CBD and Amphetamines (e.g. Adderall, Adderall XR)
David ReichUpdated:Key points at a glance:
CBD may inhibit the enzymes CYP2D6 and CYP3A4, which can potentially increase amphetamine levels. This may be relevant for medicines such as Adderall, Attentin and Elvanse. Possible effects can include faster heart rate, increased blood pressure, sleep disturbances and anxiety-like symptoms. It is often recommended to start with a low CBD dose, separate the timing of intake from other medication and observe how you feel over 1 to 2 weeks. Monitoring pulse and blood pressure and keeping a brief diary of any changes can be helpful. Grapefruit is also known to interact with these enzymes and is usually avoided alongside such medicines. The available data are limited, and any warning signs or additional medication should be discussed with a doctor.
You are taking Adderall, Attentin or Elvanse and are considering using CBD as well? This article provides an evidence‑informed overview of what to consider when combining CBD and amphetamines – including potential CBD drug interactions, effects on liver enzymes and practical safety tips.
- CBD can inhibit liver enzymes (especially CYP2D6 and CYP3A4) and may therefore influence amphetamine levels.
- Particular caution is advisable if you have cardiovascular issues, anxiety, sleep problems or take other long‑term medicines.
- Start with low CBD doses, consider separating CBD and stimulant doses in time, and monitor symptoms – always with medical guidance.
CBD and amphetamines (e.g. Adderall, Elvanse): overview and key risks
CBD, or cannabidiol, interacts with the endocannabinoid system and is viewed positively by many users. Amphetamines such as Adderall/Adderall XR, Attentin (dexamfetamine) and Elvanse (lisdexamfetamine) are stimulants used in the treatment of ADHD. When CBD and amphetamines are used at the same time, two aspects are particularly relevant: (1) breakdown via liver enzymes (CYP2D6 and CYP3A4), which can be inhibited by CBD, and (2) potentially opposing or additive effects on heart rate, blood pressure, sleep and anxiety. Clinical evidence on the specific combination of CBD and prescription amphetamines is limited; cautious use is therefore important.
CBD may slow the breakdown of amphetamines through CYP2D6/CYP3A4 and influence their effects. If you use CBD with Adderall, Attentin or Elvanse, monitor pulse, blood pressure and sleep, and discuss the combination with your doctor.
How CBD may influence the breakdown of amphetamines (CYP2D6/CYP3A4)
CBD inhibits several cytochrome P450 liver enzymes, including CYP2D6 and CYP3A4. Dexamfetamine (e.g. in Attentin) and mixed amphetamine salts (Adderall/Adderall XR) are metabolised in part via CYP2D6; inhibition could theoretically lead to increased plasma levels and more pronounced side effects. Elvanse (lisdexamfetamine) is a prodrug that is converted into dexamfetamine in the blood independently of these enzymes; CYP2D6 then becomes relevant for the dexamfetamine formed. In addition, urine pH affects amphetamine excretion: acidic urine promotes, alkaline urine slows renal elimination.
From a pharmacodynamic perspective, CBD is often perceived as calming or anxiolytic, while stimulants are activating. In practice, two main scenarios are therefore possible: (a) a degree of balancing out (e.g. less inner restlessness) and (b) additive effects on heart rate/blood pressure or sleep problems. The evidence base for the specific combination of CBD and amphetamines is currently limited (in‑vitro data, case reports, theoretical models); robust clinical trials are lacking.
The “grapefruit effect” and CBD metabolism
Grapefruit inhibits CYP3A4 in the gut and – similarly to CBD – can slow the breakdown of certain medicines. Because CBD and grapefruit can both affect CYP3A4, using them together alongside amphetamines may further change medicine levels. If you combine CBD with Adderall, Attentin or Elvanse, it is generally advisable to avoid grapefruit or grapefruit juice unless your prescriber advises otherwise.
CBD can inhibit CYP2D6 and CYP3A4, which are involved in metabolising several amphetamines. Grapefruit also inhibits CYP3A4, so combining CBD, amphetamines and grapefruit may further increase interaction risks.
Differences: Adderall vs Adderall XR vs Attentin vs Elvanse
Products differ in active ingredient composition, release profile and metabolism. These differences affect how a CBD–amphetamine interaction via CYP2D6/CYP3A4 might play out in practice.
| Product | Active ingredient | Release | Metabolism | Relevant interactions |
|---|---|---|---|---|
| Adderall | Mixed amphetamine salts | IR | Incl. CYP2D6 | Potential increase with CYP2D6 inhibition (CBD, strong 2D6 inhibitors) |
| Adderall XR | Mixed amphetamine salts | XR | Incl. CYP2D6 | As above; longer duration of action should be considered |
| Attentin | Dexamfetamine | IR | Incl. CYP2D6 | Potential increase with CYP2D6 inhibition |
| Elvanse | Lisdexamfetamine | Prodrug → dexamfetamine | Prodrug cleavage enzyme‑independent, then CYP2D6 | Similar caution as above |
In practice, dose, release form (IR/XR), individual sensitivity and other medicines (including other CYP3A4 or CYP2D6 modulators) all play an important role when combining CBD with amphetamines.
