Food and Drug Administration Warning

The US Food and Drug Administration (FDA) requires some stimulant medicine to have a warning label. The label must note that some of these medicines have a slight increase in the risk of certain side effects. There have been reports of sudden death in those with underlying serious heart problems. There are also reports of stroke and heart attack in adults with certain risk factors. There is a slight increased risk for psychiatric side effects. This can include hallucinations, paranoia, and mania, even in those without previous problems.

*Recent research has not found a clear link between stimulants and sudden death, heart attack, and stroke.

These stimulants must carry this warning:

• Amphetamine
• Methylphenidate
• Methamphetamine
• Detroamphetamine
• Dexmethylphenidate
• Methylphenidate
• Lisdexamfetamine
• Atomoxetine

The American Heart Association suggests that children have an ECG before starting stimulant medicine. This test may help find unknown heart issues.

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

Stimulants

Common names include:

• Methylphenidate
• Dextroamphetamine
• Amphetamine
• Methylphenidate patch
• Lisdexamfetamine—this medicine can be used to treat children aged 6-12 years and adults
• Dexmethylphenidate

Stimulants are the most common treatment for ADHD. These medicines work by changing the action of a brain chemical called dopamine. It can stimulate parts of the brain that are less active in children with ADHD. This creates a calming effect that makes it easier to focus. These medicines also have the risk to become addictive. Your child’s doctor will start with the lowest effective dose. The response will be closely monitored. The doctor may also stop treatment at some points to see if treatment needs to continue.

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 a number of antidepressant medicines. New options appear often. Common names include:

• Bupropion
• Fluoxetine
• Sertraline
• Doxepin
• Protriptyline
• Amitriptyline
• Imipramine
• Desipramine

These medicines affect 2 brain chemicals norepinephrine or serotonin. Most affect both chemicals. Some may only act on one. All are used to treat depression.

Common side effects include:

• Dry mouth
• Light-headedness
• Sedation
• Insomnia
• Sweating
• Nausea
• Weight gain
• Constipation
• Urine retention (loss of ability to urinate)
• Blurred vision
• Mental changes

Side effects of bupropion include:

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

Antipsychotics

Antipsychotics may be used. It is often chosen 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

Atomoxetine is not a stimulant. It works by changing how a brain chemical called norepinephrine works.

Note: There have been a small number of reports of severe liver injury associated with atomoxetine. The damage was reversed after the medicine was stopped. Atomoxetine is stopped if there are signs of liver disease such as jaundice, yellowing of skin.

Common side effects include:

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

Modafinil

Modafinil may be somewhat helpful in patients with ADHD.

Common side effects include:

• Insomnia
• Abdominal pain
• Decreased appetite
• Cough
• Fever
• Runny nose
• Headache

Clonidine

Clonidine acts in the brain to stimulate certain areas, but not others. It is similar to how stimulants work. Morning dosing increases the calming effect. Bedtime doses lessen it. Clonidine is also available in a patch. This allows a steady dose for a week at a time.

Clonidine is fairly safe. People with certain heart and circulation issues may have a higher risk of complications.

Possible side effects include:

• Dry mouth
• Sleepiness
• Light-headedness
• Constipation
• Stomach upset
• Mental changes

Guanfacine

Guanfacine seems to help manage impulse and attention problems.

Guanfacine can be a long-acting formula. It only has to be taken once a day, usually at bedtime. The medicine should not be taken with a meal that is high in fat. The tablets need to be swallowed whole, not chewed, broken, or crushed.

It may take 2 weeks before results can be seen. Never take guanfacine with other medicines that have the same drugs.

Possible side effects include:

• Headache
• Light-headedness, sleepiness, blurred vision, change in the ability to think clearly
• Constipation
• Dry mouth
• Sexual problems