Mixed Amphetamines

Also indexed as: Adderall®, Dexamphetamine

This drug contains two central nervous system stimulants: amphetamine and dextroamphetamine. It is used to treat narcolepsy and attention deficit disorder (ADD) with hyperactivity.

Safetychecker Summary for Mixed Amphetamines
(for details about the summarized interactions, read the full article)

Beneficial May be Beneficial: Depletion or interference—The medication may deplete or interfere with the absorption or function of the nutrient. Taking these nutrients may help replenish them.

Veratrum species
Beneficial May be Beneficial: Side effect reduction/prevention—Taking these supplements may help reduce the likelihood and/or severity of a potential side effect caused by the medication.

Vitamin B6

L-tryptophan*
Beneficial May be Beneficial: Supportive interaction—Taking these supplements may support or otherwise help your medication work better.

Ephedra sinica

Tyrosine

Magnesium
Avoid Avoid: Reduced drug absorption/bioavailability—Avoid these supplements when taking this medication since the supplement may decrease the absorption and/or activity of the medication in the body.

Lithium

Vitamin C
Avoid Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.

Magnesium

Alcohol

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Dietary Supplements

Magnesium
Dextroamphetamine can increase blood levels of magnesium, which causes significant lowering of the calcium to magnesium ratio in the blood. The change in this ratio may in part explain the effectiveness of stimulants like dextroamphetamine in hyperactive boys.1 Another magnesium-amphetamine interaction involves supplements of magnesium hydroxide, which are known to cause retention of amphetamines in the body.2 This could theoretically result in increased blood levels of these drugs. Finally, animal studies have suggested that magnesium supplements can increase learning and enhance the behavioral response to stimulants.3 For these reasons, the use of magnesium along with amphetamines may enhance the effectiveness of these drugs in the treatment of ADD, but controlled studies of this possibility are needed.

Vitamin C
Ingestion of some types of vitamin C results in acidification of the intestinal contents and thus a decreased absorption of amphetamines.4 Supplements containing vitamin C should be taken an hour before or two hours after taking amphetamines.

Tyrosine
Tyrosine is an amino acid used by the body to produce brain chemicals stimulated by amphetamines. Reduced stimulant effects of amphetamines were observed in individuals who had been made tyrosine deficient.5 It is possible that a dietary deficiency of tyrosine may reduce the effectiveness of amphetamines. Tyrosine deficiency is not common unless a protein deficiency exists. Adequate tyrosine intake from dietary protein or supplements is necessary in individuals taking amphetamines.

Lithium
Lithium is a mineral that may be present in some supplements and is also used in large amounts to treat mood disorders such as bipolar disorder (manic depression). Taking lithium at the same time as amphetamines may inhibit the appetite suppressant and stimulatory effects of the amphetamines.6 Therefore, people taking amphetamines should take lithium only under the supervision of a doctor.

Vitamin B6
Occasionally, individuals taking amphetamines develop compulsive behavior and anxiety, even after the drug is discontinued. When this side effect occurred in an eight-year-old boy,7 supplementation with 200 mg vitamin B6 each day for one week followed by 100 mg daily, reduced the compulsive behavior and anxiety within three weeks. The symptoms were eliminated after a few months of treatment. Controlled research is needed to determine conclusively the usefulness of vitamin B6 supplementation for preventing and treating this side effect.

L-tryptophan
In an uncontrolled study of schizophrenic patients, 200 mg per day of L-tryptophan reduced disturbances in thinking, as well as hallucinations caused by dextroamphetamine.8 Symptoms of psychosis rarely occur in people who take amphetamines and are not schizophrenic. Controlled research is needed to establish the benefits of L-tryptophan and related supplements for people taking amphetamines.

Interactions with Herbs

Ephedra sinica (Ma huang)
Ephedra sinica contains a compound called ephedrine. A seven-year-old boy who had 12 mg of ephedrine twice daily added to his dextroamphetamine therapy experienced improvement in hyperactive behavior.9 He also experienced relief from symptoms, such as headaches and spots before his eyes, that may have been caused by dextroamphetamine. Further research may reveal an additive effect between ephedrine and amphetamines. No research has investigated the usefulness of ephedra sinica as an add-on therapy to or a replacement for amphetamines.

Veratrum (Veratrum sp.)
Veratrum (Hellebore) is an herb used by doctors of natural medicine to treat high blood pressure;however, amphetamines can inhibit this effect.10 Therefore, people taking veratrum to treat hypertension should avoid amphetamines.

Interactions with Foods and Other Compounds

Fruit juices
Fruit juices may acidify the intestinal contents, causing reduced absorption of amphetamines.11 Therefore, juices should be consumed an hour before or two hours after administration of amphetamines.

Alcohol
The combination of alcohol and methamphetamine makes the heart work harder and consume more oxygen, which may produce unwanted effects.12 Alcohol consumption may also suppress the breakdown of amphetamines, causing elevations in blood levels of the drug.13 Individuals taking amphetamines should avoid alcoholic beverages, especially if they have known heart problems.

References:

1. Schmidt ME, Kruesi MJ, Elia J, et al. Effect of dextroamphetamine and methylphenidate on calcium and magnesium concentration in hyperactive boys. Psychiatry Res 1994;54:199–210.

2. Hurwitz A. Antacid therapy and drug kinetics. Clin Pharmacokinet 1977;2:269–80.

3. Reviewed in Schmidt ME, Kruesi MJ, Elia J, et al. Effect of dextroamphetamine and methylphenidate on calcium and magnesium concentration in hyperactive boys. Psychiatry Res 1994;54:199–210.

4. Sifton DW, ed. Physicians Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 2953–4.

5. McTavish SF, McPherson MH, Sharp T, Cowen PJ. Attenuation of some subjective effects of amphetamine following tyrosine depletion. J Psychopharmacol 1999;13:144–7.

6. Sifton, DW, ed. Physicians Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 2953–4.

7. Frye PE, Arnold LE. Persistent amphetamine-induced compulsive rituals: response to pyridoxine (B6). Biol Psychiatry 1981;16:583–7.

8. Irwin MR, Marder SR, Fuentenebro F, Yuwiler A. L-5-hydroxytryptophan attenuates positive psychotic symptoms induced by D-amphetamine. Psychiatry Res 1987;22:283–9.

9. Scanlon J. Treatment of hyperkinetic child with dextroamphetamine and ephedrine. Pediatrics 1970;46:975–6.

10. Sifton DW, ed. Physicians Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 2953–4.

11. Sifton DW, ed. Physicians Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 2953–4.

12. Mendelson J, Jones RT, Upton R, Jacob P 3rd. Methamphetamine and ethanol interactions in humans. Clin Pharmacol Ther 1995;57:559–68.

13. Shimosato K. Urinary excretion of p-hydroxylated methamphetamine metabolites in man. II. Effect of alcohol intake on methamphetamine metabolism. Pharmacol Biochem Behav 1988;29:733–40.