Methylphenidate (Ritalin®)
U.S. Brand Names: Ritalin®
Use: Used to treat attention deficit disorder and hyperactivity.
Contraindications: Do not use in children under six years of age since safety and efficacy in this age group has not been established.
Warnings/Precautions: Use with caution with emotionally unstable patients, especially if these patients have a history of abuse. In psychotic children Ritalin may worsen symptoms of behavior disturbance and thought disorder. Abuse of this drug can lead to tolerance and psychic dependence with varying degrees of abnormal behavior, severe depression can occur with withdrawal.
Growth retardation (suppression of height and/or weight gain) has been reported in children using this drug. Long-term therapy (greater than 24 months) is especially dangerous.
Adverse Reactions:
Common: Trouble sleeping, nervousness, loss of appetite (anorexia or nausea), fast heartbeat (tachycardia), increased blood pressure.
Less Common: Dizziness, drowsiness, headache, nausea, stomach pain, black stools, blood in urine or stools, chest pain, fever, joint inflammation and pain, pinpoint red spots on skin, skin rash or hives, uncontrolled twitching or jerking of muscles, unusual bleeding or bruising
Rare (have been reported): Blurred vision or any changes in vision; abnormal liver function from minor to hepatic coma; narrowing and sometimes blockage of arteries in the head; transient depressed mood; a few instances of scalp hair loss; Tourette's syndrome--defined as repetitive grimaces and tics of head, neck, arms, legs, and trunk, also, involuntary barks, grunts, or other noises, in about half the cases the sufferer has episodes of coprolalia (using foul language).
Long-Term Use: Mood or mental changes, weight loss, stunted growth problems.
Methamphetamine
U.S. Brand Names: Desoxyn®; Dexedrine®
Use: Used to treat hyperactivity in children.
Contraindications: Do not use if you haven't tried other antidepressants and psychotherapy first, if you have high blood pressure, if you are very nervous or have severe insomnia, if you have a history of addiction to drugs or alcohol, or if you have Tourette's syndrome.
Adverse Reactions:
Common side effects include nervousness, insomnia, loss of appetite, and addiction. Less common side effects include high blood pressure, rapid pulse rate, tolerance, and feelings of suspicion and paranoia. This drug has a high potential for abuse, and studies have shown that in psychotic children, administration of amphetamines may exacerbate symptoms of behavior disturbance and thought disorder and may also exacerbate motor and phonic tics and Tourette's Syndrome.
Central Nervous System: Psychotic episodes at recommended doses (rare), overstimulation, restlessness, dizziness, insomnia, euphoria, dyskinesia, dysphoria, tremor, headache, exacerbation of motor and phonic tics and Tourette's syndrome.
Gastrointestinal: Dry mouth, unpleasant taste, diarrhea, constipation, other GI disturbances, anorexia and weight loss.
Allergic: Urticaria.
Endocrine: Impotence, changes in libido
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Mixed Amphetamine Salts
U.S. Brand Names: Adderall®
Adverse Reactions:
Common Side Effects: Restlessness, dizziness, insomnia, headache, dry mouth, weight loss.
Less Common Side Effects: Euphoria, unpleasant taste, diarrhea, constipation, gastrointestinal disturbances.
Rare Side Effects: Palpitations, tachycardia, elevation of blood pressure, psychotic episodes at recommended doses, overstimulation, dyskinesia, dysphoria, tremor, exacerbation of motor and phonetic tics and Tourette's syndrome.
Other Side Effects: Uticaria, impotence, changes in libido.
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Pemoline
U.S. Brand Names: Cylert®
Use: Used to treat ADD/ADHD.
Warnings/Precautions: Stimulant drugs are addictive, they produce a short-term mood elevation even in people who are not depressed and when the effect wears off the user crashes and feels very depressed, sleepy, and sluggish. Stimulants can stunt growth in children with long term use. In psychotic children these drugs may exacerbate symptoms of behavior disturbance and thought disorder, administer with caution to patients with significantly impaired renal function, CNS stimulants have been reported to precipitate motor and phonic tics and Tourette's syndrome.
