What Parents Need to Know About the Side Effects of ADHD Drugs

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by Nick Smith

Side Effects of ADHD DrugsThis report outlines common side effects of drugs prescribed for ADHD, many of which are extremely serious even if they are considered “rare.” If parents do not tolerate a child running across a neighborhood street without looking for cars because there is a “rare” chance they will be hit, then why should they be okay with taking the risk that their child may be hit with heart dysfunction, liver failure, suicide, or even sudden death? ADHD is not a lethal “condition,” but the current drugs being prescribed for it can certainly cause one.

Please note that most of the statistics on the side effects reported here are for clinical populations that often include many adults. Side effect prevalence and severity are generally even more substantial for populations of just children [1-3]. Furthermore, it is important to note that the long-term, chronic side effects of these drugs have not been adequately researched. Therefore, the current children prescribed these drugs are “guinea pigs” by default of a continuing medical experiment. For example, does heavy stimulant use throughout a child’s life increase their chance of a heart attack or stroke when they are 50 or 60 years old? The data do not exist yet to answer that question. But the current side effects already known are not looking too pretty. Let’s take a look.

Psychostimulants

Psychostimulants are the most frequently prescribed drugs given to children and adults diagnosed with ADHD. Here is a list of psychostimulant drugs commonly used for ADHD [4]:

  • Methylphenidate (Ritalin, Concerta, Metadate, Daytrana)
  • Dexmethylphenidate (Focalin)
  • Amphetamine-Dextroamphetamine (Adderall)
  • Dextroamphetamine (Dexedrine, Dextrostat)
  • Lisdexamfetamine (Vyvanse)

Side Effects

All stimulants have many potential side effects that include the following: fast, pounding, or uneven heartbeats; the feeling that one might pass out; fever, sore throat, and headache with a severe blistering, peeling, and red skin rash; aggression, restlessness, hallucinations, unusual behavior, or motor tics (muscle twitches); easy bruising, purple spots on the skin; dangerously high blood pressure (severe headache, blurred vision, buzzing in the ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure; stomach pain, nausea, vomiting, loss of appetite; vision problems, dizziness, mild headache; sweating, mild skin rash; numbness, tingling, or cold feeling in hands or feet; nervous feeling, sleep problems (insomnia); weight loss; and others [6,7]. In fact, one type of stimulant drug, Pemoline (Cylert), had to be withdrawn from the market in 2005 because of repeated reports of liver failure [4].

Out of all the psychostimulants, methylphenidates are the most commonly prescribed [8]. A review of 10 different studies on the adverse effects of these drugs found that 31% of users reported dry mouth, 27% decreased appetite/anorexia, 18% moodiness, 22% jitteriness, 21% depression, 11% weight loss, and 12.5% reported vertigo. Furthermore, 7.4% had to drop out of the studies because of adverse effects that were too harsh [9]. It should also be noted there is a lack of research on the long-term effects of using these drugs [9]. Therefore, not much is understood about the chronic side effects of taking these drugs over a prolonged amount of time.

Drug Abuse

Perhaps the worst “side effect” of all is the abuse potential and addictive nature of these drugs. The U.S. Drug Enforcement Administration (DEA) classifies many of these psycholstimulants as schedule 2 drugs, which are substances with a large potential for misuse [10,11]. A review of studies that report the addictive effects of some of the most common stimulants prescribed for ADHD states, “[In] 10 out of 11 studies for which comparative data were reported, the reinforcing effects . . . were generally similar to those of cocaine and D-amphetamine” [12]. A recent study found that 40% of those with prescriptions misuse these drugs [13]. Another study reported on the different types of misuse within a clinical sample and found that 22% took too much of their prescribed stimulants, 10% used the stimulants to “get high,” and 31% used their drugs with alcohol or other drugs [14].

