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The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, and according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Medications for ADHD can help control hyperactive and impulsive behavior and increase attention span.

Prescription Medications
Food and Drug Administration (FDA) Warning

The FDA has directed all manufacturers of ADHD drugs to notify patients about a slight increased risk of cardiovascular and psychiatric side effects. There have been reports of sudden death in patients with underlying serious heart problems and reports of stroke and heart attack in adults with certain risk factors.

Recent research, though, has not shown a clear link between stimulants and sudden death, heart attack, and stroke. There is a slight increased risk (about 1 per 1,000) for psychiatric side effects, such as hallucinations, paranoia, and mania, even in patients without previous psychiatric problems.

The stimulants that are the focus of the labeling are:

  • Amphetamine (Adderall, Adderall XR)
  • Methylphenidate (Concerta)
  • Methamphetamine (Desoxyn)
  • Detroamphetamine (Dexedrine)
  • Dexmethylphenidate (Focalin, Focalin XR)
  • Methylphenidate (Metadate CD, Ritalin, Ritalin SR, Ritalin LA)
  • Lisdexamfetamine (Vyvanse)
  • Atomoxetine (Strattera)

Because of the concern of serious heart problems, the American Heart Association suggests that children have an electrocardiogram (ECG) before starting stimulant medication for ADHD.

Talk to your doctor about these warnings before you take the medication.

Stimulants

Common names include:

  • Methylphenidate (Ritalin, Concerta, Metadate)
  • Dextroamphetamine (Dexedrine, Adderall)
  • Amphetamine (Adderall)
  • Methylphenidate patch (Daytrana Transdermal System)
  • Lisdexamfetamine (Vyvanse)—this medication can be used to treat children aged 6-12 years and adults
  • Dexmethylphenidate (Focalin, Focalin XR)

Stimulants are the most common treatment for ADHD. These drugs increase activity in parts of the brain that appear to be underactive in children with ADHD. When used properly to treat ADHD, they produce a calming effect that promotes concentration, rather than a stimulating effect. However, they also have the potential to become addictive. Your child’s doctor will prescribe the lowest effective dose, monitor the response closely, and stop treatment occasionally to determine the need for on-going treatment.

Common side effects of stimulants include:

  • Insomnia
  • Stomach ache
  • Headache
  • Reduced appetite
  • Irritability
  • Rage
  • Confusion
  • Shakiness
  • Hallucinations
  • Seizures
  • Possible decrease in growth rate
Antidepressants

There are numerous kinds of antidepressants, and new ones appear frequently. Common names include:

  • Bupropion (Wellbutrin)
  • Doxepin (Sinequan)
  • Protriptyline (Vivactil)
  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Amitriptyline (Elavil)
  • Imipramine (Tofranil)
  • Desipramine (Norpramin)

All of these drugs prevent the inactivation of natural chemical stimulants in the body, either norepinephrine (noradrenalin) or serotonin. Most of these drugs act on both chemicals, but some act mainly or exclusively on only one. All are used to treat depression.

Common side effects include:

  • Dry mouth
  • Dizziness
  • Sedation
  • Insomnia
  • Sweating
  • Nausea
  • Weight gain
  • Constipation
  • Urine retention
  • Blurred vision
  • Mental changes

Side effects of bupropion include:

  • Weight loss
  • Agitation
  • Anxiety
  • Seizures
  • Dry mouth
  • Insomnia
Antipsychotics

Antipsychotics may be used to treat children and young adults who have aggressive behavior. Examples of antipsychotics include:

  • Risperidone
  • Quetiapine

Common side effects include:

  • Sedation
  • Constipation
  • Urine retention
  • Dry mouth
  • Blurred vision
  • Mental changes
  • Muscle spasms
  • Restlessness
  • Sexual problems
  • Abnormal heartbeat
  • Weight gain
Atomoxetine (Strattera)

Atomoxetine is not a stimulant but prevents the inactivation of norepinephrine.

Note: There have been a small number of reports of severe liver injury associated with Atomoxetine, which reversed after stopping the drug. Atomoxetine should be discontinued in patients who exhibit jaundice or laboratory evidence of liver injury.

Common side effects include:

  • Decreased appetite
  • Nausea
  • Vomiting
  • Fatigue
  • Weight loss
  • Slowed growth rate
  • Mild increase in blood pressure and heart rate
Modafinil (Provigil)

Modafinil is a drug that is used to promote wakefulness in narcolepsy , a neurological condition. It has also been somewhat effective in patients with ADHD.

