Why Drug Interactions Matter When You Take Evekeo

When you take Evekeo (amphetamine sulfate) alongside other medications, supplements, or even certain foods, the way your body processes Evekeo can change — sometimes dangerously. Drug interactions can make Evekeo less effective, increase its side effects, or create entirely new health risks.

Because Evekeo is a Schedule II stimulant that affects brain chemistry, it has several important interactions you need to be aware of. This guide covers the major ones so you can have an informed conversation with your doctor.

How Drug Interactions Work

Drug interactions happen in a few ways:

• One drug changes how another is absorbed — For example, antacids can increase how much Evekeo your body absorbs.
• One drug changes how another is broken down — Certain medications slow or speed up the enzymes that process Evekeo in your liver.
• Two drugs affect the same body system — When Evekeo and another medication both increase the same brain chemicals, the combined effect can be dangerous.

Not all interactions are equally risky. Some are life-threatening, while others just require monitoring or a dose adjustment.

Medications That Interact With Evekeo

Major Interactions (Contraindicated or Dangerous)

• MAO inhibitors (MAOIs) — Including Phenelzine (Nardil), Tranylcypromine (Parnate), Isocarboxazid (Marplan), and Selegiline (Emsam). Taking Evekeo with an MAOI — or within 14 days of stopping one — can cause a hypertensive crisis (a sudden, dangerous spike in blood pressure). This combination is strictly contraindicated.
• Serotonergic medications — Including SSRIs like Fluoxetine (Prozac), Sertraline (Zoloft), and Escitalopram (Lexapro); SNRIs like Venlafaxine (Effexor) and Duloxetine (Cymbalta); and triptans like Sumatriptan (Imitrex). The combination can cause serotonin syndrome, a potentially life-threatening condition with symptoms like agitation, rapid heart rate, high body temperature, and muscle rigidity.
• Tricyclic antidepressants (TCAs) — Including Amitriptyline (Elavil) and Nortriptyline (Pamelor). TCAs can enhance the effects of amphetamines, increasing cardiovascular risk.

Moderate Interactions (Require Monitoring)

• CYP2D6 inhibitors — Medications like Bupropion (Wellbutrin), Paroxetine (Paxil), and Quinidine can slow down the breakdown of amphetamines, leading to higher Evekeo levels in your blood and increased side effects.
• Antacids and urinary alkalinizers — Sodium bicarbonate and similar alkalinizing agents reduce how quickly your kidneys eliminate Evekeo, effectively increasing its strength and duration.
• Urinary acidifiers — Ascorbic acid (vitamin C) and ammonium chloride speed up Evekeo excretion, making it less effective.
• Antihypertensives — Blood pressure medications like Lisinopril, Amlodipine (Norvasc), and Metoprolol (Lopressor) may be less effective when taken with Evekeo, since stimulants tend to raise blood pressure.
• Proton pump inhibitors (PPIs) — Medications like Omeprazole (Prilosec) and Esomeprazole (Nexium) may alter Evekeo's absorption.
• Antihistamines — Evekeo may counteract the sedating effects of antihistamines like Diphenhydramine (Benadryl).

Supplements and OTC Medications to Watch

It's not just prescription drugs that can interact with Evekeo:

• Vitamin C (ascorbic acid) — High doses can reduce Evekeo's effectiveness by increasing how fast it's excreted. Avoid taking large vitamin C supplements around the same time as your dose.
• Melatonin — While not a direct pharmacological interaction, some patients use melatonin to counteract Evekeo-related insomnia. Discuss this with your doctor.
• St. John's Wort — This herbal supplement affects serotonin levels and could increase the risk of serotonin syndrome when combined with Evekeo.
• Decongestants containing pseudoephedrine — Found in products like Sudafed. These are also stimulants and can compound Evekeo's effects on heart rate and blood pressure.
• Caffeine pills or high-caffeine supplements — Can amplify stimulant side effects including increased heart rate, anxiety, and insomnia.

Food and Drink Interactions

What you eat and drink can also affect how Evekeo works:

• Acidic foods and beverages — Orange juice, grapefruit juice, tomato-based foods, and sodas can reduce Evekeo's absorption and effectiveness. Try to avoid consuming these within an hour of taking your medication.
• Alkaline foods — Foods that make your urine more alkaline (like certain vegetables and dairy) can increase Evekeo absorption and prolong its effects.
• Caffeine — Coffee, tea, energy drinks, and chocolate all contain caffeine, which is also a stimulant. Combining caffeine with Evekeo can increase side effects like rapid heartbeat, jitteriness, and insomnia. You don't necessarily have to quit caffeine, but be mindful of how much you're consuming.
• Alcohol — While not a direct pharmacological interaction, alcohol can mask Evekeo's effects and impair your judgment. It's generally best to limit alcohol while taking any stimulant medication.

What to Tell Your Doctor

Before starting Evekeo, make sure your doctor knows about:

1. Every medication you take — Including prescription drugs, over-the-counter medications, and anything you take "as needed."
2. All supplements and vitamins — Especially vitamin C, St. John's Wort, and any herbal products.
3. Your caffeine habits — How many cups of coffee, energy drinks, or caffeinated teas you consume daily.
4. Any recent medication changes — Particularly if you've taken an MAOI in the past 14 days.
5. Medical conditions — Especially heart conditions, high blood pressure, thyroid problems, or a history of seizures.

Keep an updated medication list and bring it to every appointment. If you start any new medication while taking Evekeo, always check with your prescriber or pharmacist before combining them.

Final Thoughts

Evekeo is generally safe when taken as prescribed and when your doctor is aware of everything else you're taking. The most dangerous interactions — like MAOIs and serotonergic drugs — are well-known and easy to avoid with proper communication.

For more about Evekeo, see our guides on side effects, how it works, and uses and dosage. If you need help finding Evekeo at a pharmacy, Medfinder can help you check availability near you.