Adderall Vs. Lexapro: Drug Comparison

The information below is about Adderall XR^®, an extended-release formulation of mixed salts of a single-entity amphetamine product. This information may not be accurate for the immediate-release formulation, Adderall^®.

Adderall XR (amphetamine/dextroamphetamine extended-release) contains amphetamine, a Schedule II controlled substance. It is a stimulant medication used primarily to treat attention-deficit hyperactivity disorder (ADHD) by increasing levels of dopamine and norepinephrine in the brain, which helps improve focus, attention, and impulse control. Its FDA-approved indications include ADHD in both children and adults, and it may also be used to treat narcolepsy, though this is more common with immediate-release formulations. Adderall XR comes in capsule form and is designed for once-daily dosing. Common side effects include insomnia, decreased appetite, and increased heart rate, while serious warnings include a boxed warning for potential abuse, dependence, and cardiovascular risks, especially in individuals with underlying heart conditions or a history of substance abuse. It also interacts with certain other medications.

Lexapro^® (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) used to treat anxiety and depression by increasing available serotonin levels in the brain, which helps improve mood and reduce anxiety. Its FDA-approved indications include the treatment of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in adults and adolescents. Off-label uses may include treating panic disorder, obsessive-compulsive disorder (OCD), and social anxiety disorder. Lexapro is available in tablet and oral solution forms, taken once daily. Common side effects include nausea, insomnia, and sexual dysfunction, and it carries a boxed warning for an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults, particularly during the initial stages of treatment.

Central nervous system (CNS) stimulant

Selective serotonin reuptake inhibitor (SSRI)

Adderall XR (mixed salts of a single-entity amphetamine product) is indicated:

• For the treatment of attention deficit hyperactivity disorder (ADHD) in adults and pediatric patients 6 years and older.

Lexapro (escitalopram) is indicated for the:

• Treatment of major depressive disorder (MDD) in adults and pediatric patients 12 years of age and older

• Treatment of generalized anxiety disorder (GAD) in adults and pediatric patients 7 years and older

• Typically taken orally once daily

• Comes in 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, and 30 mg extended-release capsules

• Typically taken orally once daily

• Comes in 5 mg, 10 mg (scored), and 20 mg (scored) tablets

Pediatric patients ages 6 to 12: Most common adverse reactions (≥5% and with a higher incidence than on placebo) were:

• Loss of appetite

• Insomnia

• Abdominal pain

• Emotional lability

• Vomiting

• Nervousness

• Nausea

• Fever

Pediatric patients ages 13 to 17: Most common adverse reactions (≥5% and with a higher incidence than on placebo) were:

• Loss of appetite

• Insomnia

• Abdominal pain

• Weight loss

• Nervousness

Adults: Most common adverse reactions ≥5% and with a higher incidence than on placebo were:

• Dry mouth

• Loss of appetite

• Insomnia

• Headache

• Weight loss

• Nausea

• Anxiety

• Agitation

• Dizziness

• Fast heart beat

• Diarrhea

• Weakness

• Urinary tract infections

Most commonly observed adverse reactions (incidence ≥ 5% and at least twice the incidence of placebo patients) are:

• Insomnia

• Ejaculation disorder (primarily ejaculatory delay),

• Nausea

• Sweating increased

• Fatigue and sleepiness

• Decreased libido

• Inability to orgasm

• Known hypersensitivity or idiosyncrasy to amphetamine

• During or within 14 days following the administration of monoamine oxidase inhibitors (MAOI)

• Drug interactions: alkalinizing agents (GI antacids and urinary), acidifying agents (GI and urinary)

• Do not use MAOIs intended to treat psychiatric disorders with Lexapro or within 14 days of stopping treatment with Lexapro. Do not use Lexapro within 14 days of stopping an MAOI intended to treat psychiatric disorders. In addition, do not start Lexapro in a patient who is being treated with linezolid or intravenous methylene blue

• Concomitant use of pimozide

• Known hypersensitivity to escitalopram or citalopram or any of the inactive ingredients

• Drug interactions: SSRIs, SNRIs, tryptophan, drugs that affect hemostasis (NSAIDs, aspirin, warfarin)

• Risks to patients with serious cardiac disease

• Increased blood pressure and heart rate

• Psychiatric adverse reactions

• Long-term suppression of growth in pediatric patients

• Seizures

• Peripheral vasculopathy, including Raynaud’s phenomenon

• Serotonin syndrome: Increased risk when coadministered with serotonergic agents (e.g., SSRIs, SNRIs, triptans), but also during overdosage situations

• Motor and verbal tics, and worsening of Tourette’s syndrome

• Pregnancy: May cause fetal harm

• Lactation: Breastfeeding not recommended

• Serotonin syndrome

• Discontinuation syndrome

• Seizures

• Activation of mania/hypomania

• Low blood sodium: Can occur in association with syndrome of inappropriate antidiuretic hormone secretion

• Increased risk of bleeding

• Interference with cognitive and motor performance

• Angle closure glaucoma

• Use in patients with concomitant illness

• Sexual dysfunction

• Pregnancy: SSRI use, particularly later in pregnancy, may increase the risk for persistent pulmonary hypertension and symptoms of poor adaptation (respiratory distress, temperature instability, feeding difficulties, hypotonia, tremor, irritability) in the neonate

WARNING: ABUSE, MISUSE, AND ADDICTION

Adderall XR has a high potential for abuse and misuse, which can lead to the development of a substance use disorder, including addiction. Misuse and abuse of CNS stimulants, including Adderall XR, can result in overdose and death:

• Before prescribing Adderall XR, assess each patient’s risk for abuse, misuse, and addiction.

• Educate patients and their families about these risks, proper storage of the drug, and proper disposal of any unused drug.

• Throughout treatment, reassess each patient’s risk and frequently monitor for signs and symptoms of abuse, misuse, and addiction.

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS

Increased risk of suicidal thoughts and behavior in pediatric and young adult patients taking antidepressants. Closely monitor all antidepressant-treated patients for clinical worsening and emergence of suicidal thoughts and behaviors. Lexapro is not approved for use in pediatric patients less than 7 years of age.

*This information is from the label for brand name Adderall XR^®. See the Full Prescribing Information for more complete information. Dextroamphetamine sulfate, dextroamphetamine saccharate, amphetamine sulfate, and amphetamine aspartate, the active ingredients in Adderall XR, may also be the active ingredients in other medications, and this information may not be accurate for all medications that include the active ingredients dextroamphetamine sulfate, dextroamphetamine saccharate, amphetamine sulfate, and amphetamine aspartate.

*This information is from the label for brand name Lexapro^®. See the Full Prescribing Information for more complete information. Escitalopram, the active ingredient in Lexapro, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient escitalopram.