Table 2.
Common/less common adverse effects of stimulant medications a
| Stimulant Adverse Effect | Suggested Intervention | Evidence |
|---|---|---|
| Appetite suppression | Strategies to improve nutrition; dose after meals; high fat intake may delay the onset and increase peak concentrations of some formulations Decrease dose Drug holiday |
(14, 15, 16) Common |
| Xerostomia | Educate on dental hygiene and hydration • Commercial salvia substitute • Saliva stimulation (sugar-free gum, lozenges) |
(20) Common |
| Insomnia | Educate on sleep hygiene, sleep diary Restrict or eliminate caffeine Change/reduce dose, timing, medication, omit or reduce the last dose of the day |
(13, 17, 20, 21) Varies among patients Inconsistent outcomes in children; sleep problems may be more related to attention deficit/hyperactivity disorder symptoms rather than medication |
| Irritability | Consider coexisting mental health conditions or medications Consider changing to extended-release form, a different stimulant medication |
(18, 21) |
| Elevations in heart rate Elevations in blood pressure |
Pretreatment checking and monitoring of pulse and blood pressure Children should be routinely evaluated |
(3, 4, 5) Less common Modest cardiovascular effects: 1. 3-10 beats per minute 2. 3-5 mm Hg |
| Headaches | Determine if symptoms develop: Acute phase (1-2 h after administration)—consider changing to extended-release form or reducing dose. Wean-off phase—consider adding a second dose or changing to extended-release form |
(20, 21) |
| Symptom rebound | Change to sustained-release stimulant | (20, 21) |
a
The numbers within parentheses refer to the numbers listed in footnote to Table 3.