| Decreased appetite; nausea; stomachache; weight loss (less common) |
Frequent snacks or additional “4th meal” at bedtime |
| Dose medication with food or after meals |
| Consider switch to short acting agent |
| Drug holiday if significant change in growth |
| Sleep difficulties |
Bedtime routine, reduce bedtime stimuli |
| Reduce or eliminate afternoon dose (if on immediate release preparation) |
| Move dosing regimen to earlier time |
| Reduce or eliminate caffeine intake |
| Consider addition of melatonin |
| Transient headache |
Symptomatic management and observation |
| Reduce dose, try another stimulant, or another class |
| Consider alpha-agonist medication or atomoxetine |
| Behavioral rebound |
Try sustained-release stimulant |
| Add later afternoon dose of short acting stimulant |
| Exacerbation of tics (rare) |
Reduce dose, try another stimulant, or another class |
| Consider alpha-agonist medication or atomoxetine |
| Increased heart rate or blood pressure |
Reduce dose, try another stimulant, or another class |
| Consider alpha-agonist medication or atomoxetine |
| Irritability or dysphoria |
Decrease dose, try another stimulant or class |
| Consider coexisting conditions, especially depression |
| Psychosis, euphoria, mania, severe depression |
Stop treatment with stimulants |
| Refer to mental health specialist urgently |
