Nick asked
I take 15mg of Adderall XR and it's only lasting for 4 hours, how come? Are there better alternatives to Adderall?
Answer
Adderall XR contains amphetamine and dextroamphetamine mixed salts in an extended release formulation. Adderall may be used for the treatment of attention-deficit hyperactivity disorder (ADHD), narcolepsy, and obesity (off-label indication).
The XR formulation of Adderall is designed to last significantly
longer than the immediate release formulation and “should” last longer than 4
hours. With that being said, ADHD medications require dose titration in order
to ensure the best effect. Starting with
a low dose and increasing weekly usually produces the best results. Because
these medications have known side effects, it is important to allow enough time for the medication to take effect in
order to find the right dose.
How long does Adderall XR last?
The extended-release capsules (Adderal XR) has been shown to reach maximum absorption after 7 hours on average. The immediate-release tablets reach maximum absorption after 3 hours on average. Both Adderall and Adderall XR reach 50% of their concentration after about 9-11 hours in children, 11-14 hours in adolescents, and 10-13 hours in adults.
Drug
metabolism tends to differ between individuals based on their genetic profile.
In this case, amphetamine metabolism relies on CYP2D6 to break down the drug. If
you happen to have a type of CYP2D6 that is considered a rapid metabolizer, it is possible that the drug will not work
as long for you. This is not a common scenario, but in the chance that you
are a rapid metabolizer, changing your medication to methylphenidate may be a
good option. Methylphenidate is not extensively metabolized by CYP enzymes like
CYP2D6.
ADHD Treatment Options
In terms of treatment for ADHD, there are two categories of drugs: stimulants and non-stimulants. Stimulants include dextroamphetamine/amphetamine (Adderall), methylphenidate (Ritalin, Concerta), and dexmethylphenidate (Focalin). The most popular nonstimulant is atomoxetine (Strattera), but guanfacine (Intuniv) and clonidine are also considered nonstimulants.
Both stimulants and nonstimulants have an impact on neurotransmitters which leads to the calming effect with hyperactivity. Stimulants are generally used as the first-line treatment option in most cases. Stimulants have been used in practice longer and therefore have more evidence than the nonstimulants.
Nonstimulants are generally considered less prone to abuse and are not controlled substances. There is not enough evidence to support improved efficacy of one drug over another as response depends on individual factors.
Both stimulants and nonstimulants can cause upset stomach, irritability, and weight loss. Stimulants are more prone to cause headaches, cardiac problems in patients with pre-existing cardiac conditions, and insomnia. The potential also exists of an increased risk of suicidal ideation with both classes, although a black box warning exists with Strattera.
If you feel your dose is not working for you it is worth
discussing with your physician your concerns. The dose may need to be
increased, assuming the dose has been tried for at least a week. Adderall has
been studied in doses up to 60 mg/day. Other options include changing
medications to other stimulants or nonstimulants as you may respond differently
to each drug.
Source: Adderall Package Insert
