What should I do if I experience a new internal sensation while taking Adderall (amphetamine)?

What to Do If You Experience a New Internal Sensation While Taking Adderall

If you develop a new internal sensation while taking Adderall, immediately contact your prescribing physician to evaluate whether this represents a serious adverse effect requiring medication discontinuation or dose adjustment. 1

Assess the Nature of the Sensation

The specific type of internal sensation determines urgency and management:

Cardiovascular Sensations (Highest Priority)

• Chest discomfort, palpitations, or irregular heartbeat require immediate medical evaluation, as amphetamines can cause serious cardiovascular events including arrhythmias, hypertension, and in rare cases myocardial infarction 1, 2
• Shortness of breath or difficulty breathing warrants urgent assessment, as amphetamines have been associated with non-cardiogenic pulmonary edema and respiratory complications, even at routine prescription doses 3
• Amphetamines consistently increase systolic blood pressure by approximately 2 mmHg and diastolic blood pressure by approximately 2 mmHg, with heart rate increases of approximately 4 beats per minute 4

Gastrointestinal Sensations

• Nausea, vomiting, diarrhea, or abdominal cramps are recognized manifestations of amphetamine toxicity and may indicate overdosage 1
• These symptoms require dose reassessment and evaluation for other causes 1

Neurological/Psychiatric Sensations

• Restlessness, tremor, confusion, or unusual mental states are manifestations of acute amphetamine effects that may indicate excessive dosing 1
• Persistent sedation lasting more than one week can be managed with psychostimulants like methylphenidate or dextroamphetamine, though this creates a complex polypharmacy situation requiring careful monitoring 5, 6

Immediate Actions

Document the Sensation

• Record the timing relative to your Adderall dose (within 24 hours of last dose is most relevant for cardiovascular effects) 4
• Note the severity and duration of the sensation 7
• Identify any triggers such as changes in diet, caffeine intake, or other medications 7

Rule Out Serious Complications

• Check your blood pressure and heart rate if you have access to monitoring equipment, as amphetamines cause sustained increases in both parameters 4, 8
• Seek emergency care immediately if you experience chest pain, severe shortness of breath, confusion, hallucinations, or signs of cardiovascular collapse 1

Follow-Up Management

Medication Reassessment

• Your physician should evaluate whether the sensation represents tolerance development, requiring dose adjustment within recommended ranges 7
• Consider opioid rotation principles applied to stimulants: if adverse effects are significant, switching to an alternative ADHD medication may achieve better balance between efficacy and tolerability 5
• Maximum dosing should be based on weight, clinical response, and absence of significant side effects 7

Monitoring Requirements

• Blood pressure and heart rate should be checked at baseline and periodically during treatment, as both stimulant and non-stimulant ADHD medications cause minor but statistically significant cardiovascular changes 8
• Reassess effectiveness at least every 3 months with documentation of target symptoms and functional improvements 7
• Watch for signs of misuse or diversion, especially when patients report medication is "not working" 7

Critical Pitfalls to Avoid

• Never abruptly discontinue Adderall without medical supervision, as this may lead to withdrawal symptoms or rebound effects 7
• Avoid combining Adderall with other sedating medications (benzodiazepines, alcohol) due to FDA black box warnings about serious effects including respiratory depression 5
• Do not ignore progressive symptoms, as sedation often precedes respiratory depression and requires immediate care adjustments 5
• Be aware that acidification of urine increases amphetamine excretion but may increase risk of acute renal failure if myoglobinuria is present 1

When to Consider Alternative Treatments

• If the sensation persists despite dose adjustments, behavioral therapy techniques should be implemented or reinforced alongside medication 7
• Optimize sleep hygiene to improve medication effectiveness, as poor sleep can mimic or worsen ADHD symptoms 7
• Address comorbid conditions (anxiety, depression, substance use) that may be affecting treatment response 7