ADHD Medication
Stimulant Medications
Methylphenidate (e.g., Ritalin, Concerta XL)
Absolute Contraindications
- Severe anxiety or agitation
- History of drug or alcohol abuse
- Glaucoma
- Severe cardiovascular disease
Main Side Effects
- Appetite suppression, weight loss
- Insomnia
- Tachycardia, hypertension
- Mood swings or anxiety
- Rare: Growth retardation in children
Main Interactions
- MAOIs (risk of hypertensive crisis)
- Antihypertensives (may reduce their efficacy)
- Serotonergic drugs (risk of serotonin syndrome)
Main Monitoring Requirements
- Blood pressure and heart rate (baseline and during treatment)
- Weight and height in children (to monitor growth)
- Assess for mood changes or psychiatric symptoms
Pregnancy & Breastfeeding
- Pregnancy: Avoid unless benefits outweigh risks (limited safety data).
- Breastfeeding: Avoid; excreted in breast milk.
Lisdexamfetamine (e.g., Elvanse)
Absolute Contraindications
- Symptomatic cardiovascular disease or arrhythmias
- Glaucoma
- Hyperthyroidism
- History of drug or alcohol abuse
Main Side Effects
- Appetite suppression, weight loss
- Insomnia
- Tachycardia, hypertension
- Irritability or mood swings
Main Interactions
- MAOIs (risk of hypertensive crisis)
- Antihypertensives (reduced efficacy)
Main Monitoring Requirements
- Blood pressure and heart rate
- Weight and height in children
Pregnancy & Breastfeeding
- Pregnancy: Avoid unless benefits outweigh risks; limited safety data.
- Breastfeeding: Avoid; excreted in breast milk.
Non-Stimulant Medications
Atomoxetine
Absolute Contraindications
- Narrow-angle glaucoma
- Severe cardiovascular disease or arrhythmias
- MAOIs within the last 14 days
Main Side Effects
- GI upset (nausea, abdominal pain)
- Reduced appetite
- Insomnia
- Mood swings or irritability
- Rare: Suicidal ideation
Main Interactions
- MAOIs (risk of hypertensive crisis)
- Beta agonists (increased cardiovascular effects)
Main Monitoring Requirements
- Blood pressure and heart rate
- Weight and appetite
- Monitor for mood changes or suicidal ideation
Pregnancy & Breastfeeding
- Pregnancy: Avoid unless benefits outweigh risks; limited safety data.
- Breastfeeding: Avoid; excreted in breast milk.
Guanfacine (Adjunct Therapy)
Absolute Contraindications
- Severe hypotension or bradycardia
Main Side Effects
- Sedation, drowsiness
- Hypotension, bradycardia
- Weight gain
Main Interactions
- CNS depressants (e.g., benzodiazepines) – additive sedation
- Antihypertensives (additive hypotensive effects)
Main Monitoring Requirements
- Blood pressure and heart rate
- Monitor for sedation or fatigue
Pregnancy & Breastfeeding
- Pregnancy: Avoid unless essential; limited safety data.
- Breastfeeding: Avoid; insufficient data available.
Key Considerations:
Monitoring: Regular follow-up is critical to assess therapeutic benefit, side effects, and adherence.
Shared Care: ADHD medications often require shared care between specialists and primary care providers.
Substance Misuse: Monitor for potential misuse or diversion of stimulant medications.