From the Guidelines
Common side effects of ADHD medications include decreased appetite, sleep problems, headaches, and increased heart rate or blood pressure, as reported in the most recent study by 1.
Overview of Side Effects
Stimulant medications like methylphenidate (Ritalin, Concerta) and amphetamine-based drugs (Adderall, Vyvanse) most frequently cause:
- Appetite suppression, which may lead to weight loss and growth concerns in children
- Insomnia, particularly if medications are taken later in the day
- Mild headaches, dry mouth, and stomach discomfort, especially when starting treatment
- Cardiovascular effects, including slight increases in heart rate and blood pressure, which are typically not clinically significant in healthy individuals but require monitoring
Non-Stimulant Medications
Non-stimulant medications like atomoxetine (Strattera) and guanfacine (Intuniv) generally have milder stimulant-related side effects but may cause:
- Fatigue
- Dizziness
- Mood changes Most side effects are dose-dependent and often diminish within a few weeks as the body adjusts to the medication.
Management of Side Effects
Proper timing of doses, starting with lower doses, and gradually increasing can help minimize these effects. Regular monitoring by healthcare providers is essential to manage side effects and adjust treatment as needed, as suggested by 1 and 1. Some tactics for dealing with stimulant-associated side effects include:
- Giving the stimulants with meals and a high-calorie drink or snack late in the evening to address appetite loss
- Lowering the last stimulant dose of the day or moving it to earlier in the day to address difficulty falling asleep
- Reducing the dose or changing to sustained-release products to address sadness or irritability It is also important to note that the choice of medication and dosing regimen can affect medication adherence, and healthcare providers should regularly assess and discuss potential issues with patients, as mentioned in 1.
From the FDA Drug Label
- 7 Aggressive Behavior or Hostility Patients beginning treatment for ADHD should be monitored for the appearance or worsening of aggressive behavior or hostility. In pediatric short-term controlled clinical trials, 21/1,308 (1.6%) of atomoxetine patients versus 9/806 (1. 1%) of placebo-treated patients spontaneously reported treatment emergent hostility-related adverse events Although uncommon, allergic reactions, including analycial reactions, angioneurotic edema, urticaria, and rash, have been reported in patients taking atomoxetine hydrochloride.
- 10 Priapism Rare postmarketing cases of priapism, defined as painful and nonpainful penile erection lasting more than 4 hours, have been reported for pediatric and adult patients treated with atomoxetine hydrochloride.
- 2 Severe Liver Injury Postmarketing reports indicate that atomoxetine hydrochloride can cause severe liver injury.
- 3 Serious Cardiovascular Events Sudden Death and Pre-existing Structural Cardiac Abnormalities or Other Serious Heart Problems
Common side effects of ADHD medications include:
- Aggressive behavior or hostility
- Allergic reactions (e.g. anaphylaxis, angioedema, urticaria, rash)
- Priapism (rare)
- Severe liver injury (rare)
- Serious cardiovascular events (e.g. sudden death, pre-existing structural cardiac abnormalities) 2, 2
From the Research
Common Side Effects of ADHD Medications
The common side effects of Attention Deficit Hyperactivity Disorder (ADHD) medications can be broken down into several categories.
- The most frequently reported side effects include:
- Loss of appetite
- Sleep problems
- Mood disturbances
- Irritability
- Anxiety
- Apathy
- Reduced talk
- Sadness
- Emotional lability
- Decreased appetite
- Insomnia
- Headache
- Abdominal pain
- Vomiting
- Somnolence
- Nausea
- Drowsiness
- Agitation
- Hyperactivity
- GI upset
- Tremor
- Hyperreflexia
- Tachycardia
- Hypertension
- Seizure
- Mydriasis
- Tremor
- Agitation
- Hyperreflexia
- Combative behavior
- Confusion
- Hallucinations
- Delirium
- Anxiety
- Paranoia
- Movement disorders
- Seizures
- Dizziness
- Insomnia
- Tremors
- Dystonia
- Bradycardia
- Hypotension
- Depressed sensorium
- Paradoxical hypertension
- Drowsiness
- Lethargy
- Dry mouth
- Diaphoresis
- Hypotension or hypertension
Factors Influencing Side Effects
The risk of side effects can be influenced by several factors, including:
- Study year and design
- Patients' sex and age
- Drug dose and release formulation
- Type of medication (e.g., methylphenidates, amphetamines, atomoxetine)
Comparative Effectiveness of ADHD Medications
Comparative studies have shown that:
- Methylphenidates may be safer than amphetamines, although younger patients and females may incur higher risks, especially with high-dose, immediate-release methylphenidates 3
- ER d-MPH and ER MAS were associated with significant reductions in ADHD symptoms, with improvement in Total ADHD and Hyperactivity/Impulsivity symptoms strongly associated with increasing dose 4
- Atomoxetine has a black-box warning for suicidal ideation, but amphetamines and methylphenidates also did not show a safe profile regarding mood and emotional symptoms 3
Real-World Data on ADHD Medication Side Effects
Real-world data has shown that:
- 48% of patients reported experiencing a side effect as a result of taking an ADHD medication 5
- Most common side effects mentioned included loss of appetite, sleep problems, and mood disturbances 5
- Only 21% of side effects were considered very bothersome or extremely bothersome 5
- Regardless of how bothersome the side effects were, only 20% of patients mentioned the side effects to their prescribing physicians 5
Management of ADHD Medication Overdose
The management of ADHD medication overdose is largely supportive, with a focus on:
- Sedation
- Control of dyskinesias and seizures
- Support of blood pressure
- Interruption of the sympathomimetic syndrome with judicious use of benzodiazepines 6