How to manage constipation caused by Adderall (amphetamine and dextroamphetamine)?

Management of Constipation Caused by Adderall

For constipation caused by Adderall (amphetamine and dextroamphetamine), implement a stepwise approach starting with lifestyle modifications and over-the-counter laxatives, progressing to prescription medications if needed. While the guidelines primarily address opioid-induced constipation, the principles can be applied to stimulant-induced constipation as well.

Initial Management Strategies

• Increase fluid intake to maintain adequate hydration 1
• Increase physical activity and exercise, if feasible 1
• Maintain adequate dietary fiber intake through food sources 1
• Avoid supplemental medicinal fiber (such as Metamucil), as it may worsen constipation rather than improve it 1

First-Line Pharmacological Treatment

• Start with a stimulant laxative such as senna (2 tablets every morning; maximum 8-12 tablets per day) 1
• Consider polyethylene glycol (17g in 8 oz of water twice daily) as an alternative or additional first-line agent 1
• Note that stool softeners like docusate have not shown benefit when used alone and are not recommended as monotherapy 1

If Constipation Persists

• Assess for other causes and severity of constipation 1
• Rule out bowel obstruction through physical examination 1
• Consider adding another agent such as:
  • Magnesium hydroxide (30-60 mL daily) 1
  • Bisacodyl (2-3 tablets PO daily or suppository) 1
  • Lactulose (30-60 mL daily) 1
  • Sorbitol (30 mL every 2 hours × 3 then as needed) 1
  • Magnesium citrate 1

For Severe or Refractory Constipation

• Consider using a prokinetic agent such as metoclopramide (10-20 mg PO three times a day) 1
• Fleet, saline, or tap water enema may be used sparingly, with awareness of possible electrolyte abnormalities 1
• Consider reducing Adderall dosage if possible, after consulting with the prescribing physician 1

Special Considerations

• Stimulant medications like Adderall can cause gastrointestinal side effects including constipation through their sympathomimetic effects 2
• Unlike opioid-induced constipation, peripherally acting μ-opioid receptor antagonists (PAMORAs) like methylnaltrexone would not be effective for Adderall-induced constipation 1
• Patients with comorbid conditions like diabetes may require more aggressive management of constipation 3
• Monitor for other potential side effects of Adderall that may accompany constipation, such as dry mouth, which can worsen constipation by reducing fluid intake 2

Treatment Algorithm

1. Start with lifestyle modifications (hydration, exercise, dietary fiber)
2. If no improvement in 2-3 days, add stimulant laxative (senna) or osmotic agent (polyethylene glycol)
3. If still constipated after 2-3 more days, combine stimulant and osmotic agents
4. For persistent constipation, add magnesium-based products or lactulose
5. For severe cases, consider enemas or prokinetic agents
6. Throughout treatment, aim for one non-forced bowel movement every 1-2 days 1

Remember that constipation from stimulants like Adderall may not resolve spontaneously while continuing the medication, unlike some other medication side effects that improve with time 1.