Street Use

The most common “street uses” include partying, getting high, cramming for tests, improving concentration, enhancing alertness, and decreasing fatigue [15-17]. All the prescribed stimulants are abused, but Ritalin appears to be the most commonly abused [17]. One study found 13% of high school students, not just those prescribed Ritalin, had abused the drug [18], and 4% of all middle school students had abused Ritalin at some point in their lives [19]. Also about 1 out of 4 children and adolescents prescribed a stimulant will be solicited to sell, trade, or give away their medication [20]. The statistics are even scarier when the individual prescribed stimulant medication enters college. Approximately 54% of college students prescribed stimulants for ADHD have been solicited to divert their medication [21]. Essentially, the prescribing of these drugs is subjecting our youth to a drug dealer’s role.

Atomoxetine (Strattera)

Atomoxetine, under the common trade name Strattera, is the only non-stimulant that is FDA approved to treat children with ADHD [22]. This drug was recently released in 2002, therefore many long-term effects, such as possible stunted growth, remain unknown [1]. Strattera has many known side effects, including chest pain, shortness of breath, fast or uneven heartbeats; the feeling that one might pass out; unusual thoughts or behavior, aggression, hallucinations (seeing things that are not there); nausea, pain in the upper stomach, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); increased blood pressure (severe headache, blurred vision, buzzing in the ears, anxiety, confusion, seizure); urinating less than usual or not at all; numbness, burning pain, or tingly feeling; feeling irritable; feeling dizzy or drowsy; constipation; cough, dry mouth; skin rash or itching; sleep problems (insomnia); increased menstrual cramps; impotence, loss of interest in sex, or trouble having an orgasm [23]. One review of controlled trials found that while using atomoxetine, 11% had gastrointestinal problem side effects, 5% had side effects related to sleep, 4% to abdominal pain, 3% to vomiting, and 2% to indigestion [24]. Also 4 out of every 1000 patients on Strattera develop suicidal thoughts and intentions [25], and the side effects appear to be just as adverse as stimulants [26].

Furthermore atomoxetine is only effective in 29% of patients diagnosed with ADHD [24], and the stimulant Adderall was shown to reduce the magnitude of ADHD symptoms to nearly twice the extent of atomoxetine [26]. In other words, atomoxetine appears to have side effects just as bad as stimulants, but it is much less effective in reducing symptoms.

Off-label drugs

Many other drugs are given to patients with ADHD symptoms, even though they are not approved by the FDA. Some doctors opt to prescribe these so-called “off-label” drugs despite a lack of evidence that they are safe and effective [22, 27].

The off-label drugs sometimes prescribed for ADHD symptoms include, but are not limited to, the following:

  • Atypical antipsychotics [Risperdal (Risperidone), aripiprazole, quetiapine, olanzapine, ziprasidone, paliperidone, and clozapine]
  • Antidepressants [Bupropion (Wellbutrin), Imipramine (Tofranil), nortriptyline (Pamelor, Aventil), and desipramine (Norpramin)]
  • Alpha-2 agonists [clonidine (Catapres) and guanfacine)
  • Phenytoin (Dilantin)

One study found that the patients prescribed these “off-label” drugs, especially atypical antipsychotics, had to be hospitalized more and had more emergency room and outpatient visits compared to children prescribed the regular stimulants [28]. Another study reported significantly higher dropout rates for the patients receiving only one prescription of “off-label” drugs compared to the children only receiving stimulants [29]. Most likely these trends are noted because the lack of benefits and/or side effect prevalence and severity of these “off-label” drugs are even worse than stimulants.

Atypical antipsychotics

One study found a recent surge in the prescription of these antipsychotics to children with ADHD going from 8% in 1996 to 18% in 2005 [22], even though current guidelines do not recommend using antipsychotics for ADHD and do not address the use of antipsychotics by children with ADHD and psychiatric comorbidities [30-32]. In fact, one study found that of the 22,622 patients with ADHD who were using an atypical antipsychotic, 69% of them did not have a normal psychiatric diagnosis for which atypical antipsychotics are FDA-indicated or commonly used [28].

