From the Guidelines
Long-term use of stimulants for ADHD is associated with potential side effects including cardiovascular risks, growth suppression, and psychological impacts, emphasizing the need for careful monitoring and management by healthcare providers. When considering the long-term side effects of stimulants for ADHD, it's crucial to weigh the benefits against the risks. Stimulants, such as methylphenidate and amphetamine, are first-line treatments for ADHD due to their efficacy in enhancing dopamine and norepinephrine levels, thus improving attention and executive function 1. However, their use is not without potential long-term consequences.
Cardiovascular Effects
Cardiovascular effects are a significant concern with long-term stimulant use. These medications can cause increases in blood pressure and heart rate, which may be clinically relevant, especially for patients with preexisting cardiovascular diseases 1. Although the overall risk is considered small, regular monitoring of pulse and blood pressure is recommended as part of the treatment protocol 1.
Growth Suppression
Growth suppression is another area of concern. Longitudinal studies have shown that treatment with psychostimulants can lead to a statistically significant reduction in height and weight gain in children 1. While these effects are generally minor and may be dose-related, they necessitate careful monitoring, particularly since it remains unclear whether the effects on height are reversible 1.
Psychological Impacts
Psychological side effects, including mood changes, anxiety, and in rare cases, the development of psychosis or tics, can also occur with long-term stimulant use. Moreover, sleep disturbances and appetite suppression are common side effects that may persist over time 1. The potential for tolerance and the need for dose adjustments are additional considerations in the long-term management of ADHD with stimulants.
Other Considerations
Less common but serious concerns include liver effects and the risk of substance abuse or dependence. However, studies suggest that properly prescribed stimulants may actually reduce the risk of substance abuse in ADHD patients 1. Regular monitoring by healthcare providers through check-ups, growth measurements, and cardiovascular assessments is essential for patients on long-term stimulant therapy to minimize these risks.
Given the potential long-term side effects, it is crucial for healthcare providers to closely monitor patients on stimulant therapy for ADHD, balancing the benefits of treatment with the potential risks to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life. This approach allows for the early identification and management of side effects, optimizing the therapeutic benefits of stimulant medications while minimizing their risks 1.
From the FDA Drug Label
When these animals were tested as adults (postnatal Weeks 13-14), decreased spontaneous locomotor activity was observed in males and females previously treated with 50 mg/kg/day (approximately 4 times the MRHD of 60 mg/day given to children on a mg/m2 basis) or greater, and a deficit in the acquisition of a specific learning task was seen in females exposed to the highest dose (8 times the MRHD given to children on a mg/m2 basis). The no effect level for juvenile neurobehavioral development in rats (5 mg/kg/day) is less than the MRHD given to children on a mg/m2 basis. The clinical significance of the long-term behavioral effects observed in rats is unknown.
The long-term side effects of stimulants for ADHD may include:
- Cardiovascular effects: increased heart rate and blood pressure
- Psychiatric effects: anxiety, psychosis, hostility, aggression, and suicidal or homicidal ideation
- Neurobehavioral effects: decreased spontaneous locomotor activity and deficit in the acquisition of a specific learning task However, the clinical significance of these effects is unknown 2. Caution is indicated in treating patients whose underlying medical conditions might be compromised by increases in blood pressure or heart rate 3. Physical dependence and tolerance may also occur with long-term use of stimulants 2 2.
From the Research
Long-term Side Effects of Stimulants for ADHD
- The long-term side effects of stimulants for ADHD include headache, insomnia, anorexia, and weight loss 4
- Stimulants have a high potential for abuse and dependence, and should be handled safely to prevent misuse and abuse 4
- Common side effects of long-term stimulant medications in ADHD include cardiovascular effects, growth effects, and tics 5
- Long-term adverse effects from stimulant treatment in childhood regarding adult height or future substance abuse have not been supported by existing studies 6
- Methylphenidate appears to cause minor increases in blood pressure and heart rate, but there is no strong data to suggest that it increases the corrected QT interval (QTc) 7
- Amphetamines appear to cause minor increases in heart rate and blood pressure over the long term, but there is growing evidence to suggest that they do not cause statistically or clinically significant increases in QTc 7
- Atomoxetine may increase blood pressure and heart rate in the short term, and its effects on QTc remain uncertain 7
Cardiovascular Effects
- The use of stimulants such as methylphenidate, amphetamines, and atomoxetine has been questioned due to concerns about their cardiovascular safety 7
- Sudden death remains an extremely rare event, and there is no clear evidence to attribute this to methylphenidate or other stimulants 7
- Some data suggest that the risk of sudden death in treated children may be less common than in the background population 7