Medical Conditions and History: Who Cannot Be Prescribed Adderall?

October 11, 2025 •

3 min read

The U.S. Food and Drug Administration (FDA) places a boxed warning on Adderall due to its high potential for abuse and dependence, which is one of several significant considerations in determining who cannot be prescribed Adderall. The decision rests heavily on a patient's full medical history.

Quick Summary

A healthcare provider assesses potential risks before prescribing Adderall, evaluating patient history for serious heart disease, severe mental health conditions, substance abuse, and certain drug interactions.

Key Points

Cardiovascular Health: Pre-existing heart conditions, uncontrolled high blood pressure, and structural heart defects are major contraindications for Adderall due to stimulant-induced cardiac stress.
Mental Health Considerations: Severe anxiety, agitation, psychosis, and bipolar disorder can be exacerbated by Adderall, potentially worsening symptoms or inducing manic episodes.
History of Addiction: A personal or family history of drug or alcohol abuse significantly increases the risk of misuse and addiction, making a prescription inadvisable.
Dangerous Drug Interactions: Taking Adderall with MAO inhibitors or certain serotonergic drugs can lead to life-threatening conditions like hypertensive crisis or serotonin syndrome.
High-Risk Patient Groups: Individuals who are pregnant, breastfeeding, or children under certain ages are typically advised against Adderall due to risks to fetal development and potential effects on infants.
Other Physical Conditions: Glaucoma, hyperthyroidism, and a history of seizures can also be reasons for not prescribing Adderall.

Critical Reasons Why Adderall May Not Be Prescribed

Adderall, a combination of amphetamine and dextroamphetamine, is a central nervous system (CNS) stimulant used primarily to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy. However, due to its potent effects, it is not safe for everyone. Before a prescription is issued, a thorough medical and psychiatric history is taken to identify potential risks. A significant number of pre-existing conditions and lifestyle factors can serve as contraindications.

Cardiovascular Conditions

Adderall can increase heart rate and blood pressure, making it risky for individuals with serious heart problems. Such conditions include structural cardiac abnormalities, moderate to severe hypertension, coronary artery disease, and other symptomatic cardiovascular diseases like heart failure. Hyperthyroidism can also be a contraindication as it already affects heart rate and blood pressure. These risks can lead to serious complications such as sudden death, stroke, and heart attack.

Mental and Behavioral Health Disorders

Stimulant medications like Adderall can worsen certain mental health conditions. Individuals with psychotic disorders may experience increased symptoms such as hallucinations. For those with bipolar disorder, stimulants can trigger manic episodes. Severe anxiety or agitation can also be exacerbated. A history of aggression, suicidal thoughts, or tic disorders like Tourette's syndrome may also preclude a prescription. Additionally, Adderall may worsen certain types of glaucoma by affecting eye pressure.

History of Substance Abuse

As a Schedule II controlled substance, Adderall carries a high risk of abuse and dependence. Individuals with a history of substance use disorder, including abuse of alcohol, prescription drugs, or street drugs, are at a higher risk of misusing Adderall and developing addiction. Misuse can lead to overdose and death.

Drug Interactions

Adderall can interact dangerously with various medications. Taking it with Monoamine Oxidase Inhibitors (MAOIs) within 14 days can cause a hypertensive crisis. Combining it with serotonergic drugs can lead to serotonin syndrome. Acidifying agents like vitamin C can reduce Adderall's effectiveness, while alkalinizing agents like antacids can increase its levels and potential side effects. It is vital to inform a doctor of all current medications and supplements.

Other Special Populations and Considerations

Certain life stages and physical conditions can also prevent an Adderall prescription.

Pregnancy and Breastfeeding: Animal studies indicate potential harm to a fetus, and Adderall passes into breast milk. It is generally not recommended during pregnancy or while breastfeeding.
Children under a certain age: Adderall is not approved for children under 3, and the extended-release version is not for those under 6.
Seizure disorders: Stimulants can increase the risk of seizures.
Peripheral vasculopathy: Conditions like Raynaud's phenomenon can worsen.
Allergy: A known allergy to amphetamines is a direct contraindication.

Comparison of Prescription Eligibility

To illustrate the doctor's decision-making process, here is a comparison of typical patient profiles for Adderall consideration.


Patient Profile	Typical Prescription Outcome	Rationale
Healthy Adult with confirmed ADHD	Possible	Symptoms are managed effectively with a low, monitored dose.
Individual with severe anxiety	Unlikely	Stimulants worsen anxiety and agitation.
Patient with history of heart disease	Contraindicated	Increased heart rate and blood pressure risk serious cardiac events.
Adult in recovery for substance abuse	Unlikely	High potential for addiction and misuse.
Child under 3 years old	Contraindicated	Not approved for this age group.
Pregnant or breastfeeding woman	Typically advised against	Potential risks to the fetus and infant.

Conclusion: A Thorough Evaluation Is Essential

Determining who cannot be prescribed Adderall is a multifaceted process that involves a comprehensive medical evaluation. Conditions such as pre-existing heart disease, uncontrolled hypertension, severe anxiety, and bipolar disorder present clear risks. Furthermore, a history of substance abuse or addiction is a critical contraindication due to Adderall's high potential for misuse. Certain drug interactions, including with MAOIs, pose serious health threats. Patient-specific factors, like pregnancy, breastfeeding, and age, are also pivotal considerations. Ultimately, a healthcare provider must carefully weigh the potential therapeutic benefits against the significant health risks for each individual patient before initiating or continuing treatment. The FDA provides detailed prescribing information, which can be reviewed by patients and healthcare professionals for additional guidance on who is eligible for this medication based on their unique health profile [based on information from the FDA Drug Label].

Frequently Asked Questions

Contraindications include heart disease, structural cardiac abnormalities, moderate to severe high blood pressure, coronary artery disease, and history of heart attack or arrhythmia due to the risk of increased heart rate and blood pressure.

Yes, Adderall can worsen existing psychiatric conditions. It may exacerbate symptoms of psychosis, induce manic episodes in patients with bipolar disorder, and worsen severe anxiety or agitation.

Typically, no. Given its high potential for abuse and dependence, Adderall is generally not prescribed to individuals with a history of drug or alcohol addiction.

Patients should avoid taking Adderall with MAO inhibitors (e.g., phenelzine) within 14 days. It also interacts dangerously with serotonergic drugs, antacids, and vitamin C, among others.

Due to potential risks to the developing baby, including low birth weight and premature delivery, Adderall is generally not recommended during pregnancy.

No, you should not breastfeed while taking Adderall. Amphetamines can pass into breast milk and potentially cause adverse effects in the infant.

Adderall is not recommended for children under 3 years old. A doctor will determine the appropriate age and dosage, if any, for children between 3 and 17 based on their specific needs.