From the Guidelines
Patients should stop taking Adderall (dextroamphetamine and amphetamine) under the guidance of a healthcare provider, typically when the therapeutic benefits no longer outweigh the potential risks, such as when significant adverse effects occur, including increased anxiety, insomnia, or cardiovascular complications 1.
Discontinuation Considerations
- Discontinuation should be considered if the patient experiences severe anorexia, severe insomnia, new, marked, severe tics, or severe anxiety 1.
- A gradual tapering of the dose, by 5-10mg every 1-2 weeks, is recommended to minimize withdrawal symptoms.
- The daily dose should not exceed 40mg for extended periods (greater than 2 years) 1.
Monitoring and Alternative Treatments
- Patients should be monitored for signs of tolerance and side effects, such as weight loss, blood pressure increase, or agitation 1.
- Alternative treatments, such as behavioral therapies, should be considered if the patient experiences significant adverse effects or if the therapeutic benefits are no longer outweighing the potential risks 1.
From the FDA Drug Label
If bothersome adverse reactions appear (e.g., insomnia or anorexia), dosage should be reduced. The decision to stop Adderall (amphetamine and dextroamphetamine) due to adverse effects should be made on a case-by-case basis.
- The drug label does not provide specific guidance on when to stop the medication due to adverse effects, only to reduce the dosage if bothersome adverse reactions appear.
- It is recommended to consult with a healthcare professional to determine the best course of action if adverse effects occur 2.
From the Research
Adverse Effects of Adderall
The decision to stop Adderall (amphetamine and dextroamphetamine) due to adverse effects should be based on the severity and type of side effects experienced by the patient. Some common adverse effects of Adderall include:
Cardiovascular Risks
Adderall use has been associated with cardiovascular risks, including cardiomyopathy and heart failure 4. Patients with preexisting cardiac conditions should be carefully monitored and managed by a multidisciplinary team to minimize the risk of cardiac deterioration.
Peripheral Vascular Manifestations
Adderall use has also been linked to peripheral vascular manifestations, including vasospastic symptoms and tissue loss 5. Patients experiencing these symptoms should be advised to stop taking the medication.
Discontinuation of Adderall
There is no clear consensus on when to stop Adderall due to adverse effects. However, patients experiencing severe or persistent side effects should be evaluated on a case-by-case basis, and the decision to discontinue the medication should be made in consultation with a healthcare provider. Some studies suggest that amphetamine use need not be stopped before surgery and anesthesia 6, while others highlight the importance of careful monitoring and management of patients with dual diagnoses, especially those involving amphetamine use and preexisting cardiac conditions 4.
Treatment for Amphetamine Withdrawal
There is limited evidence on the effectiveness of treatments for amphetamine withdrawal 7. Some studies suggest that amineptine may reduce discontinuation rates and improve clinical presentation, but its use is limited due to concerns over abuse liability. Further research is needed to develop effective treatments for amphetamine withdrawal.