Adverse Reactions:
Hepatic: Hepatic dysfunction including elevated liver enzymes, hepatitis and jaundice
Hematopoietic: Rare aplastic anemia
Miscellanous: Suppression of growth, skin rash
Central nervous system: Convulsive seizures, may precipitate attacks of Gilles de la Tourette syndrome, hallucinations, dyskinetic movements of the tongue, lips, face and extremities, abnormal oculomotor function including nystagmus and oculogyric crisis, mild depression, dizziness, increased irritability, headache, and drowsiness
Common side effect: Insomnia,
Gastrointestinal: Anorexia, weight loss, nausea, stomach ache
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Venlafixine
U.S. Brand Names: Effexor®.
Use: Used to treat ADD/ADHD..
Contraindications: Do not take with MAOIs since interactions could be lethal.
Warnings/Precautions: Use with caution if you are taking cimetidine or if you have high blood pressure or liver disease or are elderly.
Adverse Reactions:
Body as a whole: Headache, asthenia, infection, chills, chest pain, trauma,
Cardiovascular: Vasodilatation, increased blood pressure, tachycardia, postural hypotension,
Dermatological: Sweating, rash, pruritus,
Gastrointestinal: Nausea, constipation, anorexia, diarrhea, vomiting, dyspepsia, flatulence
Metabolic: Weight loss
Nervous system: Somnolence, dry mouth, dizziness, insomnia, nervousness, anxiety, remora, abnormal dreams, hypertonia, paresthesia, libido decreased, agitation, confusion, thinking abnormal, depersonalization, depression, urinary retention, twitching
Respiration: Yawn
Special Senses: Blurred vision, taste perversion, tinnitus, mydriasis
Urogenital: Abnormal ejaculation/orgasm, impotence, urinary frequency, urination impaired, orgasm disturbance, menstrual disorder
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Paroxetine
U.S. Brand Names: Paxil®
Contraindications: Do not use with MAOIs or in patients with a hypersensitivity to paroxetine or to any of the inactive ingredients in paroxetine HC1 formulations.
Pregnancy Risk: Do not use during pregnancy unless you absolutely need to. This drug is secreted in human milk, use caution when nursing.
Adverse Reactions:
10% experienced:
CNS: Somnolence, insomnia, agitation, tremor, anxiety, dizziness
Gastrointestinal: Constipation, nausea, diarrhea, dry mouth, vomiting, flatulence
Other: Asthenia, abnormal ejaculation, sweating, impotence, libido decreased
1% to 10% experienced:
Body as a whole: Infection, trauma, allergic reaction,
headache, asthenia, abdominal pain, chest pain, back pain, chills, trauma
Cardiovascular: Vasodilation, palpitation, vasodilation
Dermatologic: Photosensitivity, sweating, rash
Gastrointestinal: Nausea, dry mouth, constipation, diarrhea, decreased appetite, dyspepsia, flatulence, increased appetite, oropharynx disorder, vomiting
Musculoskeletal: Myopathy, myalgia, myasthenia
Nervous system: Hypertonia, somnolence, dizziness, insomnia, tremor, nervousness, anxiety, paresthesia, libido decreased, drugged feeling, confusion, agitation, abnormal dreams, concentration impaired, depersonalization, myoclonus, amnesia
Respiratory: Cough increased, bronchitis, rhinitis, yawn, pharyngitis
Special Senses: Abnormal vision, blurred vision, taste perversion
Urogenital System: Ejaculatory disturbance, other male genital disorders, urinary frequency, urination disorder, female genital disorders, dysmenorrhea, impotence, menstrual disorder, vaginitis
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Fluxetine
U.S. Brand Names:Prozac®
Contraindications: Do not use with MAOI inhibitor.
Pregnancy Risks: C; is excreted in human milk, nursing or being pregnant while on fluxetine is not recommended.
