Adderall and Cold Hands: Raynaud's Phenomenon and ADHD Medication

Creator: Ryan S. Sultan, MD
Published: 2026-11-12

By Ryan S. Sultan, MD
Psychiatrist · Columbia University Irving Medical Center
Published November 12, 2026 · 6-minute read

Stimulant ADHD medications carry a label warning for peripheral vasculopathy, including Raynaud's phenomenon. The Adderall XR label describes it as fingers or toes that may feel numb, cool, or painful and may change color from pale, to blue, to red.¹ A 2025 systematic review identified 61 published cases and no randomized controlled studies.²

Most of those cases were mild and resolved within weeks of discontinuation, dose reduction, or a switch to another medication. The review concluded that a causal relationship between ADHD medication and Raynaud's could not be determined reliably.²

What the Adderall, Vyvanse, and Concerta labels say

The Adderall XR label states: "CNS stimulants, including ADDERALL XR, used to treat ADHD are associated with peripheral vasculopathy, including Raynaud's phenomenon." The Vyvanse and Concerta labels carry the same sentence under their own names.^{1, 3, 4} Adderall XR is an amphetamine product, Vyvanse contains a prodrug of amphetamine, and Concerta is methylphenidate, so the warning appears on both stimulant classes.^{1, 3, 4}

According to the Adderall XR label, signs and symptoms "are usually intermittent and mild; however, sequelae have included digital ulceration and/or soft tissue breakdown." Effects were observed in postmarketing reports, at therapeutic doses, in all age groups, and throughout the course of treatment. Signs and symptoms generally improved after dosage reduction or discontinuation of the stimulant.¹

The Concerta label tells prescribers to carefully assess for digital changes during treatment.⁴ All three labels add that further clinical evaluation, such as a rheumatology referral, may be appropriate for patients who develop signs or symptoms.^{1, 3, 4}

The atomoxetine (Strattera) label lists Raynaud's phenomenon among adverse reactions reported after approval, without a separate warning section.⁵

The published evidence is 61 cases

Besag and colleagues found 61 cases in 15 case reports, 5 case series, 1 retrospective case-control study, and 1 retrospective cohort study. The medications implicated were methylphenidate, amphetamines, and, more rarely, atomoxetine.²

The case reports and case series described 20 children and adolescents aged 7 to 16 and 24 adults aged 19 to 57. Of these 44 people, 27 (61%) were treated for ADHD, and 32 (73%) were female. Assessment of 28 cases against the Naranjo criteria suggested a possible causative role for the medication in 13, a probable role in 13, and a definite role in two.²

The review found no published cases associated with clonidine or guanfacine. It also notes that clonidine's product information lists Raynaud's as an adverse effect, and that a Health Canada report left guanfacine's safety information describing it as "possibly guanfacine-related."²

The one controlled study was small

A 2008 study enrolled 64 children seen in a pediatric rheumatology clinic: 32 with Raynaud's syndrome and 32 matched controls. There was a statistically significant association between Raynaud's and past or current use of ADHD stimulants (methylphenidate and dextroamphetamine; P = 0.01).^{6, 2} The systematic review reports the counts behind it: 6 of the 32 children with Raynaud's had taken a stimulant, compared with 1 of the 32 controls.²

The authors called the study small and its findings preliminary.⁶ These were children referred to rheumatology, so the result may not describe children taking stimulants in general.

What happened after the dose was changed

Three reports in the review directly suggested that the effect depended on dose.² The labels say signs and symptoms generally improved after dosage reduction or discontinuation.^{1, 4}

The period of greatest risk for reporting Raynaud's appeared to be up to 2 years after starting or modifying treatment, and in some cases features emerged only after several years. The review recommends routine monitoring for signs of Raynaud's, especially when treatment starts or the dose increases.²

Any change in dose or medication is a decision made with the prescriber. I've written separately about the outcomes of untreated ADHD.

Severe cases were few and associated with systemic disease

A few of the published cases were associated with systemic disease and led to ulceration, gangrene, and the need for amputation or revascularization in some individuals. In one case series of adults that the review summarizes, only the presence of rheumatologic disease was associated with more severe vascular problems in correlation analysis.²

Raynaud's may in some cases be an early sign of systemic disease. For that reason the review recommends autoantibody tests and nailfold capillaroscopy for people who develop Raynaud's symptoms, or whose existing Raynaud's worsens, after starting treatment.²

Which symptoms to report

The Adderall XR and Vyvanse labels instruct patients "to report to their physician any new numbness, pain, skin color change, or sensitivity to temperature in fingers or toes." They also instruct patients "to call their physician immediately with any signs of unexplained wounds appearing on fingers or toes."^{1, 3} The Concerta label gives the same two instructions.⁴

Chest pain, fainting, or shortness of breath is a different situation: call 911 or go to an emergency department. A fast or pounding heartbeat is covered in the article on palpitations on ADHD medication, and the main article on ADHD medication and the heart covers blood pressure and heart rate.

Limitations of the evidence

This evidence has limitations. First, the review identified no randomized controlled studies, and all but one of the studies it found were uncontrolled. Second, 61 published cases cannot show how often Raynaud's occurs on ADHD medication, and the published reports describe Raynaud's and related conditions, so they say little about hands that feel cold without a color change. Nevertheless, the labels and the case literature agree that symptoms are usually mild and generally improve after the prescriber lowers the dose or changes the medication.^{2, 1}

Color change, numbness, or pain in the fingers or toes during ADHD treatment should be reported to the prescriber, and an unexplained wound on a finger or toe should be reported right away.

Frequently asked questions

Does Adderall cause Raynaud's?

The Adderall XR label states that CNS stimulants used to treat ADHD are associated with peripheral vasculopathy, including Raynaud's phenomenon. A 2025 systematic review identified 61 published cases and concluded that a causal relationship could not be determined reliably.^{1, 2}

Why are my hands and feet cold on Adderall or Vyvanse?

The Adderall XR and Vyvanse labels warn of peripheral vasculopathy, including Raynaud's phenomenon, in which fingers or toes may feel numb, cool, or painful and may change color from pale, to blue, to red. The labels instruct patients to report new numbness, pain, skin color change, or sensitivity to temperature in fingers or toes to their physician.^{1, 3}

Does Raynaud's from ADHD medication go away?

In a 2025 review of 61 published cases, most were mild and resolved within weeks of discontinuation, dose reduction, or a switch to an alternative medication. The labels say signs and symptoms generally improved after dosage reduction or discontinuation. Any change in dose or medication is a decision made with the prescriber.^{2, 1, 4}

Can Concerta cause Raynaud's?

The Concerta label carries the same warning as the amphetamine labels: CNS stimulants used to treat ADHD are associated with peripheral vasculopathy, including Raynaud's phenomenon. In the 2025 systematic review, the implicated medications were methylphenidate, amphetamines, and, more rarely, atomoxetine.^{4, 2}

When should I call the doctor about cold or discolored fingers on ADHD medication?

The Adderall XR and Vyvanse labels instruct patients to report any new numbness, pain, skin color change, or sensitivity to temperature in fingers or toes to their physician, and to call immediately with any signs of unexplained wounds appearing on fingers or toes. The Concerta label gives the same two instructions.^{1, 3, 4}

Chest pain, fainting, or shortness of breath during treatment needs immediate medical assessment. Call 911 or go to the nearest emergency department for severe symptoms. Medication changes are made with the prescriber.