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Key takeaways
Azstarys can last up to 13 hours, which is why patients are advised to take the drug in the morning to help manage their ADHD symptoms.
Most people begin to feel the benefits of Azstarys within 30 to 60 minutes of taking the drug, with a fuller effect over the next one to two hours.
It is not common for Azstarys to have sedating effects because it is a stimulant.
Azstarys is a brand-name medication that is FDA approved to treat attention-deficit hyperactivity disorder (ADHD). ADHD is the most commonly diagnosed behavioral disorder in children, which also affects an estimated 15.5 million adults in the United States. Azstarys belongs to a group of medicines called central nervous system (CNS) stimulants and helps improve attention, focus, and impulsiveness by increasing certain neurotransmitters, such as dopamine and norepinephrine, in the brain. The drug is a once-daily pill that works for up to 13 hours to help manage ADHD symptoms.
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How long does Azstarys last?
Azstarys is designed to last up to 13 hours, giving people with ADHD all-day symptom relief. It contains two active ingredients: a short-acting medication (immediate-release dexmethylphenidate) that starts working quickly, and a long-acting medication (extended-release serdexmethylphenidate) that’s gradually converted in the body to extend its effects.
“Living with ADHD is hard. It’s like driving a car with a flat tire and wondering why everyone else is speeding past you,” says Cooper Stone, DO, Clinical Assistant Professor of Psychiatry at Perelman School of Medicine at the University of Pennsylvania. “For many, medications like Azstarys can help level the playing field by keeping symptoms under control throughout the day.”
Unlike many drugs, Azstarys isn’t broken down by the liver’s CYP system, which means it has fewer drug-to-drug interactions for most patients..
What factors can impact the duration of action?
The good news is that most people experience steady coverage, regardless of age, gender, or even common health conditions. Research shows that kidney or liver issues don’t significantly change how long Azstarys remains effective, says Allison Hinkle, Pharm.D., clinical pharmacy manager with HCA Florida Healthcare.
That said, certain situations may shorten or reduce its effect:
- Absorption issues: Conditions that speed up digestion or reduce absorption, such as severe diarrhea, Crohn’s disease, or celiac disease, can limit how much of the medication your body is able to process.
- Tachyphylaxis: Like other stimulants, Azstarys may become less effective over time if your body adapts to repeated use, Dr. Stone explains.
How long does it take Azstarys to wear off?
Azstarys usually reaches peak effect about two hours after taking it, then tapers off gradually. Unlike some short-acting stimulants, it doesn’t typically cause a sudden “crash.”
“It’s not sedating, it’s a stimulant,” notes Raj Dasgupta, MD, clinical researcher and associate professor at the University of Southern California. “If taken first thing in the morning, most people don’t notice trouble falling asleep. Problems arise mainly if it’s taken too late in the day, since it can keep the mind active.”
How long does Azstarys take to work?
Most people begin to notice the effects of Azstarys within 30 to 60 minutes, with the full benefit building over the next one to two hours, says Matt Glowiak, Ph.D., LCPC, chief addiction specialist with Recovered.
“There isn’t an immediate, all-or-nothing sensation,” Glowiak explains. “Effectiveness is usually observed as improved focus and task completion in real-life activities.”
Azstarys can be taken with or without food, depending on preference. For those who have trouble swallowing Azstarys capsules, the medication can be opened and sprinkled into 2 ounces of water or onto 2 tablespoons of applesauce. The mixture should be taken right away, within 10 minutes, and not saved for later.
If someone doesn’t notice meaningful improvements, their healthcare provider may adjust the dose or treatment plan.
What are the side effects of Azstarys?
Like any medication, Azstarys can have side effects. The most common side effects of Azstarys are:
- Decreased appetite or weight loss
- Trouble sleeping (insomnia)
- Stomach upset, nausea, or vomiting
- Headache
- Irritability or nervousness
Less common but possible side effects:
- Increased sweating
- Dizziness or blurred vision
- Anxiety
Serious side effects:
- Chest pain or trouble breathing
- Increased risk of heart problems, including fast, pounding, or irregular heart rate
- Increased blood pressure
- Hallucinations, confusion, or false beliefs (psychosis-like symptoms)
- Muscle weakness or sudden problems speaking/moving
- Slowed growth in children and adolescents
- Raynaud’s phenomenon, a condition that causes reduced blood flow and circulation problems
- Priapism (sustained or painful erections)
- Worsening Tourette’s Syndrome, including increased motor and verbal tics
- Increased intraocular pressure (fluid pressure inside the eye) and glaucoma
- Manic episode in patients with bipolar disorder
If you experience any of these, seek medical attention from a healthcare professional for medical advice immediately.
The safety of Azstarys during pregnancy and breastfeeding is unknown, but the medication passes into breast milk, so be sure to seek guidance from your healthcare provider. Additionally, you should discuss preexisting medical conditions and medications or dietary supplements you are taking with your provider.
Azstarys has a boxed warning, the highest safety precaution issued by the FDA, due to its high potential for abuse and substance use disorder. Abuse of CNS stimulants like Azstarys, which are controlled substances, can cause overdose and death.
How long should you take Azstarys?
Azstarys can be used long-term under careful supervision by the prescribing provider with ongoing monitoring, Glowiak says.
“Regular follow-up visits help assess effects on sleep, appetite, growth in children, cardiovascular parameters, and mood over time,” he explains. “If the response wanes or adverse effects become problematic, clinicians may adjust the dose of Azstarys, switch formulations, or add non-stimulant options.”
If your provider decides to discontinue your Azstarys treatment, Dr. Stone says it would take approximately 60 hours for the medicine to completely wash out of your system, based on the half-life of the active drug, which is just under 12 hours. Depending on how long you’ve been taking the medication, your provider may taper your dose gradually to avoid rebound ADHD symptoms.
Azstarys alternatives
There are three main categories of alternative treatment options to Azstarys:
- Other types of CNS stimulants: Common stimulant medications that may be used in place of Azstarys include Adderall (amphetamine dextroamphetamine), Ritalin (methylphenidate), Concerta (methylphenidate), Focalin (dexmethylphenidate), and Vyvanse (lisdexamfetamine).
- Non-stimulants: Examples of non-stimulant ADHD medications include clonidine, guanfacine, atomoxetine, bupropion, and viloxazine.
- Therapy: Cognitive behavioral therapy, dialectical behavioral therapy, behavior therapy, parent/family training, and social skills training can also help.
“The best approach combines medication with lifestyle strategies – structured routines, good sleep habits, exercise, and coaching or counseling,” Dr. Dasgupta says.” The key is finding an ADHD treatment routine that works for you and sticking with it.
- ADHD, Cleveland Clinic (2025)
- Attention-deficit/hyperactivity disorder diagnosis, treatment, and telehealth use in adults, Centers for Disease Control and Prevention (2024)
- Azstarys, Manufacturer’s website
- What’s driving the rise in ADHD diagnosis among children and adults?, Syracuse University (2024)
- Azstarys prescribing information, Corium