Adverse Reactions:
10% experienced:
Body as a whole: Asthenia, flu syndrome, fever, headache
Cardiovascular: Vasodilation, palpitation
Digestive: Nausea, anorexia, dry mouth, dyspepsia, diarrhea, flatulence, vomiting
Nervous: Insomnia, abnormal dreams, anxiety, nervousness, somnolence, tremor, libido decreased
Respiratory: Pharyngitis, sinusitus, yawn
Skin: Sweating, rash, pruritus
Urogenital: Impotence, abnormal ejaculation
Metabolic & nutritional disorders: Weight loss
Special senses: Abnormal vision
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Bupropion
U.S. Brand Names:Welbutrin®
Contraindications: Patients with a seizure disorder, patients using other medications containing bupropion, patients with a current or prior diagnosis of bulimia or anorexia nervosa, patients using a MAO inhibitor, and patients who are allergic to bupropion should not use bupropion.
Warnings/Precautions: Do not use Wellbutrin with Zyban or with any other medications containing bupropion.
Pregnancy Risk: B; is secreted in human milk, potential for serious adverse reactions in nursing infants, do not use when nursing or pregnant.
Adverse Reactions:
10% experience: rash, nausea, agitation, migraines>
1% to 10% experience:
Body (General): Headache, infection, abdominal pain, asthenia, chest pain, pain, fever
Cardiovascular: Palpitation, flushing, migraine hot flashes
Digestive: Dry mouth, nausea, constipation, diarrhea, anorexia, vomiting, dysphagia
Musculoskeletal: Myalgia, arthralgia, arthritis, twitch
Nervous system: Insomnia, dizziness, agitation, anxiety, tremor, nervousness, somnolence, irritability, memory decreased, paresthesia, CNS stimulation
Respiratory: Pharyngitis, sinsusitis, increased cough
Skin: Sweating, rash, pruritus, urticaria
Special Senses: Tinnitus, taste perversion, amblyopia
Urogenital: Urinary frequency, urinary urgency, vaginal hemorrhage, urinary tract infection,
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Valproic Acid
U.S. Brand Names: Depakote® Depacon®; Depakene®
Use: Management of simple and complex absence seizures; mixed seizure types; myoclonic and generalized tonic-clonic (grand mal) seizures; may be effective in partial seizures, infantile spasms, bipolar disorder; prevention of migraine headaches.
Contraindications: Hypersensitivity to valproic acid or derivatives or any component; hepatic dysfunction.
Dietary Considerations:
Alcohol: Additive CNS depression, avoid or limit alcohol
Food: Valproic acid may cause gastrointestinal upset; take with large amounts of water or food to decrease gastrointestinal upset. May need to split doses to avoid gastrointestinal upset. Food may delay but does not affect the extent of absorption. Coated particles of divalproex sodium may be mixed with semisolid food (eg, applesauce or pudding) in patients having difficulty swallowing; particles should be swallowed and not chewed. Valproate sodium oral solution will generate valproic acid in carbonated beverages and may cause mouth and throat irritation; do not mix valproate sodium oral solution with carbonated beverages.
Milk: No effect on absorption; may take with milk.
Sodium: SIADH and water intoxication; monitor fluid status. May need to restrict fluid.
Warnings/Precautions: Hepatic failure resulting in fatalities has occurred in patients; children under two years of age are at considerable risk; monitor patients closely for appearance of malaise, weakness, facial edema, anorexia, jaundice, and vomiting; may cause severe thrombocytopenia, bleeding; hepatotoxicity has been reported after 3 days to 6 months of therapy; tremors may indicate overdosage; use with caution in patients receiving other anticonvulsants.
Adverse Reactions:
1% to 10% experience:
Endocrine & Metabolic: Change in menstrual cycle
Gastrointestinal: Abdominal cramps, anorexia, diarrhea, nausea, vomiting, weight gain.
Less than 1% experience: Drowsiness, ataxia, irritability, confusion, restlessness, hyperactivity, headache, malaise, alopecia, erythema multiforme, hyperammonemia, pancreatitis, thrombocytopenia, prolongation of bleeding time, transient increased liver enzymes, liver failure, tremor, nystagmus, spots before eyes.
Overdose/Toxicology: Symptoms of overdose include coma, deep sleep, motor restlessness, and visual hallucinations. Supportive treatment is necessary. Naloxone has been used to reverse CNS depressant effects, but may block the action of other anticonvulsants.
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Coverage of ADD/ADHD Drugs and Their Side Effects