Tips to Reduce the Side Effects of ADHD Medications

Stomach upsets, weight loss, insomnia are all common side effects of ADHD medications. Often they are mild, not lasting beyond the first few weeks -- but not always. For many kids, the battle with side effects is constant.

Steven Parker, MD, director of behavioral and developmental pediatrics at Boston Medical Center and Richard Sogn, MD, a clinical specialist in ADD/ADHD -- offer their advice on dealing with common problems.

"ADHD medications are extremely beneficial for the vast majority of kids, but most will have one or more side effects," says Parker.

"Whether you will then switch to a different medication will depend on the benefits and how significant the side effects are. If the medication is helping the ADHD symptoms, sometimes it's worth it to tough it out and see if the side effects go away, which they often do. Other times you can work around the side effects, such as giving the medication with food to avoid stomachaches. But sometimes the side effects prove unacceptable and a change of medication is required," Parker tells WebMD.

Here are the top tips from Parker and Sogn. Parker is the senior pediatric consultant for WebMD. Sogn is a discussion board leader at WebMD.

Stomach and Appetite Troubles

Stomach upsets often disappear within a few weeks, as the child's system gets used to the ADHD medication. Many children, however, continue to have appetite problems. Try these three simple steps:

• Give ADHD medication with food. If morning medication is taken after breakfast, there's less risk of stomach upsets.
• Encourage healthy snacking. Have lots of healthy after-school and bedtime snacks available. High-protein and energy bars, protein shakes, and liquid meals such as Carnation Instant Breakfast and Ensure are good options.
• Change dinnertime. Eat later in the evening, when your child's medication has worn off.

Headaches

Headaches, like stomach upsets, are related to taking ADHD medication without food in the stomach, says Sogn. "It's like having a strong cup of coffee on an empty stomach." Try these tips:

• Always give ADHD medication with food. Without food, ADHD medication gets absorbed more quickly, which causes blood levels of the medication to rise quickly. This can trigger a headache.
• Consider long-acting medication. Headache can also be a rebound effect when medication is wearing off quickly, and is more common with short-acting medications. It may be necessary to switch to a longer-acting version of the drug or try a different ADHD medication altogether.

Difficulty Sleeping

Sleep problems are common for children with ADHD, partly because of the child's naturally high activity level. For many kids, insomnia occurs when a stimulant medication wears off. For others, the stimulant affects them much like coffee affects adults.

To offset sleep problems, it helps to develop a bedtime ritual for the child. This routine will help the child calm down at bedtime and get the sleep they need. Try these tips:

• Give the morning dose of ADHD medication earlier in the day.
• Discuss medication changes with the doctor. It may be necessary to try shorter-acting medications.
• Don't allow your child to drink caffeinated beverages. Cocoa and many sodas, coffees, and teas all contain caffeine. A child who drinks these in the afternoon or evening may be tossing and turning at bedtime.
• Establish a sleep-only zone. Your child's bedroom should be dedicated to sleep -- not for homework, not for entertainment. Move the computer, radio, television, toys, and games to another room. A few stuffed animals are fine, but there should be no other distractions.
• Teach your child to relax at bedtime. A special blanket or a stuffed animal can help a child fall asleep. But it's best to avoid bedtime activities that depend on a parent's presence -- like rocking or holding the child until sleep comes.
• Establish consistency. Bedtimes and waking times should be the same seven days a week. Waking times are more important than bedtimes in establishing sleep rhythms. It is easier to enforce a waking time than a bedtime. "Sleeping in" can be a sign that the child is not getting enough sleep.
• Establish daytime routines. Regular meal and activity times help, too. Routines make it easier for children to "wind down" to sleep.
• Discourage midnight visits. Waking up at night can become a habit for children. It can also be a way to get attention. While you don't want to let a child cry themselves to sleep, it's best to discourage middle-of-the-night visits with mom and dad or midnight snacks. Also, don't allow interesting toys near the child's bed (a stuffed animal or two is fine).
• Avoid sleep medications. Medications stop working over time, and may affect daytime alertness. They may also wear off during the night, and cause night waking. Some medications may cause nightmares or other types of sleep problems. If medications are absolutely necessary, talk to your child's doctor about safe and effective treatments.
• Consider medical problems. Allergies, asthma, or conditions that cause pain can disrupt sleep. If your child snores loudly and/or pauses in breathing, medical evaluation is necessary. Consult your physician for help with the possible medical causes of sleep problems.

Tics

Tics are involuntary motor movements such as excessive eye blinking, throat clearing, sniffing, blinking, shrugging, or head-turning. About one in three boys and one in six girls with ADHD will develop tics with or without medication. "ADHD medications can bring out an underlying predisposition to tics -- but the medications don't cause tics," says Parker.

