Acute Cardiovascular Responses to Amphetamine/Dextroamphetamine Salts (Adderall) in Adderall-Naïve Young Adults: A Randomized Clinical Trial.

Abstract

To examine the acute cardiovascular responses to a single dose of Adderall (a combination of amphetamine-dextroamphetamine salts widely abused off-prescription for recreational use) in healthy Adderall-naïve individuals to better understand the mechanistic implications for acute cardiovascular events and increased emergency room visits associated with illicit Adderall use. We examined effects of Adderall vs identical placebo in 30 healthy volunteers who were free of attention-deficit/hyperactivity disorder and naïve to Adderall, using a randomized double-blind placebo-controlled crossover study conducted between June 15, 2018, and July 23, 2021. Each participant consumed a single 25-mg dose of oral generic Adderall or placebo. Adderall and placebo tablets were compounded and encapsulated in lactose powder by the Mayo Clinic Research Pharmacy. Resting blood pressure (BP), heart rate (HR), and plasma catecholamine levels were measured before and 3 hours after consuming Adderall or placebo. The study group consisted of 29 participants (16 females; mean ± SE age, 27±1 years) who completed both Adderall and placebo studies. Adderall increased systolic BP significantly from 116±2 mm Hg to 126±2 mm Hg, whereas no change in systolic BP was observed with placebo (group by time interaction, P<.001). Similarly, diastolic BP and mean BP increased by 6±1 mm Hg and 7±1 mm Hg, respectively, and HR increased by 10±2 beats/min after Adderall (all P<.01), with no changes after placebo. Plasma norepinephrine levels increased significantly after Adderall consumption from 215±15 pg/mL to 301±14 pg/mL but was unchanged after consumption of placebo (group by time interaction, P=.027). Healthy Adderall-naïve participants consuming a single dose of Adderall manifest striking increases in BP, HR, and sympathetic activation, even at rest. These findings may have important mechanistic implications for understanding acute cardiovascular events associated with illicit Adderall use. clinicaltrials.gov Identifier: NCT02979327.