Table 2.

Possible Strategies for Stimulant Side Effects

Frequency of Side Effect	Stimulant Side Effect	Suggested Interventions
Common	Decreased appetite	Dose after meals, encourage frequent snacks, drug holidays, decrease dose
	Behavioral rebound	Try a sustained-release stimulant, add reduced dose in late afternoon
	Irritability/dysphoria	Try another stimulant medication, consider coexisting conditions (eg, depression) or medications (eg, antidepressants)
	Sleep problems	Institute a bedtime routine, reduce or eliminate afternoon dose, reduce overall dose, restrict or eliminate caffeine
	Edginess	Change preparation, change class of stimulant, consider adding low-dose β blocker
	Dry mouth	Proactive dental hygiene, encourage sips of water through the day, use of biotene or equivalent, avoid sugared candies
Rare	Exacerbation of tics	Observe, try another stimulant or class of attention-deficit/hyperactivity disorder medication (eg, α-adrenergic drugs)
	Psychosis/euphoria/mania/depression	Stop treatment with stimulants, refer to mental health specialist