From the Guidelines
Non-stimulant medications like atomoxetine (Strattera) typically have the fewest side effects for ADHD treatment. Atomoxetine works by increasing norepinephrine levels in the brain, improving attention and reducing impulsivity without the stimulant effects that can cause insomnia, decreased appetite, and cardiovascular issues 1. The standard adult dose is 40mg daily, increasing to 80mg after 3 days, with a maximum of 100mg daily. For children, dosing is weight-based, usually starting at 0.5mg/kg/day and increasing to 1.2mg/kg/day. Other low side effect options include guanfacine (Intuniv) and clonidine (Kapvay), which are alpha-2 adrenergic agonists that help with impulse control and hyperactivity. These medications take 4-6 weeks to reach full effectiveness, unlike stimulants which work immediately. Common mild side effects include initial drowsiness, dry mouth, and occasional stomach upset.
Key Considerations
- Atomoxetine has been shown to have a lower risk of cardiovascular events compared to stimulants, but may cause initial somnolence and gastrointestinal tract symptoms 1.
- Guanfacine and clonidine may cause somnolence, dry mouth, dizziness, irritability, headache, bradycardia, hypotension, and abdominal pain, but are suitable for patients with anxiety, tic disorders, or those who experience significant side effects from stimulants 1.
- The choice of medication should be individualized based on the patient's specific needs and medical history, and should be monitored regularly for potential side effects and efficacy 1.
Medication Comparison
- Stimulants have a higher effect size for reducing ADHD core symptoms, but may have more significant side effects such as appetite loss, abdominal pain, headaches, and sleep disturbance 1.
- Non-stimulants have a lower effect size, but may be preferred for patients with certain comorbidities or those who experience significant side effects from stimulants 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
ADHD Medications with Least Side Effects
- Currently approved pharmacological treatments for ADHD include stimulant and nonstimulant medications, which have been shown to be effective in treating ADHD symptoms with minimal side effects 2.
- Nonstimulant medications, such as atomoxetine, guanfacine, and clonidine, are considered to have a lower risk of side effects compared to stimulant medications 3, 4.
- Atomoxetine, in particular, has been found to be generally well-tolerated in children and adolescents with ADHD, with common adverse events including headache, abdominal pain, and decreased appetite 3.
- A study comparing methylphenidate and atomoxetine in adults with ADHD found that both medications were well-tolerated and efficacious, with no significant difference in the rates of adverse effects 5.
- Alpha agonists, such as guanfacine extended-release, and norepinephrine reuptake inhibitors, such as atomoxetine, are recommended nonstimulant ADHD medications that can be used as monotherapy or added to a stimulant as an augmentation strategy 4.
Comparison of Side Effects
- Atomoxetine has been found to have a lower risk of abuse and misuse compared to stimulant medications, making it a useful option for patients at risk of substance abuse 3.
- Methylphenidate, a common stimulant medication, has been found to be safe in healthy children and has shown no cardiac side effects in these patients 6.
- Nonstimulant medications, such as atomoxetine, may be associated with a higher risk of suicidal ideation, and rare cases of serious liver injury have been reported 3.
- The side effect profiles of atomoxetine and stimulants differ, with somnolence appearing more common among atomoxetine recipients and insomnia appearing more common among stimulant recipients 3.