Adderall XR Appetite & Cravings Changes: What the Evidence Says

How often does Adderall XR reduce appetite?

Appetite loss sits at or near the top of every age group's adverse-reaction list in the Adderall XR prescribing information [1].

In the pediatric study, 22% of 374 children aged 6 to 12 taking Adderall XR had loss of appetite, against 2% of 210 children on placebo; weight loss was reported in 4% versus 0% [1]. In the adolescent study, 36% of 233 patients aged 13 to 17 who weighed 75 kg or less had loss of appetite versus 2% of 54 on placebo, and weight loss was reported in 9% versus 0% [1]. In the adult study, with 191 patients on active drug and 64 on placebo and dosing forced up to 60 mg a day, loss of appetite occurred in 33% versus 3%, weight loss in 10% versus 0%, and dry mouth in 35% versus 5% [1].

These are the shares of patients whose appetite loss was recorded as an adverse event. They are not average kilograms lost, and the trials were short: 3 weeks in children and 4 weeks in adults [2][3].

How large were the trials behind those numbers?

The pediatric figures come from a 3-week, double-blind, placebo-controlled trial at 47 sites that randomized 584 children aged 6 to 12 to Adderall XR 10, 20 or 30 mg once daily or placebo. Teacher and parent Conners Global Index scores improved significantly at every active dose [2].

The adult figures come from a 4-week, dose-escalation trial that randomized 255 adults to 20, 40 or 60 mg a day or placebo; ADHD Rating Scale scores fell significantly in every dose group, with a mean effect size of 0.8 [3].

Do specific cravings change?

The trial data above record appetite loss as a single adverse reaction. They do not report ratings of cravings for sweets, carbohydrates, fat or any named food, so claims that Adderall XR selectively removes a sweet tooth go beyond what was recorded [1].

How might a stimulant reduce appetite?

Amphetamines are thought to block reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of both into the space outside it [4]. Reverse transport through plasma-membrane carriers, in which the carriers that normally clear catecholamines run backwards, is one proposed primary mechanism for amphetamine-related catecholamine release [5]. The Adderall tablet label states that the mode of therapeutic action in ADHD is not known [4].

As background physiology, norepinephrine in the hypothalamic paraventricular nucleus has been studied in rats, where activating alpha-1 receptors suppresses eating while activating alpha-2 receptors increases it [6]. That is not a finding about Adderall XR itself.

When is the blood level highest?

Adderall XR is a single morning capsule made from two bead types, an immediate-release bead and a delayed-release bead, that together spread out the release [1]. According to the Adderall XR prescribing information, peak plasma concentration arrives about 7 hours after the dose, roughly 4 hours later than the immediate-release tablets, and one 20 mg capsule produces a profile similar to immediate-release 10 mg taken twice, 4 hours apart [1]. The mean half-life of d-amphetamine is about 10 hours in adults and 9 hours in children aged 6 to 12 [1]. Taking the capsule with food does not change how much is absorbed, but it delays the peak by about 2.5 hours [1].

Those figures describe blood levels, not hunger. They do not establish the hour at which appetite is lowest.

Weight and growth

The Adderall tablet labeling lists anorexia and weight loss among the undesirable effects of amphetamine treatment, and warns that CNS stimulants have been associated with weight loss and slowing of growth rate in children; it says to monitor weight and height closely during treatment and that children who are not growing or gaining as expected may need their treatment interrupted [4].

Longer-term data come from two places. A quantitative review of longitudinal studies found that stimulant treatment produced statistically significant delays in height and weight, with evidence that the deficits attenuate over time; the authors noted that growth deficits may be dose dependent, may not differ between methylphenidate and amphetamine, and that stopping treatment may lead to normalization of growth. They concluded that height and weight deficits do not appear to be a clinical concern for most children treated with stimulants [7].

The follow-up of the NIMH Multimodal Treatment Study of ADHD found no significant differences in 14- to 24-month growth rates among its randomly assigned groups, in contrast to significant growth suppression at the end of the treatment phase, and children who consistently reported taking medication showed reduced height gain compared with those who never did [8].

What happens to appetite if the drug is stopped?

The Adderall tablet label lists increased appetite among the withdrawal signs that can follow abrupt discontinuation or a significant dose reduction after prolonged use of CNS stimulants, together with dysphoric mood, depression, fatigue, vivid unpleasant dreams, insomnia or hypersomnia, and psychomotor retardation or agitation [4]. That labeling covers the immediate-release tablets; the capsule has its own prescribing information.

Is Adderall XR a weight-loss drug?

No. Adderall XR is approved only for ADHD in adults and children aged 6 and older, and it is not recommended under age 6, where plasma exposure is higher and there are more adverse reactions such as weight loss [1]. Weight loss in the trials is an adverse effect, not a treatment goal, and the capsule carries no obesity indication [1].