Amphetamine

Is amphetamine safe?

Taken as prescribed by someone who has been checked for heart disease and mental health risks, amphetamine is a well-understood ADHD treatment. Most people's side effects are a dry mouth, poor appetite and trouble sleeping, not anything dangerous. The concerns are of a different kind: it is one of the most misused prescription drugs in the US, it pushes up heart rate and blood pressure, and a small share of users develop psychosis.

We score it 53, close to zolpidem (53) and well below the antidepressants on our list such as bupropion (60). That score reflects misuse and regulatory controls as much as day-to-day safety. A lower score does not mean a person whose ADHD is well treated should stop; talk to your doctor or pharmacist before any change.

Doses on the label

Adderall comes as immediate-release tablets and Adderall XR capsules. Other amphetamine products include dexamfetamine and lisdexamfetamine (Vyvanse in the US, Elvanse in the UK), the forms most often prescribed in Britain.

Product and group	Start	Label limit or target
Adderall XR, adults	20 mg once a day	Adult trial used up to 60 mg
Adderall XR, age 6 to 12	10 mg (or 5 mg) once a day	30 mg a day
Adderall XR, age 13 to 17	10 mg once a day	20 mg after a week if needed
Adderall tablets, age 6 and over	5 mg once or twice a day	Rarely above 40 mg a day
Adderall tablets, narcolepsy	5 to 10 mg	5 to 60 mg a day in divided doses

Doses are taken on waking because afternoon doses cause insomnia. People with severe kidney impairment start lower, and Adderall XR is not recommended in end-stage kidney disease. Since 2025 the Adderall XR label says it is not recommended for children under 6, who had higher drug levels and more weight loss at the same dose.

Heart and blood pressure

On average, stimulants raise blood pressure by 2 to 4 mmHg and pulse by 3 to 6 beats a minute. That is minor for a healthy 25-year-old. The label reports sudden death in people with structural heart abnormalities or other serious heart disease, which is why prescribers ask about fainting, chest pain and family history of sudden death before starting.

Long use may matter more than any single dose. A Swedish study of 278,027 people with ADHD, published in JAMA Psychiatry in 2024, found each extra year of ADHD medication use was linked to a 4% higher risk of cardiovascular disease, mostly high blood pressure and arterial disease. It was an observational study, so it cannot prove cause, but it supports checking blood pressure for as long as treatment lasts.

Psychosis, mood and growth

New hallucinations, delusions or mania are uncommon but well documented. A 2019 study in the New England Journal of Medicine followed 221,846 US teenagers and young adults starting a stimulant: psychosis occurred in 0.21% of those on amphetamine against 0.10% on methylphenidate. People with bipolar disorder or a past psychotic episode need particular care.

In adult trials of Adderall XR, 33% lost their appetite (3% on placebo), 27% had insomnia and 10% lost weight. In children, slower growth is the main long-term question, so height and weight are tracked.

Misuse is the biggest issue

Amphetamine is Schedule IIControlled substanceA medicine or drug that the law restricts because it can be misused or cause dependence. Countries group them into schedules or classes.More in the glossary in the US and Class B in the UK. A 2025 JAMA Psychiatry analysis of US survey data found that a quarter of adults using prescription stimulants had misused them in the past year, for example by taking extra doses, and 9% met criteria for a stimulant use disorder. Most of those with a use disorder were using their own prescription, and amphetamine users had 3.1 times the misuse rate of methylphenidate users.

The boxed warningBoxed warningThe strongest safety warning the US FDA puts on a medicine's label, printed inside a black border at the top.More in the glossary says misuse can lead to overdose and death, especially at high doses or when tablets are snorted or injected. Overdose brings racing heart rhythms, body temperatures above 40 °C, seizures, stroke and muscle breakdown. In an emergency call 911 or Poison Help (1-800-222-1222) in the US, or 999 in the UK. Lock tablets away: US poison centres recorded 156,365 child and teenage exposures to ADHD medicines between 2000 and 2014, many from dosing mistakes.

Interactions to know

• MAOIs: contraindicatedContraindicationA situation in which a medicine should not be used, because the risk clearly outweighs any benefit, such as a known allergy to it.More in the glossary during and for 14 days after, including linezolid and IV methylene blue, because of hypertensive crisis.
• Antidepressants: SSRIs such as sertraline, SNRIs, triptans and CYP2D6CYP450 enzymesA family of liver enzymes that break down many medicines. When another drug or supplement speeds them up or slows them down, drug levels change.More in the glossary inhibitors raise the risk of serotonin syndromeSerotonin syndromeA reaction caused by too much serotonin in the body, usually from combining medicines that raise it. Symptoms range from shivering to high fever.More in the glossary.
• Stomach and urine pH: antacids and other alkalinising agents raise amphetamine levels. Acidifying agents such as vitamin C lower them. Proton pump inhibitors such as omeprazole speed up absorption.
• Other stimulants: high-dose caffeine pills and pre-workout products add to the jitteriness and pulse rise.

Who should be careful

Talk to your doctor or pharmacist before starting if you have heart disease, high blood pressure, a history of psychosis, bipolar disorder, tics or Tourette's syndrome, seizures, glaucoma, a past substance use problem, or if you are pregnant or breastfeeding (the Adderall XR label advises against breastfeeding). Never share tablets: it is illegal and the other person has not been screened.

How we scored it

Track record (90) is the strongest factor. Dependence (25) and regulatory warnings (25) are the weakest because of the Schedule IIControlled substanceA medicine or drug that the law restricts because it can be misused or cause dependence. Countries group them into schedules or classes.More in the glossary status, the boxed warningBoxed warningThe strongest safety warning the US FDA puts on a medicine's label, printed inside a black border at the top.More in the glossary and the misuse data. Serious side effects (60) reflect the small cardiovascular and psychiatric risks at prescribed doses.