CBD formats, product choice and amphetamine use
When considering CBD with Adderall, Attentin or Elvanse, the type of CBD product can influence tolerability, but not the basic interaction potential via liver enzymes.
- Full spectrum: contains CBD plus other cannabinoids including traces of THC. May be associated with “entourage”‑type effects; THC may, in some people, be linked with palpitations or anxious feelings.
- Broad spectrum: low or no THC, otherwise similar plant compounds – often chosen alongside stimulants when THC is not desired.
- Isolate: pure CBD, minimal THC‑related risk; interaction potential via CYP enzymes remains.
- Quality: pay attention to quality (e.g. certificates of analysis/CoA) and start with a low dose. CBD can be purchased in the form of CBD oil.
Read our article here about how CBD acts in the body
Potential side effects and CBD–amphetamine interactions in practice
The combination of CBD and amphetamines may influence several body systems. Not everyone will experience problems, but careful observation is sensible.
- Cardiovascular: possible increases in blood pressure/pulse; particular care is needed if you have pre‑existing high blood pressure or arrhythmias.
- Sleep: stimulants can contribute to insomnia; depending on dose/timing, CBD in the evening may feel calming for some people, but can occasionally be stimulating.
- Anxiety/restlessness: CBD is often experienced as balancing; in some cases there may be paradoxical effects (restlessness), especially at very high doses or with THC content.
- Appetite/gastrointestinal: stimulants reduce appetite; CBD may influence gastrointestinal symptoms (e.g. nausea) – monitor individually.
- Interactions: CBD inhibits CYP2D6 and CYP3A4 → possible enhancement of amphetamine effects; consider other inhibitors/inducers (see below).
- marked increase in pulse/blood pressure, chest pain, shortness of breath
- persistent insomnia, pronounced agitation, aggressive behaviour
- fainting, confusion, severe anxiety or panic attacks
When using CBD with amphetamines, pay particular attention to cardiovascular signs, sleep and anxiety. If warning signs occur, seek medical assessment without delay.
For whom is CBD with amphetamines particularly risky?
Theoretical CBD drug interactions are more concerning in some groups. Extra caution and medical supervision are advisable if you have:
- Uncontrolled or difficult‑to‑control high blood pressure, known arrhythmias, cardiovascular disease
- Pronounced anxiety disorders, panic disorder, sleep disorders
- Liver disease (metabolism/enzyme inhibition more relevant)
- Pregnancy/breast‑feeding
- Concurrent use of strong CYP inhibitors/inducers:
- CYP2D6 inhibitors: e.g. paroxetine, fluoxetine, bupropion, quinidine
- CYP3A4 inhibitors: e.g. ketoconazole, itraconazole, clarithromycin
- Inducers: e.g. carbamazepine, rifampicin, St John’s wort
If any of these points apply to you, plan any combination of CBD and amphetamines particularly carefully and with medical support.
Practical safety steps when combining CBD and amphetamines
The following steps can help you use CBD more cautiously alongside Adderall, Attentin or Elvanse. They do not replace medical advice.
- Inform your prescribing doctor and pharmacist that you are considering CBD (list all medicines, including SSRI/MAO inhibitors, PPIs and supplements).
- Start with a low CBD dose and increase slowly if needed; observe effects for 1–2 weeks at each step. Take note of advice on CBD dosage.
- Consider separating CBD and stimulant doses in time (e.g. by >2–4 hours); discuss the timing individually with your doctor.
- Track pulse/blood pressure, sleep, anxiety and appetite; keep a brief symptom diary and share it at follow‑up appointments.
- Prefer low‑THC or THC‑free options if palpitations or anxiety are a concern.
- Avoid grapefruit or grapefruit juice (additional CYP3A4 inhibition) unless your prescriber advises otherwise.
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The combination of CBD and amphetamines should be approached slowly and systematically: inform your doctor, start low, separate doses in time if advised, and monitor cardiovascular, psychological and sleep‑related symptoms.
Side effects of CBD and amphetamines
CBD
- Common: tiredness/drowsiness, dry mouth, gastrointestinal complaints
- Possible: interactions via CYP enzymes (CYP2D6/3A4 inhibition)
- No intoxicating “high” (no THC‑type effect)
- Dependent on dose and product
- Seek medical advice if you use it alongside long‑term medication
Amphetamines
- Common: reduced appetite, sleep disturbances, nervousness
- Cardiovascular: increase in blood pressure/pulse
- Psychological: anxiety/agitation
- Risk: misuse/dependence – requires regular medical monitoring
Disclaimer: This article is for information purposes only and does not replace medical advice. Do not change medicines or dosages without consulting your doctor. No claims are made regarding the treatment or cure of illnesses.