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You may “have a friend” who’s taken Adderall to help cram for a test or pull an all-nighter (*cough cough*). But as magical as Adderall seems, there are a few reasons this powerful medication isn’t available over the counter.

Real talk:

Adderall is a Schedule II federally controlled substance, which means it has high potential for abuse. That’s the same classification as fentanyl, OxyContin, and cocaine. But for people with ADHD, this medication can be life-changing.

Adderall and ADHD

Up to 80 percent of kids with attention deficit hyperactivity disorder (ADHD) see improvement of symptoms when they take a stimulant like Adderall. ADHD can cause higher-than-average levels of hyperactive, impulsive, and inattentive behavior.

Adderall helps manage these behaviors by improving concentration and focus. Since it can reduce daytime sleepiness, Adderall is also an FDA-approved treatment for narcolepsy.

Stimulants are commonly used to treat ADHD, but this class of medication can have serious side effects and should only be taken with medical supervision.

It’s important to be up-front with your doctor about your health history — mental and physical — when discussing Adderall. Certain preexisting conditions and medications may not be compatible with the drug.

Once you get a prescription, it’s also important to follow a regimen. Adderall comes in two different forms, which affect your dosage amount and frequency.

If you’re prescribed a tablet, your doctor will likely recommend one to three doses a day. The first should be taken in the morning. The remaining tablets should be taken 4 to 6 hours later (or as needed).

There’s also Adderall XR, an extended-release capsule. Its active ingredients are released in your body throughout the day, so only one dose is necessary.

Regardless of which form you’re prescribed, it’s important to avoid taking Adderall in the late afternoon or evening. Doing so could make it hard for you to catch much-needed Zzz’s.

Common side effects

Adderall is a central nervous system stimulant. By boosting certain chemicals in your brain, it can make it easier for you to stay calm and focused.

But with the good also comes a long list of potential side effects, including:

  • nervousness
  • restlessness
  • headaches
  • nausea
  • constipation
  • loss of appetite
  • problems getting to sleep or staying asleep
  • dizziness
  • dry mouth
  • hoarseness
  • slowed speech
  • changes in vision

Luckily, many people experience fewer side effects with continued use.

Children who lose their appetites while taking Adderall may grow more slowly since they’re taking in fewer nutrients. A 2014 study found that kids taking stimulants to treat their ADHD experienced slower weight gain.

This is usually temporary, but make sure a doctor is closely monitoring your child’s height and weight.

Another problematic side effect is less vertical and more… horizontal.

For some men, Adderall can cause erectile dysfunction or a decreased sex drive. These effects are more commonly associated with abuse of amphetamines like Adderall, but you should talk to your doctor about any lasting effects on your sex life.

Serious side effects

Call your doctor or seek emergency medical treatment immediately if you experience any unusual symptoms. Serious side effects are possible with Adderall, such as:

  • heart problems, including high blood pressure, rapid heartbeat, heart attack, or stroke
  • depression and hallucinations
  • agitation, aggressive behavior, and irritability
  • impaired or delusional thinking
  • blurred vision
  • severe allergic reaction, including swelling of the tongue, throat, or face
  • muscle breakdown (called rhabdomyolysis)
  • seizures
  • sudden death
  • fever
  • uncontrollable shaking or tics

Side effects of abuse and overuse

Abusing or misusing Adderall for an extended period can lead to physical and psychological dependence. This can cause serious side effects, including:

  • depression
  • aggression
  • hallucinations
  • euphoric feelings
  • severe insomnia
  • fatigue
  • heart damage
  • unwanted weight loss

Stopping the medication cold-turkey can also lead to serious withdrawal symptoms, such as:

  • hunger
  • anxiety and irritability
  • panic attacks
  • fatigue
  • insomnia
  • depression
  • phobias

Unfortunately, there’s no treatment for Adderall withdrawal. You may have to wait it out — and symptoms can last a few days or even a few weeks.

If you feel you’re misusing Adderall (or if you want to stop taking it), talk to your doctor. They’ll come up with a plan to help wean you off the drug safely.

