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Adderall XR and Imaging Contrast Dye: What You Need to Know Before Your Scan

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At a glance

  • Contrast agents on the XR interaction list / not named [1]
  • Average blood pressure rise / about 2 to 4 mm Hg [1]
  • Average heart rate rise / about 3 to 6 bpm [1]
  • Peak level after an XR dose / about 7 hours [1]
  • Cardiac caution / avoid in structural heart abnormalities, cardiomyopathy, serious arrhythmia, coronary artery disease [1]
  • IV contrast and kidney outcomes / acute kidney injury not significantly different in a matched cohort of 21,346 patients; contrast not an independent risk factor for dialysis or 30-day death [2]

Does Adderall XR interact with contrast dye?

The Adderall prescribing information describes interactions with MAO inhibitors (contraindicated, including within 14 days of stopping one), serotonergic drugs, CYP2D6 inhibitors, and alkalinizing agents such as antacids and sodium bicarbonate and acidifying agents such as ascorbic acid [1][3]. Contrast agents are not among them. The immediate-release Adderall tablet label carries a longer list of other drugs, among them tricyclic antidepressants, antihypertensives, antihistamines, chlorpromazine, haloperidol, lithium, meperidine and norepinephrine [3].

What is documented on the stimulant side is its effect on blood pressure and heart rate.

The stimulant side: blood pressure and heart rate

The label says CNS stimulants raise blood pressure by about 2 to 4 mm Hg and heart rate by about 3 to 6 bpm on average, with larger rises in some patients, and calls for monitoring [1]. It says to avoid the drug in people with known structural heart abnormalities, cardiomyopathy, serious arrhythmia, coronary artery disease or other serious heart disease, and notes that sudden death has been reported in patients with structural cardiac abnormalities or other serious cardiac disease treated with CNS stimulants at recommended ADHD doses [1].

One capsule is taken on awakening and peaks about 7 hours after the dose, roughly 4 hours later than the immediate-release tablets; food delays that peak by about 2.5 hours without changing total absorption [1].

The contrast side: kidney outcomes

In a single-center retrospective study published in Radiology, 21,346 patients who had abdominal, pelvic or thoracic CT were matched 1:1 by propensity score (10,673 with intravenous iodinated contrast and 10,673 without). Risks of acute kidney injury (odds ratio 0.94, 95% CI 0.83 to 1.07), emergent dialysis (odds ratio 0.96, 95% CI 0.54 to 1.60) and 30-day mortality (hazard ratio 0.97, 95% CI 0.87 to 1.06) were not significantly different between the groups. Contrast exposure was also not an independent risk factor for dialysis (odds ratio 0.89, 95% CI 0.40 to 2.01) or mortality (hazard ratio 1.03, 95% CI 0.82 to 1.32) [2].

Information relevant to a scan day

  • The product, strength and time of the last dose. Adderall XR comes as 5, 10, 15, 20, 25 and 30 mg capsules taken once daily on awakening [1].
  • Any high blood pressure, structural heart disease, cardiomyopathy, arrhythmia or coronary artery disease, which the label's cardiac cautions address [1].
  • Any MAO inhibitor, which the label lists as contraindicated with amphetamines and for 14 days after it stops [1].

Frequently asked questions

Can I take Adderall XR on the morning of a contrast CT?
The Adderall XR label directs one dose on awakening and says to avoid afternoon doses [1]. It also says the drug can raise blood pressure and heart rate and warns about use in people with serious heart disease [1].
Does iodinated contrast dye interact with amphetamines?
The Adderall prescribing information describes interactions with MAO inhibitors, serotonergic drugs, CYP2D6 inhibitors, alkalinizing agents such as antacids and sodium bicarbonate, and acidifying agents such as ascorbic acid; iodinated contrast is not among them [1][3].
Is gadolinium contrast different from CT contrast?
Yes. Gadolinium agents are a separate class used for MRI, and the European Society of Urogenital Radiology guidance on them concerns nephrogenic systemic fibrosis risk and agent stability rather than stimulant drugs [4].
Does it matter which amphetamine product I take?
Adderall XR is approved for ADHD from age 6, is taken once daily on awakening and peaks about 7 hours after a dose [1]. Mydayis is a separate triple-bead extended-release product for age 13 and older whose effects can last up to 16 hours, and it is not substituted milligram for milligram [5].

References

  1. Drugs@FDA: FDA-Approved Drugs. Drugs@FDA: FDA-Approved Drugs
  2. McDonald RJ, McDonald JS, Carter RE, Hartman RP, Katzberg RW, Kallmes DF, et al. Intravenous contrast material exposure is not an independent risk factor for dialysis or mortality. Radiology. 2014;273(3):714-25. Intravenous contrast material exposure is not an independent risk factor for dialysis or mortality
  3. Drugs@FDA: FDA-Approved Drugs. Drugs@FDA: FDA-Approved Drugs
  4. Thomsen HS, Morcos SK, Almén T, Bellin MF, Bertolotto M, Bongartz G, et al. Nephrogenic systemic fibrosis and gadolinium-based contrast media: updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol. 2013;23(2):307-18. Nephrogenic systemic fibrosis and gadolinium-based contrast media: updated ESUR Contrast Medium Safety Committee guidelines
  5. Drugs@FDA: FDA-Approved Drugs. Drugs@FDA: FDA-Approved Drugs
Evidence overview for interactions adderall: Adderall XR and Imaging Contrast Dye: What You Need to Know Before Your Scan