Tips to Reduce the Side Effects of ADHD Medications
Stimulant Medications continued...
During stimulant treatment, some children also develop tics, which can include excessive blinking, grimacing, or jerking of the head, Pakyurek says. It’s not clear whether the drugs cause the tics. Rather, he says, the tics may coexist with ADHD and stimulants make the tics more pronounced.
If your child develops tics, call the doctor right away, Pakyurek says. The dose may need to be reduced or stopped. Or, he says, “If [tics] are mild enough, you may just want to wait it out. … They may improve and disappear, even though you did not change the medication that the child is being treated with.”
In some children, stimulants aren’t effective or well-tolerated. Or if a child already has tics or anxiety, stimulants may worsen these problems. In such cases, nonstimulant drugs, such as atomoxetine, or other medications such as guanfacine and clonidine, may be good choices, Pakyurek says.
Here’s the rundown on nonstimulant drugs and possible side effects.
Atomoxetine for ADHD
Atomoxetine (Strattera) is an antidepressant-like drug that also has anti-anxiety effects, Pakyurek says. It can be taken once or twice a day.
Side effects include reduced appetite, stomach upset, nausea, and drowsiness, but these problems usually go away after the first month of treatment.
More serious problems can occur, although they are quite rare. “One potential problem that needs to be monitored closely with Stattera is potential for liver enzyme increase and liver injury,” Pakyurek says.” Children on atomoxetine will need blood tests to monitor liver enzymes, he says.
Atomoxetine can also cause slight increases in pulse and blood pressure, Pakyurek says.
Strattera also carries a black box warning from the FDA for increased risk of suicidal thoughts in children and teens. “We have to warn parents about this potential side effect,” Pakyurek says, but he adds that this problem is rare among his patients.
However, if a child has depression along with ADHD, or “if there’s a concern that the medication may be contributing to increased suicidal thoughts, absolutely, the medication may have to be stopped,” he says.
Alpha-2 Adrenergic Agonists for ADHD
Two hypertension medications, guanfacine and clonidine, are also prescribed to treat ADHD. Both are called alpha-2 adrenergic agonists.
Intuniv, a long-acting form of guanfacine that lasts for 8 to 14 hours, is approved for children ages 6 to 17 with ADHD, Pakyurek says. Tenex is a short-acting form of guanfacine.
Clonidine is marketed under the name Kapvay.
Since alpha-2 adrenergic agonists also treat hypertension, they can cause blood pressure to drop too low in children. “The vital signs, just like with stimulants, have to be monitored closely in all these children,” Pakyurek says.
Nervousness, sedation, and tiredness are other possible side effects, he says.