Atypical antipsychotics have been linked to significant risks, including heart failure, weight gain, metabolism dysfunction, and type 2 diabetes [33]. Other common side effects include fever, stiff muscles, confusion, sweating, fast or uneven heartbeats; restless muscle movements in the eyes, tongue, jaw, or neck; drooling, tremor (uncontrolled shaking); seizure (convulsions); fever, chills, body aches, flu symptoms; nosebleeds; white patches or sores inside the mouth or on the lips; trouble swallowing; the feeling that one might pass out; penis erection that is painful or lasts 4 hours or longer; weight gain; feeling hot or cold; headache, dizziness; drowsiness, tired feeling; dry mouth, increased appetite; feeling restless or anxious; sleep problems (insomnia); nausea, vomiting, stomach pain, constipation; cough, sore throat, runny or stuffy nose; or mild skin rash [34]. More research is needed on the long-term side effects of using antipsychotics with children with ADHD [22].

Antidepressants (Bupropion and tricyclics)

Antidepressants are also sometimes prescribed to children with ADHD, especially when the child is also diagnosed with depression [35, 36], although there appears to be a decrease in these prescriptions. This decrease in antidepressants is most likely due to a noted link between suicidal ideation and suicide and these antidepressants in adolescents [37, 38]. Other possible side effects of Bupropion (Wellbutrin) include restlessness, agitation, sleeplessness, headache, stomach problems, and a noted increase in seizures [4]. The other antidepressants sometimes used for ADHD symptoms are tricyclic antidepressants, which commonly cause cardiac dysrhythmias. Desipramine is even known to have caused sudden death in some children and adolescents [4].

Alpha-2 agonists

Alpha-2 agonists, such as clonidine (Catapres) and guanfacine, have a number of very common side effects that include dry mouth, sedation (somnolence), weakness (asthenia), dizziness, constipation, and impotence [39]. Furthermore, some of these drugs have been found to slow the heart down, and going off the drug too soon or even missing a dose can cause rapid heartbeats and can lead to severe problems [4].

Phenytoin (Dilantin)

Finally, there have been some reports of doctors prescribing Dilantin for ADHD symptoms [40]. Dilantin works by literally slowing down the brain, including cognition and thinking, and is normally used to treat epilepsy [41]. Besides the fact that it operates by slowing the brain, countless other side effects are known to occur with this drug, such as suicidal thoughts, swollen glands, easy bruising or bleeding, swollen or tender gums; fever, sore throat, and headache with a severe blistering, peeling, and red skin rash; confusion, hallucinations, unusual thoughts or behavior; slurred speech, loss of balance or coordination; tremor (uncontrolled shaking), restless muscle movements in the eyes, tongue, jaw, or neck; extreme thirst or hunger, urinating more than usual; loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); changes in the shape of the face or lips; mild skin rash or itching; dizziness, nervousness, sleep problems (insomnia); nausea, vomiting, constipation; or headache, joint pain [42]. This drug also decreases folate levels in the blood and can directly cause macrocytic anemia [43].

Conclusion

There are many drugs prescribed to children with ADHD, and all of the drugs have many reported common side effects and some possible serious side effects. Although potential long-term side effects are not fully known, these drugs continue to be prescribed at an increasing rate. In 2007 approximately 66% of children with ADHD in the United States were prescribed at least one drug for the condition, compared to only 56% in 2003 [44,45]. Another increasing trend is that children are being prescribed multiple drugs at once for a condition like ADHD [46]—presumably because one drug is not effective enough at lessening all the symptoms of the condition, or in an attempt to counteract side effects caused by the first drug. Please keep in mind that all of these drugs are prescribed in a trial-and-error manner. When making a decision regarding the use of one of these drugs with a child, one must take this into account, as well as the data reported here regarding common side effects, the probability of misuse or abuse, the potential for serious or lethal effects, and the unknown long-term effects.

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