Is it safe to take Adderall and Xanax together?

Adderall and Xanax are sometimes taken together, either because a doctor is treating both ADHD and anxiety or, more riskily, without a prescription. The combination can be used safely under close medical supervision, but it has real risks: Adderall can hide how impaired Xanax makes you, both drugs can lead to misuse and dependence, and Xanax becomes dangerous when combined with opioids or alcohol. For most people with ADHD and anxiety, there are safer options. Your genes and other medications also affect how your body handles both drugs.

What are Adderall and Xanax?

Adderall (mixed amphetamine salts) is a stimulant used to treat ADHD (attention-deficit/hyperactivity disorder). It increases dopamine and noradrenaline in the brain, improving attention and reducing impulsivity and hyperactivity. Common side effects include trouble sleeping, poor appetite, a faster heart rate and, in some people, anxiety or irritability.

Xanax (alprazolam) is a benzodiazepine used for anxiety and panic disorder. It strengthens the calming effect of the brain chemical GABA. Side effects include drowsiness, poor coordination and memory problems. In 2020, the US Food and Drug Administration strengthened its boxed warning for all benzodiazepines about abuse, addiction, physical dependence and withdrawal reactions.

Both are controlled substances because of their potential for misuse.

Why would someone take Adderall and Xanax together?

ADHD and anxiety often occur together. A doctor may occasionally prescribe a short course of a benzodiazepine for severe anxiety or panic in someone who also takes a stimulant. Taking the two together without a prescription, for example to "come down" from a stimulant or to stay awake while using Xanax, is a form of misuse and is risky.

What are the risks of combining them?

• Adderall can mask impairment from Xanax. In a controlled study, amphetamine only partly reversed the drowsiness and memory problems caused by a benzodiazepine, and memory problems were reversed the least. People may feel alert while their memory and judgment are still impaired.
• Driving and safety. In a laboratory study of driving-related skills, alprazolam impaired performance, while dextroamphetamine caused "tunnel vision". Neither drug makes driving safer.
• Misuse and dependence. Both drugs can be misused, and stopping Xanax suddenly after regular use can cause dangerous withdrawal, including seizures.
• Opioids and alcohol. Combining Xanax with opioids, alcohol or other sedatives can slow breathing and cause fatal overdose. Adderall does not protect against this.
• Anxiety can get worse. A stimulant can increase anxiety, which may lead to a cycle of taking more Xanax to calm down.

What are safer ways to manage anxiety with ADHD?

If anxiety starts or gets worse on a stimulant, talk to your prescriber before adding a sedative. Options include:

• Adjusting the stimulant dose or timing, or switching to a longer-acting form.
• Switching to a non-stimulant ADHD medication, such as atomoxetine or guanfacine, which are less likely to worsen anxiety.
• Treating the anxiety with cognitive behavioural therapy (CBT) or an SSRI antidepressant. Read more about choosing anxiety and depression medications with a DNA test.
• Counselling and coaching. Teenagers with ADHD can benefit from counselling with providers who specialize in ADHD, such as Pillcheck's partner BeyondADHD, to build coping skills for anxiety, focus and daily routines.
• If a benzodiazepine is needed, using it only short term, at the lowest dose, and never with opioids or alcohol.

For ADHD medications in children and teens, read How safe are ADHD medications for children?

How do genes and other drugs affect Adderall and Xanax?

Xanax (alprazolam) is broken down in the liver by the enzymes CYP3A4 and CYP3A5. Drugs that strongly block CYP3A4, such as the antifungals ketoconazole and itraconazole, can raise alprazolam levels so much that the Xanax drug label says they must not be taken together. Other blockers, such as clarithromycin, some HIV medications and grapefruit juice, can also increase its effects. Drugs that speed up CYP3A4, such as carbamazepine and St. John's wort, can make it less effective. Natural differences in CYP3A4 and CYP3A5 activity may also influence alprazolam levels, although there are no genetic dosing guidelines yet.

Adderall (amphetamine) is partly broken down by the liver enzyme CYP2D6, and much of the rest leaves the body unchanged in the urine. CYP2D6 activity may affect how well it works. In a 2024 Canadian study of 214 children and young adults treated with amphetamines, CYP2D6 poor metabolizers were more likely to report improvement in their ADHD symptoms than intermediate metabolizers, and showed a similar trend compared with normal metabolizers. Ultrarapid metabolizers also tended to report less improvement than poor metabolizers.

Pillcheck reports CYP3A4, CYP3A5 and CYP2D6, together with many other genes that affect ADHD, anxiety and depression medications. A Pillcheck pharmacist reviews your results and all your medications to flag interactions and help your prescriber choose safer options and doses.

Summary

• Adderall and Xanax are sometimes prescribed together, but only under close medical supervision.
• A stimulant can hide impairment from Xanax without reversing it, especially effects on memory and judgment.
• Never combine Xanax with opioids or alcohol, and do not stop it suddenly after regular use.
• Non-stimulant ADHD medications, CBT and SSRIs are often safer ways to manage anxiety with ADHD.
• CYP3A4 and CYP3A5 affect alprazolam, and CYP2D6 may affect how well amphetamine works; many drug interactions go through these enzymes.

Frequently asked questions

Can you take Adderall and Xanax together?

Only if both are prescribed and your doctor is monitoring you. Taking them together without a prescription is risky.

Does Adderall cancel out Xanax?

No. Adderall can make you feel more alert, but it does not fully reverse Xanax's effects on memory, coordination and judgment.

What should I do if Adderall makes me anxious?

Talk to your prescriber. Adjusting the dose, switching to a non-stimulant such as atomoxetine or guanfacine, or treating the anxiety with therapy or an SSRI are usually preferred over adding Xanax.

Which medications interact with Xanax?

Opioids, alcohol and other sedatives are the most dangerous combinations. Drugs that block CYP3A4, such as ketoconazole, itraconazole and clarithromycin, raise Xanax levels.

Can a genetic test help with ADHD and anxiety medications?

Yes. A pharmacogenetic test shows how you metabolize many ADHD, anxiety and depression medications, and a pharmacist review can flag risky combinations.

References

US Food and Drug Administration. FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. Drug Safety Communication. September 23, 2020.

US Food and Drug Administration. XANAX (alprazolam) tablets: prescribing information. 2016.

Gerlach S, Maruf AA, Shaheen SM, et al. Effect of CYP2D6 genetic variation on patient-reported symptom improvement and side effects among children and adolescents treated with amphetamines. Pharmacogenet Genomics. 2024;34(5):149-153.

Mintzer MZ, Griffiths RR. A triazolam/amphetamine dose-effect interaction study: dissociation of effects on memory versus arousal. Psychopharmacology (Berl). 2007;192(3):425-440.

Mills KC, Spruill SE, Kanne RW, Parkman KM, Zhang Y. The influence of stimulants, sedatives, and fatigue on tunnel vision: risk factors for driving and piloting. Hum Factors. 2001;43(2):310-327.

Kiliç C, Curran HV, Noshirvani H, Marks IM, Başoğlu M. Long-term effects of alprazolam on memory: a 3.5 year follow-up of agoraphobia/panic patients. Psychol Med. 1999;29(1):225-231.

Sulzer D, Sonders MS, Poulsen NW, Galli A. Mechanisms of neurotransmitter release by amphetamines: a review. Prog Neurobiol. 2005;75(6):406-433.

Carvalho M, Carmo H, Costa VM, et al. Toxicity of amphetamines: an update. Arch Toxicol. 2012;86(8):1167-1231.