What You Should Know About Dextroamphetamine XR Side Effects

If you've been prescribed dextroamphetamine XR (extended-release) for ADHD or narcolepsy, you're probably wondering what side effects to expect. Like all medications, dextroamphetamine XR can cause side effects — some are mild and go away on their own, while others need medical attention.

This guide covers what the FDA labeling says about side effects, how to manage common ones, and when you should call your doctor right away.

What Is Dextroamphetamine XR?

Dextroamphetamine XR is an extended-release CNS stimulant used to treat ADHD in patients aged 6 and older and narcolepsy. It's the generic version of Dexedrine Spansule. The medication releases slowly throughout the day, providing symptom relief for up to 8–10 hours from a single morning dose. For more details, see our full overview: What is dextroamphetamine XR?

Common Side Effects

Most people experience at least one of these side effects when starting dextroamphetamine XR. They're usually mild and often improve after a few weeks as your body adjusts:

• Decreased appetite — This is the most commonly reported side effect. Many people notice less hunger, especially during the day while the medication is active.
• Insomnia or trouble sleeping — Because the drug is a stimulant, it can make it hard to fall asleep, especially if taken too late in the day.
• Dry mouth
• Weight loss — Often related to decreased appetite.
• Headache
• Nervousness or anxiety
• Irritability
• Stomach pain or nausea
• Dizziness

These side effects are dose-related — meaning they're more likely at higher doses. If they bother you, your doctor may adjust your dose or timing.

Serious Side Effects

While less common, dextroamphetamine XR carries a boxed warning — the FDA's most serious safety alert — about the risk of abuse, dependence, sudden death, and serious cardiovascular events.

Call your doctor or go to the emergency room if you experience:

• Chest pain, shortness of breath, or fainting — These could signal a cardiovascular event. Stimulants can raise blood pressure and heart rate.
• Signs of a heart problem — Pounding heartbeat, irregular heartbeat, or sudden unexplained death has been reported in people with pre-existing heart conditions.
• Psychiatric symptoms — New or worsening psychosis (hallucinations, paranoia), mania, or severe aggression. This can occur even in patients without a prior psychiatric history.
• Peripheral vasculopathy — Cold, numb, or painful fingers and toes, or skin color changes. This includes Raynaud's phenomenon.
• Serotonin syndrome — Agitation, confusion, rapid heartbeat, high temperature, muscle twitching, or loss of coordination. This risk increases when dextroamphetamine is taken with serotonergic drugs like SSRIs or SNRIs.
• Seizures — Especially in patients with a history of seizure disorders.

Side Effects in Specific Populations

Children and Adolescents

Dextroamphetamine XR is approved for children aged 6 and older. In addition to the side effects listed above, growth suppression is a concern with long-term use. Doctors should monitor height and weight regularly. Some children may need drug holidays during school breaks to catch up on growth.

Pregnancy and Breastfeeding

Dextroamphetamine XR may cause premature birth, low birth weight, and neonatal withdrawal symptoms. It should only be used during pregnancy if the benefit clearly outweighs the risk. The drug passes into breast milk, so breastfeeding is generally not recommended while taking it.

Older Adults

Elderly patients should use dextroamphetamine XR with caution due to increased cardiovascular risk. Doctors will typically start at the lowest dose and monitor blood pressure and heart rate closely.

People with Heart Conditions

Anyone with symptomatic cardiovascular disease, moderate to severe hypertension, or advanced arteriosclerosis should not take dextroamphetamine XR. The medication can worsen these conditions.

How to Manage Common Side Effects

Here are practical tips for dealing with the most common side effects:

• Decreased appetite: Eat a good breakfast before your morning dose. Have calorie-dense snacks available for when the medication wears off in the evening.
• Insomnia: Take your dose first thing in the morning. Avoid caffeine in the afternoon. Talk to your doctor if sleep problems persist — they may lower your dose.
• Dry mouth: Drink plenty of water throughout the day. Sugar-free gum or lozenges can help.
• Headache: Stay hydrated and make sure you're eating enough. Over-the-counter pain relievers like acetaminophen are generally safe, but check with your pharmacist.
• Stomach pain: Taking the capsule with food or sprinkling the beads on applesauce (without crushing them) can help reduce nausea.
• Nervousness or irritability: This often improves within the first 1–2 weeks. If it doesn't, your dose may be too high.

Never adjust your dose on your own. Always talk to your prescriber before making changes.

Final Thoughts

Most side effects from dextroamphetamine XR are mild and manageable, especially when the dose is right. The most important thing is to stay in touch with your doctor — report what you're feeling so they can adjust your treatment as needed.

If you're having trouble finding dextroamphetamine XR at your pharmacy due to the current shortage, use Medfinder to check availability near you. And if cost is a concern, check out our guide to saving money on dextroamphetamine XR.