What is the difference between snorting immediate release (IR) and extended release (ER) Adderall (amphetamine and dextroamphetamine)?

From the Guidelines

Snorting any form of Adderall, whether immediate release (IR) or extended release (XR), is dangerous and not medically recommended. Adderall is a prescription medication containing amphetamine salts designed to be taken orally to treat ADHD and narcolepsy. When snorted, both IR and XR forms bypass intended absorption mechanisms, delivering a more intense, rapid effect that significantly increases risks of addiction, cardiovascular problems, and overdose 1. The extended release formulation contains time-release beads specifically designed to gradually release medication over time; crushing these beads defeats this mechanism and delivers the entire dose at once, which is particularly dangerous.

Some key points to consider:

• The pharmacokinetics of stimulants like Adderall are characterized by rapid absorption, low plasma protein binding, and rapid extracellular metabolism 1.
• Stimulants are rapidly absorbed from the gut and act within the first 30 minutes after ingestion, with effects on behavior appearing during absorption and lasting 3 to 4 hours 1.
• Snorting medications introduces foreign substances into nasal passages, potentially causing damage to nasal tissues, sinus infections, perforation of the nasal septum, and respiratory issues.
• The binders and fillers in these pills aren't meant to enter the respiratory system and can cause serious lung problems.
• If you have been prescribed Adderall, you should only take it orally as directed by your healthcare provider. If you're struggling with medication misuse, please speak with a healthcare provider about proper treatment options and support for substance use disorders.

In terms of the specific comparison between snorting immediate release versus extended release Adderall, the risks associated with snorting extended release formulations may be even higher due to the potential for a larger, more rapid release of the medication. However, both forms pose significant risks and should be avoided. It's essential to follow the prescribed dosage and administration instructions for Adderall to minimize risks and maximize benefits.

From the FDA Drug Label

CLINICAL PHARMACOLOGY Amphetamines are non-catecholamine, sympathomimetic amines with CNS stimulant activity. Pharmacokinetics The pharmacokinetics of the tablet and sustained-release capsule were compared in 12 healthy subjects The extent of bioavailability of the sustained-release capsule was similar compared to the immediate-release tablet.

The pharmacokinetics of immediate release and extended release Adderall are different.

• The Cmax for immediate release is 36.6 ng/mL at approximately 3 hours.
• The Cmax for extended release is 23.5 ng/mL at approximately 8 hours.
• The plasma T1/2 is similar for both formulations, approximately 12 hours. Snorting immediate release Adderall will likely result in a faster and higher peak concentration compared to snorting extended release Adderall, which may increase the risk of adverse effects 2.

From the Research

Snorting Immediate Release vs Extended Release Adderall

• The provided studies do not directly compare the effects of snorting immediate release vs extended release Adderall 3, 4, 5, 6, 7.
• However, it is known that Adderall is a combination of amphetamine and dextroamphetamine, which are stimulants that can be abused 4, 5.
• The studies discuss the potential risks and side effects of Adderall overdose, including hyperactivity, hyperthermia, tachycardia, tachypnea, mydriasis, tremors, and seizures 3, 4.
• The management of Adderall overdose is largely supportive, with a focus on controlling life-threatening central nervous system and cardiovascular signs 3, 4.
• It is also noted that misuse of stimulants, including Adderall, can lead to serious consequences, such as psychosis, myocardial infarction, cardiomyopathy, and sudden death 5.
• The studies emphasize the importance of education on the health risks associated with misuse of stimulants and the need for long-term safety studies 5, 6.
• In terms of formulation, a transdermal system for dextroamphetamine has been approved for the treatment of ADHD, which may offer an alternative for patients who have difficulty swallowing oral medications or prefer a non-oral formulation 6.
• Patient-reported side effects from ADHD medications, including Adderall, have been documented, with common side effects including loss of appetite, sleep problems, and mood disturbances 7.