Normal Heart Rate on Adderall or Vyvanse, and What Counts as Too High

Stimulants raise heart rate by about 3 to 6 beats per minute on average, according to the US prescribing information for Adderall XR, Vyvanse, Concerta and Ritalin. The Vyvanse, Concerta and Ritalin labels add that some patients may have larger increases.^{1, 2, 3, 4}

The labels tell prescribers to monitor patients for tachycardia and name no heart rate at which to act.^{1, 2, 4} None of the sources cited here defines a normal range for people taking Adderall or Vyvanse. A written threshold comes from UK consensus guidance: sustained resting tachycardia above 120 beats per minute, measured on 2 occasions.⁵

Chest pain, fainting or shortness of breath on a stimulant is a reason to call 911 or go to an emergency department, whatever the pulse reads. A high reading without those symptoms is a reason to contact the prescriber, and any change in dose is made with the prescriber.

How much Adderall, Vyvanse and Ritalin raise heart rate

A 2025 network meta-analysis by Farhat and colleagues compared ADHD medications with placebo in trials of 12 weeks or less.⁶ Adderall contains mixed amphetamine salts, Vyvanse contains lisdexamfetamine, and Ritalin and Concerta contain methylphenidate.^{1, 2, 3, 4}

Source: Farhat and colleagues, 2025.⁶ The intervals overlap widely, so these figures don't rank one stimulant above another.

In children and adolescents, pulse rose by 4.17 beats per minute with lisdexamfetamine (very low certainty) and 3.88 with methylphenidate (moderate certainty).⁶

A 2025 Cochrane review pooled 47 studies with 10,075 participants and found a rise of 3.71 beats per minute, rated high certainty. The review included methylphenidate trials alongside amphetamine trials, so its figure describes stimulants as a class.⁷

The rise can depend on dose. In the Concerta adult trial, standing pulse rose by 3.9 to 9.8 beats per minute across fixed doses after 5 weeks, in a dose-dependent pattern, compared with 2.7 on placebo.³

How many people go above 90 or 100

In a meta-analysis of adult stimulant trials, a resting heart rate above 90 was recorded in 4.2% of adults on a stimulant and 1.7% on placebo.⁸ I've covered the feeling of a racing heart in heart palpitations on Adderall or Vyvanse.

For lisdexamfetamine, a review written mostly by employees of its manufacturer reported post hoc analyses of an adult trial. A pulse of 100 or more during treatment occurred in 3.3% to 8.5% of patients, depending on dose, and in none on placebo. In an adolescent trial, 3.0% on lisdexamfetamine and none on placebo had a heart rate of 100 or more at the end of the study.⁹

NICE tells clinicians to compare heart rate "with the normal range for age", so 100 in a child is judged against a different range than in an adult.⁵ In a trial in children and adolescents, 15.0% on lisdexamfetamine and 24.2% on atomoxetine had a pulse of 100 or more at some point.⁹

What heart rate is too high on Adderall or Vyvanse?

The US labels ask for monitoring and give no number.^{1, 2, 4} UK guideline NG87, in a 2018 recommendation, gives one: "If a person taking ADHD medication has sustained resting tachycardia (more than 120 beats per minute), arrhythmia or systolic blood pressure greater than the 95th percentile (or a clinically significant increase) measured on 2 occasions, reduce their dose and refer them to a paediatric hypertension specialist or adult physician."⁵

The 2011 European guidelines on adverse effects of ADHD medication, which focus on children and adolescents, state: "A pulse rate consistently above 120/min should be a signal for a cardiac review."¹⁰

NICE's threshold is a sustained resting rate measured on 2 occasions, and the European one is a pulse consistently above 120. Both are expert consensus, and no source cited here shows that acting at 120, or at 100, prevents a heart problem.

Separately, patients are told to make immediate contact for "exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease".^{1, 2, 3}

Does the rise in heart rate wear off?

The sources cited here found the rise persisting while the medication is taken. In the Cochrane review, trials lasting at least eight weeks showed similar effects, which the authors read as sustained.⁷ In the 10-year follow-up of children in the MTA study, stimulants didn't increase the risk of tachycardia, and greater cumulative exposure was associated with higher heart rate at years 3 and 8. The authors described "a persistent adrenergic effect on heart rate if continued."¹¹

Open-label adult studies found average rises of 2.1 beats per minute over up to 24 months on Adderall XR and 3.2 over 52 weeks on Vyvanse.^{12, 9} In the Adderall XR study the standard deviation was 13.4, so individual changes varied widely. Seven of 223 adults stopped because of a cardiovascular adverse event, 2 of them for palpitations or tachycardia, and none of these events was reported as serious.¹²

In a 2025 study of 176 adults starting ADHD medication, recruited from clinic waiting lists in the UK and Spain, heart rate measured at home with a blood pressure monitor was 5.43 beats per minute higher during the on-medication phase than off medication, with a further 1.31 rise at each 4-weekly assessment.¹³ There was no separate untreated group.

Smartwatch and home readings

A November 2026 PubMed search for this page found no study of smartwatch readings in people taking ADHD medication. In a 2019 phase I drug trial that included an amphetamine challenge, participants wore an FDA-cleared single-lead ECG monitor. It detected clear heart-rate responses while they were physically active, and conventional resting, lying-down readings at set times missed them.¹⁴ I cover heart rate during workouts in exercise on ADHD medication.

Limitations of the evidence

This evidence has limitations. First, the averages come from trials of 12 weeks or less, and the longer studies were open label without a placebo group. Second, the 120 threshold (sustained and resting for NICE, consistent for the European guideline) is expert consensus, and none of the sources reports heart-rate change by sex. Nevertheless, trials, reviews and follow-up studies agree that the average rise is a few beats per minute and that it persists while the medication is taken.

A rise of a few beats per minute is the expected effect, tracked through regular pulse and blood pressure checks. A resting rate that stays above 120 is where UK and European guidance calls for clinical review, and that review happens with the prescriber.

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.

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