What medication can reduce appetite in children with Attention Deficit Hyperactivity Disorder (ADHD)?

Medications That Reduce Appetite in Children with ADHD

Stimulant medications, particularly methylphenidate and amphetamine-based medications, are the primary medications that reduce appetite in children with ADHD. 1, 2, 3

Stimulant Medications and Appetite Suppression

Methylphenidate-Based Medications

• Mechanism: Blocks dopamine and norepinephrine transporters in the frontal cortex and insular lobe 4
• Appetite effects:
  • Causes significant appetite suppression in 20-56% of children 1
  • Decreases weight during first 3-6 months of treatment 4
  • Appetite suppression typically occurs during peak medication hours 1
• Dosing: Starting dose 5 mg twice daily for immediate-release or 10 mg once daily for extended-release; maximum 1.0 mg/kg/day 5, 2

Amphetamine-Based Medications (including Adderall)

• Mechanism: Increases release and blocks reuptake of dopamine and norepinephrine
• Appetite effects:
  • Associated with more pronounced appetite suppression than methylphenidate 6
  • Children on amphetamine monotherapy show lowest obesity rates (4.5%) compared to drug-naïve ADHD children (13.8%) 7
• Dosing: Starting dose 5-10 mg daily; maximum 50 mg daily 5, 3

Comparative Effects on Appetite

• Stimulant medications consistently show appetite reduction as a common side effect 1, 8
• The MTA study revealed persistent effects of stimulants on decreasing growth velocity, particularly with higher and more consistently administered doses 1
• Growth effects typically range from 1-2 cm reduction in height 1, 8
• Amphetamine-based medications (like Adderall) may produce stronger appetite suppression effects than methylphenidate-based medications (like Ritalin) 6

Non-Stimulant Options with Less Appetite Impact

For children who cannot tolerate appetite suppression but still need ADHD treatment:

• Atomoxetine (Strattera):

  • Selective norepinephrine reuptake inhibitor
  • Less pronounced appetite suppression compared to stimulants 1
  • Initial dose: 0.5 mg/kg/day; target dose: 1.2 mg/kg/day 5
  • May still cause anorexia but at lower rates than stimulants 1

• Guanfacine and Clonidine:

  • Alpha-2 adrenergic agonists
  • Minimal effects on appetite compared to stimulants 1
  • Can be used as monotherapy or adjunctive therapy with stimulants 5
  • May help counteract some stimulant side effects when used in combination 1

Monitoring and Management

• Monitor weight and height regularly during stimulant treatment 5
• Consider medication timing strategies:
  • Administer medication after meals
  • Use shorter-acting formulations if appetite suppression is problematic
  • Schedule "drug holidays" during weekends or school breaks if appropriate 1
• For significant weight loss or growth concerns:
  • Consider switching from amphetamine to methylphenidate (or vice versa)
  • Consider non-stimulant alternatives
  • Evaluate for dose reduction if ADHD symptoms allow 5

Clinical Considerations

• The anorexigenic effect of stimulants tends to diminish over time (typically after 3-6 months) 4
• Weight curves often rejoin those of untreated subjects after a few years of treatment 4
• Combined stimulant and antipsychotic treatment may lead to problematic eating behaviors and emotional overeating 7
• The benefits of ADHD symptom control must be weighed against potential growth effects 8

When appetite suppression is a concern but ADHD treatment is necessary, consider starting with methylphenidate at lower doses, as it may have less impact on appetite than amphetamine-based medications, or consider non-stimulant options like atomoxetine, guanfacine, or clonidine which have minimal effects on appetite.