Side Effects of Psychostimulants (Methylphenidate/Amphetamines)
Most Common Side Effects
Agitation and insomnia are the most common side effects associated with psychostimulants, occurring frequently enough to warrant dose reduction or timing adjustments. 1
Very Common (>10%)
- Jitteriness and hyperactivity - reported in 31.8% of patients taking methylphenidate in controlled trials 1
- Dry mouth - occurs in approximately 20% of patients on bupropion-containing stimulants 1
Common (5-20%)
- Insomnia - approximately 4% with bupropion formulations, can be mitigated by dosing early in the day 1
- Nausea - 8% with similar agents 1
- Diarrhea - 9% with related medications 1
- Headache - frequently reported across stimulant classes 1
- Constipation - 5% incidence 1
- Vomiting - 4% incidence 1
Cardiovascular Effects (2-5%)
- Increased blood pressure and heart rate - occurs in 2-3% of patients and requires regular monitoring 2
- Palpitations - uncommon but notable 1
Psychiatric/Behavioral (Variable)
- Behavioral activation, agitation, and mood changes - particularly in younger children 2
- Rash - less than 1% 1
Rare but Serious Side Effects (<1%)
These side effects are reversible with discontinuation of the medication in most cases. 1
- Hypertension (uncontrolled) 1
- Cardiac arrhythmias 1
- Confusion 1
- Psychosis 1
- Tremor 1
- Seizures - particularly with bupropion component (rate of 1/1000), especially in those with predisposing factors 1
Contraindications and High-Risk Situations
Methylphenidate and dextroamphetamine should be avoided in patients with uncontrolled hypertension, underlying coronary artery disease, and tachyarrhythmias. 1
Absolute Avoidance
- Uncontrolled hypertension 1
- Active coronary artery disease 1
- Tachyarrhythmias 1
- History of seizure disorder (for bupropion-containing formulations) 1
- Within 14 days of MAOI use 1
Relative Contraindications
- Personal or family history of substance misuse (due to abuse potential) 1
- Anxiety disorders 1
- Glaucoma 1
Management Strategies
Close monitoring for agitation and insomnia is recommended, especially in the first few days of treatment initiation. 1