Could taking Adderall XR (amphetamine and dextroamphetamine) out of the capsule be causing daily vomiting, constant pressure and drainage, popping noises, and facial pulling down the sinus bone?

Adderall XR Tampering Is Not Causing These Symptoms

Your friend's symptoms of daily vomiting, sinus pressure, drainage, popping noises, and facial pulling are not caused by taking Adderall XR out of the capsule. While tampering with extended-release formulations can alter drug delivery and potentially increase cardiovascular side effects, the specific constellation of chronic sinus symptoms described here points to an entirely different medical condition that requires proper evaluation.

Why Adderall XR Tampering Doesn't Explain These Symptoms

Expected Effects of Medication Tampering

• Opening Adderall XR capsules converts the extended-release formulation into immediate-release, causing the entire dose to be absorbed at once rather than over 12 hours 1
• This would primarily cause cardiovascular effects (increased blood pressure by approximately 2 mmHg systolic and diastolic, increased heart rate by 3-4 beats per minute) and CNS stimulation (hyperactivity, tremors, anxiety) 2
• Acute amphetamine toxicity presents with hyperactivity, hyperthermia, tachycardia, tachypnea, mydriasis, tremors, and seizures—not chronic sinus symptoms 3

What's Actually Missing

• No sinus symptoms are listed as adverse effects of amphetamines in pharmacotherapy guidelines 4
• The described symptoms (constant pressure, drainage, popping noises, facial pulling down the sinus bone) are classic rhinosinusitis symptoms, not medication side effects 4
• Daily morning vomiting for 6 months suggests either chronic sinusitis with postnasal drainage triggering gagging, or a separate gastrointestinal condition—not amphetamine toxicity 4

What These Symptoms Actually Suggest

Chronic Rhinosinusitis

Your friend's symptoms align precisely with chronic rhinosinusitis 4:

• Nasal congestion and pressure (described as "constant pressure") 4
• Purulent drainage (described as "drainage") 4
• Facial pain/pressure (described as "facial pulling down the sinus bone") 4
• Morning vomiting likely from postnasal drainage accumulating overnight, triggering gagging on mucus upon waking 4

Predisposing Factors to Consider

The following conditions can cause or worsen chronic sinusitis 4:

• Allergic rhinitis
• Anatomic abnormalities (septal deviation, concha bullosa)
• Nasal polyps
• Cocaine abuse (which can cause extensive nasal/sinus destruction with crusting, bleeding, and oro-antral fistulas) 4
• Vasculitis (particularly granulomatosis with polyangiitis, which causes crusting, discharge, bleeding, and facial pain) 4

Critical Next Steps

Immediate Medical Evaluation Required

Your friend needs to see an ENT specialist or primary care physician for 4:

• Nasal endoscopy to visualize the nasal mucosa, turbinates, and identify purulent secretions or anatomic abnormalities 4
• CT scan of sinuses if chronic sinusitis is suspected 4
• Careful drug history including any intranasal drug use (cocaine, other substances) that could explain these symptoms 4

Stop Medication Tampering Regardless

While not causing the sinus symptoms, opening Adderall XR capsules should be discontinued because 1:

• It eliminates the 12-hour extended coverage, requiring twice-daily dosing
• It may increase cardiovascular side effects and withdrawal symptoms
• It represents medication misuse that could indicate underlying substance use concerns

Common Pitfall to Avoid

Do not attribute chronic symptoms to medication without biological plausibility. The 6-month timeline and specific symptom pattern (sinus-focused) make amphetamine toxicity extremely unlikely. Amphetamine adverse effects are immediate (cardiovascular, CNS stimulation) or subacute (appetite suppression, sleep disturbance), not progressive sinus disease over months 4, 3, 2.

What Actually Needs Investigation

The daily morning vomiting is particularly concerning and warrants evaluation for 4:

• Chronic sinusitis with severe postnasal drainage
• Gastroesophageal reflux disease (GERD)
• Gastroparesis or other GI motility disorders
• Increased intracranial pressure (though less likely given other symptoms)
• Substance use disorder (particularly intranasal cocaine, which causes identical sinus symptoms) 4

Your friend needs proper medical evaluation for rhinosinusitis, not medication adjustment. The Adderall tampering is a separate issue that should be addressed with her prescribing physician, but it is not the cause of her 6-month illness 4.