• Chart your child's unusual movements. Talk to your pediatrician if you think your child may have tics. A change in medication, or combining medications, may help.

Growth Problems

Some children taking stimulant ADHD medications lose their appetite, which in turn can affect weight and growth. Most children may have a tendency not to gain weight over the first six to nine months of treatment, but then resume normal weight, Sogn tells WebMD. Over two years, the majority of children weigh three to five pounds less than they would if not on medications -- and might be 0.1 to 0.5 inches shorter than their peers.

"A very small group of children is very sensitive to these medications," says Sogn. "They lose their appetite, which means they lose a significant amount of weight -- so they don't grow." The ADHD medication by itself does not stunt growth, he explains. Rather, the child doesn't eat enough to get necessary nutrition for growth. Try these tips:

• Plot a growth chart. Make sure the pediatrician takes height and weight prior to starting ADHD drugs. Measurements should be made and charted three to four times a year.
• Encourage snacking. If your child has lost weight, encourage snacking on high-protein nutrition bars, protein shakes, and liquid meals such as Carnation Instant Breakfast and Ensure.

Studies show that most kids will catch up in height and weight. "ADHD kids are often a couple of years behind other kids in growth maturation and puberty, so parents tend to worry about them," says Sogn. "Puberty will just come later, probably at 15 rather than 13. By puberty, almost all kids have caught up to the normal height and weight they would have had if they had not been taking the medications."

Noticeable Mood Changes

For many kids, ADHD medications bring a sunnier mood and more enjoyment in life. But occasionally, a child becomes too quiet and seems sadder, depressed, moody -- an extreme emotional change. Such emotional changes could prove to be an unacceptable side effect -- or perhaps a sign that the dose of medication is too high. If the moodiness is especially noticeable when the medication is wearing off, it could be a sign of what's known as "rebound effect," and may require a change in ADHD medication.

"The medication may be making the kid irritable, as happens more often with younger kids," says Parker. "But if the child is feeling sad, depressed, or extremely irritable -- and the mood doesn't lift in a week or two -- that might not be something you can work around. The cure should never be worse than the disease, so it may be a sign to change the medication." Try this tip:

• Chart your child's mood changes. Note your child's highs and lows, and the time of day they occur. Then talk to the pediatrician.

Rebound of Difficult Behaviors

Often the ADHD symptoms are under control early in the day, when the blood has a high level of medication, says Parker. As the medicine wears off and leaves the body, there may be a rebound effect. The difficult behaviors may return, often worse than before. This is not a true side effect, but rather a result of medication wearing off. If your child has afternoon irritability and trouble concentrating, it could be a sign of rebound effect. Try these tips:

• Chart your child's behavior. Note the time of day that behaviors change, and what's happening.
• Talk to the doctor. If there seems to be a pattern of ADHD symptoms appearing in the afternoon or evening, the child may need another short-acting medication in the afternoon. Or the child may need a different combination of medications, including a nonstimulant or low-dose tricyclic antidepressant, Sogn says.

Dizziness

Dizziness can occur when the ADHD medication dose is too high, Sogn notes. If you notice your child gets dizzy, have your child drink fluids and get your child's blood pressure checked right away. If that's normal, try this tip:

• Talk to the doctor. It may be time to switch to an extended-release medication to smooth out the highs and lows in medication levels in the blood, Sogn says.

Nausea, Tiredness

With the nonstimulant drug Strattera, nausea and excessive tiredness are common side effects in the first few weeks. To help the child build up a tolerance to the medication, try these tips:

• Start with a low dose. Increase the dose by a small amount every one to two weeks.
• Change dosing. Give the dose at night -- or divide the dose into morning and late afternoon dosages

In September 2005 the FDA issued a public health advisory about rare reports of suicidal thinking in children and adolescents taking Strattera. The agency asked Strattera's maker Eli Lilly and Co. to include a warning on the product's labelwarning on the product's label.

Increased Heart Rate & Pulse

These side effects develop when a child takes an ADHD drug plus a decongestant like Sudafed. "You're mixing two potent stimulants together," Sogn says. "That's when we get a call that a kid is getting panicky at school -- only to find out the parents gave him cold medicine that morning." In fact, pseudoephedrine (Sudafed) dramatically increases all side effects from stimulants, he notes. Try these tips:

• Use a nasal spray when your child has a cold.
• Skip the ADHD medication when your child is stuffed up and needs a decongestant.
• Or, choose a cold medicine that doesn't contain pseudoephedrine.

Originally published May 2005.
Medically updated June 26, 2007.

SOURCES: Steven Parker, MD, director of behavioral and developmental pediatrics at Boston Medical Center. Richard Sogn, MD, a clinical specialist in ADD/ADHD.