Since Adderall is a stimulant, your doctor will make sure you don’t have a heart abnormality or another cardiovascular issue before prescribing it.

Why is cardiovascular health so important? Stimulants can make your blood vessels constrict, raising your blood pressure and making your heart beat faster.

Adderall may increase your blood pressure by 2–4 millimeters of mercury or your heart rate by 3–6 beats per minute.

If you have chest pain, shortness of breath, or difficulty breathing or you feel faint, contact your doctor immediately. Taking Adderall when you have a preexisting heart condition could cause a heart attack, stroke, or even sudden death.

Adderall and alcohol

Use caution if you’re drinking alcohol while taking Adderall. The combination can increase your chances of having heart problems.

Alcohol poisoning is another risk. You probably know that alcohol is a depressant. But mixing a stimulant (like Adderall) with a depressant doesn’t cancel out their effects.

Instead, the two substances compete in your body. Adderall may start to dull the symptoms of drinking, leading to a potentially dangerous overconsumption of alcohol.

Stimulants like Adderall may cause your glucose level (aka blood sugar) to spike. This can cause side effects that resemble the Pepto Bismol song:

  • constipation
  • diarrhea
  • nausea
  • stomach pain
  • vomiting

The medication can also affect your appetite and stimulate weight loss by suppressing hunger. This has led some people to misuse Adderall as a weight loss aid.

Adderall isn’t FDA-approved for weight loss, and using it for this purpose can have serious complications. In some cases a doctor may prescribe the medication off-label to support weight loss goals, but only as part of a professionally monitored plan.

Allergic reactions are rare, but if they happen, they may resemble common allergy symptoms.

If you notice any of the following, your skin may be having a reaction to Adderall:

  • blistering
  • hives
  • itching
  • rashes

Symptoms of ADHD can be sneaky. They may resemble those of mood disorders, which makes it difficult for doctors to diagnose people with depression or anxiety as also having ADHD.

Co-occurring disorders are actually fairly common: 50 percent of adults and 33 percent of children with ADHD also have anxiety.

Adderall may interact with other medications and supplements you’re taking. If you’re being treated for depression or anxiety, your doctor should make sure before prescribing Adderall that it won’t interfere with your current medications.

In some cases, Adderall may impede other drugs or cause increased side effects.

MAOIs

Monoamine oxidase inhibitor antidepressants, or MAOIs, were the first type of antidepressant developed.

Taking an MAOI with Adderall can lead to dangerous side effects, including chest pain, increased body temperature, severe headache, and very high blood pressure.

For these reasons, you shouldn’t use Adderall within two weeks of taking MAOIs, which include:

  • isocarboxazid (Marplan)
  • linezolid (Zyvox)
  • phenelzine (Nardil)
  • selegiline (Emsam, Eldepryl, Zelapar)
  • tranylcypromine (Parnate)

Serotonin syndrome

When it comes to serotonin, the old adage “too much of a good thing” may be true. An excess of this chemical — which is thought to contribute to well-being and happiness — may put you at risk for a dangerous drug reaction.

Serotonin syndrome can occur when two drugs that affect serotonin levels are taken at the same time. Symptoms can appear up to 8 hours after taking the drugs and may include:

  • agitation
  • restlessness
  • confusion
  • increased heart rate and blood pressure
  • pupil dilation
  • diarrhea
  • headaches
  • shivering, sweating, and goosebumps
  • loss of muscle coordination
  • muscle rigidity

Discontinuing the use of serotonin-boosting medications may be enough to stop the symptoms, but in severe cases, hospitalization could be necessary.

Many of us have joked about needing Adderall at one time or another. A study published in 2010 even found that university students don’t consider it to be a drug.

But the reality is that Adderall poses serious risks to your health if you take it without proper medical supervision (and without an ADHD diagnosis).

If you’re taking Adderall and having side effects that last longer than a few days or weeks, talk to your doctor. If you start to have more serious side effects, contact your doctor immediately.

And if your symptoms feel life-threatening or warrant a medical emergency, don’t hesitate to call 911.