Table 3.
Rare/theoretical adverse effects of stimulant medicationsa
| Stimulant Adverse Effect | Suggested Intervention | Evidence |
|---|---|---|
| Exacerbation of tics | Observe, change to different stimulant or medication class | (7) Children with tics may benefit from stimulant medication but high doses of dextroamphetamine should be avoided |
| Psychosis/mania | Discontinue medication, refer to mental health specialist | Rare (6) Slightly higher risk of new-onset psychosis with amphetamines than methylphenidate, but absolute risk remains low. |
| Depression/suicide-related events | Discontinue medication, refer to mental health specialist | (20, 21) Rare No causality has been established |
| Cardiovascular | Depends on severity of the adverse effect; consider decreasing dose, discontinue medication, refer to specialist | (1, 2, 20, 21) Stimulant therapy does not appear to increase the risk of sudden unexpected cardiac death or other serious cardiac complications Patients with known cardiac disease or concerns on physical examination should undergo further evaluation |
| Priapism | Discontinue medication | (8, 20,21) Rare Limited studies; uncertain correlation between stimulants and priapism |
| Growth Restriction | Regularly monitor growth in children Strategies to improve nutrition Drug-holiday |
(11, 12, 20, 21) Deceleration of linear growth may occur but appears to attenuate over time Adult height dose not appear to be affected |
| Seizures/epilepsy | Refer to specialist | Rare (9, 10, 20, 21) Low to medium doses of methylphenidate are safe and effective, even in children with active seizures |
aThe numbers in parentheses refer to the following reference list:
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US Food and Drug Administration. FDA drug safety communication: FDA warns of rare risk of long-lasting erections in males taking methylphenidate ADHD medications and has approved label changes. Accessed June 25, 2021. https://www.fda.gov/downloads/Drugs/DrugSafety/UCM378835.pdf
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