Can You Take Adderall With Proton Pump Inhibitors?

Answer

Thanks for reaching out to us! There is a moderate interaction between Adderall (mixed amphetamine; dextroamphetamine salts) and all PPI (proton pump inhibitors), including esomeprazole.

PPI drugs, like omeprazole, suppress stomach acid secretion, reducing the acidity of the stomach (i.e. has an alkalinizing effect). Various sources report that alkalinizing drugs (such as esomeprazole) can increase Adderall absorption, potentially increasing the risk of side effects occurring.

However, these two drugs are still often used together, so it is important to be monitored when taking this combination.

Interaction Detail

The Prescribing Information for Adderall specifically mentions interactions with alkalinizing agents (i.e. drugs that reduce the acidity of the stomach):

Alkalinizing Agents Increase blood levels and potentiate the action of amphetamine. Co-administration of Adderall and gastrointestinal alkalinizing agents should be avoided. Examples of alkalinizing agents include gastrointestinal alkalinizing agents (e.g., sodium bicarbonate) and urinary alkalinizing agents (e.g. acetazolamide, some thiazides).

This warning is based on the results of several studies, which have shown that PPI drugs, when co-administered with Adderall, increase how quickly the drug (Adderall) is absorbed.

Why The Interaction Occurs

Amphetamine is a weakly basic drug that is in an ionic form when it reaches the stomach. As a general rule of thumb, non-ionic compounds diffuse more readily through epithelial cell membranes in the gastrointestinal tract. In other words, non-ionic compounds are better absorbed.

Proton pump inhibitors block acid production, and therefore, reduce the acidity in the stomach. A reduction in gastric acidity can lead to more non-ionized species of amphetamine and enhanced drug absorption.

One study showed that in individuals receiving 20 mg single-dose of extended-release mixed amphetamine salts (i.e. Adderall XR) with 40 mg omeprazole, the time to reach peak plasma concentration (Tmax) was shortened from 5 hours to 2.75 hours, indicating faster absorption of the drug.

Watch For Side Effects

This interaction affects all PPI drugs, including:

• Prilosec (omeprazole)
• Prevacid (lansoprazole)
• Nexium (esomeprazole)
• Aciphex (rabeprazole)
• Protonix (pantoprazole)

An increase in amphetamine concentration could increase the risk of amphetamine-related side effects, such as:

• Increased heart rate
• Sweating
• Anxiety
• Irritability

Now, I mentioned at the beginning of this answer that even though there is an interaction here, it's not uncommon for amphetamine drugs and PPIs to be used together. If they are, it would be prudent to start at a low dose of Adderall and assess your response to the drug.

If you are already on Adderall, it is possible that dosage adjustments may be necessary.

Does Spacing The Drugs Out Matter?

In general, PPI drugs, like esomeprazole, are taken consistently, on a daily basis, for at least a few weeks, if not longer. This will have the effect of consistently reducing the acidity of the stomach.

Since you are reducing stomach acidity on a long-term basis, and that is what causes this interaction, spacing out Adderall from esomeprazole will not avoid the interaction from occurring. Therefore, you can take both in the morning.

Final Words

As a quick last point, you mentioned other drugs in your question too. The HCTZ (hydrochlorothiazide) in your lisinopril pill is also considered an alkalinizing agent, and therefore, has the same interaction esomeprazole does. HCTZ is a thiazide diuretic and is specifically mentioned in the prescribing information for Adderall (see the excerpt above).

As long as you are starting Adderall at a low dose, and you are monitored while taking it, it can be used safely with a PPI.

Thanks again for your question! Reach back out anytime!