pharmacokinetics of drugs, leading to unpredictable changes in drug absorption and efficacy 5, 6.
• Patients using medications such as lisdexamphetamine after bariatric surgery should be closely monitored for adverse drug reactions and therapeutic drug monitoring should be considered if available 6.

Adderall and Abdominal Pain after Gastric Bypass Surgery

• There is limited evidence directly addressing the relationship between Adderall (amphetamine and dextroamphetamine) ingestion and abdominal pain in patients with a history of gastric bypass surgery.
• However, the altered gastrointestinal physiology after bariatric surgery may affect the absorption of Adderall, potentially leading to changes in its efficacy or adverse effects, including abdominal pain 5, 6.
• Patients with a history of gastric bypass surgery who experience abdominal pain after taking Adderall should be evaluated for potential causes of abdominal pain, including those related to the surgery itself, and monitored for adverse drug reactions 3, 4.