When should I stop Adderall (amphetamine/dextroamphetamine) before surgery?

When to Stop Adderall Before Surgery

Adderall (amphetamine/dextroamphetamine) does not need to be stopped before surgery and can be safely continued through the perioperative period. 1, 2

Evidence Supporting Continuation

Direct Clinical Evidence

• A case series of 9 patients on chronic prescription amphetamines (2-10 years duration) who underwent general anesthesia demonstrated safe outcomes without stopping the medication preoperatively. 1
• Procedures ranged from 30 minutes to 4.25 hours, with 6 of 8 patients requiring tracheal intubation, and all maintained cardiovascular stability throughout. 1
• An additional case report documented a patient with 40 years of chronic amphetamine use who underwent two general anesthetics without complications. 2

Theoretical Concerns Are Not Supported by Clinical Data

• While historical anesthesia teaching raised concerns about catecholamine depletion and blunted responses to intraoperative hypotension in chronic amphetamine users, actual clinical experience has not demonstrated these problems. 1, 2
• The authors of the largest case series explicitly concluded that "amphetamine use need not be stopped before surgery and anesthesia." 1

Important Perioperative Considerations

Drug Interaction Awareness

• Concomitant use of amphetamines with serotonergic agents (certain opioids, ondansetron, other serotonergic medications) increases the risk of serotonin syndrome. 3
• The anesthesia team should be informed that the patient takes Adderall so they can monitor for serotonergic drug combinations during the perioperative period. 3

Cardiovascular Monitoring

• Although clinical complications have not been reported, enhanced cardiovascular monitoring is prudent given amphetamines' sympathomimetic effects. 1, 2
• Be prepared to manage potential hemodynamic changes, though the evidence suggests these are uncommon. 1

Common Pitfalls to Avoid

• Do not reflexively discontinue Adderall based on outdated theoretical concerns about catecholamine depletion—the clinical evidence does not support this practice. 1, 2
• Do not confuse legitimate prescription amphetamine use with illicit amphetamine abuse—patients on stable, prescribed doses have demonstrated safe perioperative courses. 1
• Ensure the anesthesia team is aware of all serotonergic medications the patient is taking to avoid inadvertent combinations that could precipitate serotonin syndrome. 3