TaperCommunityamphetamine/dextroamphetamine
Boxed Warning
High potential for abuse and dependence. Misuse may cause sudden death and serious cardiovascular adverse events.
Adderall (mixed amphetamine salts) is a stimulant medication approved for attention-deficit/hyperactivity disorder (ADHD) and narcolepsy. It contains a 3:1 ratio of dextroamphetamine to levoamphetamine salts.
IR: 5, 7.5, 10, 12.5, 15, 20, 30mg; XR: 5, 10, 15, 20, 25, 30mg
IR tablets: 5mg, 7.5mg, 10mg, 12.5mg, 15mg, 20mg, 30mg; XR capsules: 5mg, 10mg, 15mg, 20mg, 25mg, 30mg
Category C (risk cannot be ruled out)
Amphetamines increase synaptic dopamine and norepinephrine via reverse transport through DAT and NET, inhibition of monoamine oxidase, and promotion of vesicular release. Effects on prefrontal cortex underlie therapeutic action in ADHD.
Adderall withdrawal includes rebound fatigue, low mood, increased appetite, and cognitive slowing. A staged taper using IR fractions, XR strengths, or compound pharmacy formulations can soften the landing.
Stimulant withdrawal is typically not medically dangerous but can be subjectively severe. Slow stepwise reductions (e.g., 25% per 1-2 weeks) and matching reductions to functional demands (work, school) reduce rebound. Monitor mood — depressive symptoms can be marked in the first 2 weeks.
Evidence-based phased reduction schedule. Always taper under medical supervision.
| Phase | Duration | Notes |
|---|---|---|
| Initial reductions | 1-2 weeks | Reduce by 25% of total daily dose. For XR users, switch to IR equivalents to enable finer reductions. |
| Middle reductions | 2-3 weeks | Continue 25% reductions every 1-2 weeks. Adjust dosing schedule to match work/school demands. |
| Lower-dose reductions | 2-4 weeks | Below 10mg/day, smaller increments via tablet splitting or compounded liquid help. |
| Final discontinuation | 1-2 weeks | Final cuts to off. Plan low-demand window for rebound period. |
Hours after the last dose (post-dose crash) or 1-2 days after a dose reduction
3-7 days
Acute rebound resolves within 1-2 weeks
Anhedonia, low motivation, and sleep changes can persist 2-8 weeks
Practical insights shared by members tapering Adderall. Not medical advice — always consult your prescriber.
Toxicity
Cardiovascular events (sudden death in patients with structural cardiac abnormalities), psychosis, mania, serotonin syndrome (with serotonergic agents), seizures, severe dependence, and growth suppression in children.
Pharmacokinetics
IR: Tmax ~3 hours. XR: dual-pulse release, Tmax ~7 hours. Food does not significantly affect total exposure but can delay Tmax.
~3-4 L/kg
Hepatic, primarily via CYP2D6 to 4-hydroxyamphetamine and other metabolites. Some renal excretion of unchanged drug, increased by acidic urine.
Renal (~30% unchanged at neutral urine pH; up to 70% in acidic urine).
~16-20%
Variable, urine pH-dependent
Browse our map of deprescribing-informed providers worldwide.