Azstarys Drug Interactions: What You Need to Know

If you're taking Azstarys for ADHD, it's important to know which medications, supplements, and substances can interact with it. Drug interactions can make Azstarys less effective, increase side effects, or cause dangerous reactions.

This guide breaks down the most important Azstarys drug interactions in plain language so you know what to avoid and what to discuss with your doctor.

How Drug Interactions Work

A drug interaction happens when one substance changes the way another substance works in your body. Interactions can:

• Increase the effects or side effects of one or both drugs
• Decrease how well a medication works
• Create new side effects that neither drug would cause on its own

Azstarys contains dexmethylphenidate, which affects dopamine and norepinephrine levels in the brain. Any substance that also affects these neurotransmitters — or that changes how your body processes dexmethylphenidate — has the potential to interact.

Medications That Interact with Azstarys

Major Interactions (Contraindicated or Dangerous)

These interactions are serious and should be avoided completely:

• MAOIs (Monoamine Oxidase Inhibitors) — This is the most dangerous interaction. Taking Azstarys with an MAOI — or within 14 days of stopping one — can cause a hypertensive crisis (a dangerous spike in blood pressure). MAOIs include:
  • Phenelzine (Nardil)
  • Tranylcypromine (Parnate)
  • Selegiline (Emsam)
  • Isocarboxazid (Marplan)
• Halogenated anesthetics — If you're having surgery, tell your anesthesiologist that you take Azstarys. Using halogenated anesthetics (such as Halothane, Sevoflurane, or Desflurane) with Azstarys can cause a sudden and dangerous increase in blood pressure during the procedure.

Moderate Interactions (Use with Caution)

These interactions may require dose adjustments or closer monitoring:

• Blood pressure medications (Antihypertensives) — Azstarys can increase blood pressure and heart rate, which may reduce the effectiveness of blood pressure medications. If you take medication for hypertension, your doctor may need to adjust your dose. Common examples include Lisinopril, Amlodipine, Metoprolol, and Losartan.
• Blood thinners (Coumarin Anticoagulants) — Azstarys may increase blood levels of Warfarin (Coumadin), raising the risk of bleeding. If you take Warfarin, your doctor should monitor your INR (a blood clotting test) more frequently after starting Azstarys.
• Anticonvulsants (Seizure medications) — Azstarys may increase blood levels of certain seizure medications, including Phenobarbital, Phenytoin (Dilantin), and Primidone (Mysoline). Your doctor may need to adjust doses and monitor drug levels.
• Tricyclic antidepressants — Medications like Amitriptyline, Nortriptyline (Pamelor), and Imipramine (Tofranil) may have increased blood levels when taken with Azstarys. This can raise the risk of side effects from the antidepressant.
• SSRIs and SNRIs — While not directly contraindicated with Azstarys, combining these antidepressants with MAOIs (if switching between them) creates a risk of serotonin syndrome. Make sure your doctor knows all the medications you're taking. Common SSRIs include Sertraline (Zoloft), Fluoxetine (Prozac), and Escitalopram (Lexapro). Common SNRIs include Venlafaxine (Effexor) and Duloxetine (Cymbalta).
• Other stimulant medications — Taking Azstarys with other sympathomimetic medications (like decongestants containing Pseudoephedrine, or other ADHD stimulants) can cause additive cardiovascular effects — meaning higher blood pressure and faster heart rate than either drug alone.

Supplements and Over-the-Counter Medications to Watch

Don't forget that OTC products and supplements can interact with Azstarys too:

• Decongestants (Pseudoephedrine, Phenylephrine) — Found in many cold and sinus medications like Sudafed. These are stimulants that can amplify Azstarys's effects on heart rate and blood pressure.
• Caffeine supplements — High-dose caffeine pills or energy drinks combined with Azstarys can worsen anxiety, insomnia, and cardiovascular side effects.
• St. John's Wort — This herbal supplement affects serotonin and other neurotransmitters. While not a direct interaction with methylphenidate, it can complicate psychiatric treatment and should be discussed with your doctor.
• Melatonin — Many ADHD patients use melatonin for insomnia caused by stimulants. This is generally considered safe, but talk to your doctor about the right dose.

Food and Drink Interactions

The good news: Azstarys has no significant food interactions. You can take it with or without food, and the capsule contents can be sprinkled on applesauce if you prefer not to swallow the capsule whole.

However, a few things to keep in mind:

• Caffeine — Coffee, tea, energy drinks, and soda all contain caffeine, which is a stimulant. Combining caffeine with Azstarys can increase side effects like fast heartbeat, anxiety, and trouble sleeping. You don't necessarily have to eliminate caffeine, but be mindful of your intake, especially in the afternoon.
• Alcohol — While there's no direct pharmacological interaction between alcohol and Azstarys, alcohol is a CNS depressant that can mask or alter the effects of stimulant medication. It can also impair judgment about how the medication is affecting you. Most doctors recommend limiting alcohol while on stimulant medications.
• Acidic foods and drinks — Some research suggests that highly acidic foods or drinks (like citrus juices) taken around the same time as methylphenidate may slightly affect absorption. This is less of a concern with Azstarys's prodrug design, but if you notice inconsistent effects, try taking it with plain water.

What to Tell Your Doctor

Before starting Azstarys, make sure your doctor has a complete picture of everything you take. Bring a list that includes:

• All prescription medications (including those from other doctors)
• Over-the-counter medications (pain relievers, allergy meds, cold medicines)
• Vitamins and supplements (including herbal products)
• How much caffeine you consume daily
• Any recreational substances (your doctor needs this information to keep you safe — they're not going to judge you)

Also tell your doctor if you have any upcoming surgeries, as Azstarys may need to be stopped before procedures involving certain anesthetics.

If you start any new medication while taking Azstarys, let both your prescribing doctor and pharmacist know so they can check for interactions.

Final Thoughts

Most Azstarys drug interactions are manageable with proper communication and monitoring. The most critical one to remember is the MAOI interaction — never take Azstarys with an MAOI or within 14 days of stopping one.

For everything else, the key is transparency. Keep your doctor and pharmacist informed about every substance you take, and don't be afraid to ask questions.

Want to learn more about this medication? Read our guides on what Azstarys is and Azstarys side effects. When you're ready to fill your prescription, use Medfinder to find a pharmacy with Azstarys in stock.