Can Adderall (amphetamine and dextroamphetamine) cause pulmonary hypertension?

Adderall and Pulmonary Hypertension

Yes, Adderall (amphetamine and dextroamphetamine) can cause pulmonary hypertension, particularly pulmonary arterial hypertension (PAH), as it belongs to the amphetamine class of drugs which are considered possible risk factors for PAH. 1, 2

Mechanism and Risk Classification

• Amphetamines, including those in Adderall, are classified as "possible" risk factors for pulmonary arterial hypertension according to expert consensus 1, 2
• The mechanism likely involves serotonergic pathways similar to other stimulants, with amphetamines potentially increasing serotonin levels that act as growth factors for pulmonary arterial smooth muscle cells 2
• Stimulants can cause vascular changes in the pulmonary circulation that lead to progressive obliteration of pulmonary microvasculature, resulting in elevated pulmonary vascular resistance 3

Evidence from Guidelines and Research

• The American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guidelines specifically mention methamphetamine (which is chemically related to Adderall) as being linked to the development of PAH 4
• Epidemiologic studies have linked the development of PAH to illicit drugs such as methamphetamine and cocaine, which share pharmacological properties with prescription amphetamines 4
• While anorexigens (appetite suppressants) have the strongest evidence for causing PAH, other stimulants including amphetamines are considered possible risk factors 1, 5

Clinical Considerations

• PAH remains a rare complication of stimulant medications, suggesting individual susceptibility factors may play a role 2, 3
• There is at least one documented case of Adderall at prescription doses causing non-cardiogenic pulmonary edema leading to respiratory failure 6
• The risk appears to be dose-dependent and duration-dependent, with longer exposure potentially increasing risk 1

Monitoring and Management

• Patients on Adderall who develop unexplained dyspnea, exercise intolerance, syncope, or chest pain should be evaluated for possible pulmonary hypertension 1, 6
• If PAH is suspected in a patient taking Adderall, discontinuation of the medication should be considered as part of the management strategy 6
• Diagnostic evaluation would include echocardiography and potentially right heart catheterization if PAH is suspected 4

Important Caveats

• While the association exists, PAH remains a rare complication of stimulant medications 2, 3
• Individual susceptibility factors likely play a role in determining which patients develop PAH when exposed to stimulants 1
• The European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines note that drugs used to treat attention deficit disorder have a "possible association" with PAH, though they have not yet been extensively studied 4
• Patients with other risk factors for PAH may be at higher risk when taking stimulants like Adderall 1