Common side effects include:

  • Insomnia
  • Abdominal pain
  • Decreased appetite
  • Cough
  • Fever
  • Runny nose
  • Headache
Clonidine (Catapres)

Clonidine acts in the brain to stimulate certain areas, but not others, in a fashion similar to the stimulants. It is also used to treat Tourette syndrome . Morning dosing increases the sedative effect; bedtime dosing minimizes it. It is also available in a patch that provides a steady dose for a week at a time.

Clonidine is relatively safe except in patients with certain forms of heart and circulatory disease.

Possible side effects include:

  • Dry mouth
  • Sleepiness
  • Dizziness
  • Constipation
  • Stomach upset
  • Mental changes
Guanfacine (Intuniv)

Guanfacine (Intuniv), which is also used to treat high blood pressure , seems to help with attention and impulsivity problems.

Guanfacine is available as an extended-release formulation, which only has to be taken once a day (usually at bedtime). The medication should not be taken with a meal that is high in fat. The tablets should be swallowed whole (not chewed, broken, or crushed).

It may take two weeks before the medication produces positive effects. Never take Guanfacine with other preparations that contain the same drug.

Possible side effects include:

  • Headache
  • Dizziness
  • Lightheadedness, sleepiness, blurred vision, change in the ability to think clearly
  • Constipation
  • Dry mouth
  • Sexual problems
Special Considerations

Follow these general guidelines when taking medications:

  • Take your medication as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Know what the results and side effects are. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medication and herb or dietary supplements.
  • Plan ahead for refills so you don’t run out.
When to Contact Your Doctor

Contact your doctor or mental health professional if:

  • Expected results of treatment are not happening
  • Unexpected results occur
  • Drug side effects are bothering you
  • You want to change the medication

References:

Attention deficit hyperactivity disorder (ADHD). National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/healthinformation/adhdmenu.cfm. Accessed March 31, 2007.

Biederman J, Faraone SV. Attention-deficit hyperactivity disorder. Lancet. 2005;366:237-248.

Dexedrine: prescribing information. Food and Drug Administration website. Available at: http://www.fda.gov/medwatch/safety/2006/Aug_PIs/Dexedrine_PI.pdf. Accessed on April 1, 2007.

FDA directs ADHD drug manufacturers to notify patients about cardiovascular adverse events and psychiatric adverse events. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm108849.htm. Published February 1, 2007. Accessed August 15, 2012.

FDA drug safety communication: safety review update of medications used to treat attention-deficit/hyperactivity disorder (ADHD) in children and young adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/ucm277770.htm#pat. Published November 1, 2011. Accessed August 15, 2012.

Lindsay SE, Gudelsky GA, et al. Use of modafinil for the treatment of attention deficit/hyperactivity disorder. Ann Pharmacother. 2006;40:1829-1833.

Rappley MD. Attention deficit-hyperactivity disorder. N Engl J Med. 2005;352:165-173.

4/30/2008 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: FDA approval letter. US Food and Drug Administration website. Available at: http://www.fda.gov/cder/foi/appletter/2008/021977s001ltr.pdf. Accessed April 30, 2008.

4/30/2008 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Vetter V, Elia J, et al. Cardiovascular monitoring of children and adolescents with heart disease receiving stimulant drugs. Circulation. American Heart Association website. Available at: http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.189473. Accessed April 30, 2008.

2/18/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry. 2010;71(10):1259-1272.

12/30/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Habel LA, Cooper WO, et al. ADHD medications and risk of serious cardiovascular events in young and middle-aged adults. JAMA. 2011;306(24):2673-2683.

2/15/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Westover AN, Halm EA. Do prescription stimulants increase the risk of adverse cardiovascular events? A systematic review. BMC Cardiovasc Disord. 2012;12:41.

1/28/2014 DynaMed's Systematic Literature Surveillance http://www/ebscohost.com/dynamed: Seida JC, Schouten JR, et al. First- and Second-Generation Antipsychotics for Children and Young Adults [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Feb. (Comparative Effectiveness Reviews, No. 39.) Available from: http://www.ncbi.nlm.nih.gov/books/NBK84643/. Accessed January 27, 2014.



Last reviewed September 2014 by Kari Kassir, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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