Stimulant medications are widely used to treat ADHD due to their effectiveness in improving focus and reducing impulsivity. However, like any medication, they can also come with side effects that vary in severity and impact. Understanding these side effects and knowing how to manage them is crucial for both patients and caregivers. Following are some of the most common side effects, along with suggestions for dealing with them.
- LOSS OF APPETITE
Description: It’s not unusual for kids who take ADHD medication to have a decreased interest in food and even forget to eat at times, most often at lunchtime.
Suggestions: To ensure adequate nutrition, encourage a full breakfast before taking the medication and offer a hearty dinner. For lunch, offer easy-to-eat foods such as protein granola bars, drinkable yogurt, smoothies, or cheese sticks. You can also supplement their diet with nutritional drinks, (e.g., Carnation Instant Breakfast) to provide additional nutrition and calories. Other options include Pediasure, Muscle Milk, or homemade smoothies with fruit, vegetables, and protein. Offer your child a healthy snack before bed, which will store the calories rather than burn them if eaten during the day. - DIFFICULTY FALLING ASLEEP
Description: Stimulant medications typically wear off after 8-10 hours. But even if the benefits of improved concentration have waned, your child may still feel alert and have trouble falling asleep. This side effect often resolves once a child gets used to the medication.
Suggestions: In the interim, it’s important to ensure a healthy bedtime routine that lets the body know it’s time for sleep. Limit screen time 1-2 hours before sleep. The bed should be used only for sleeping; this trains your child’s brain to know that when they get into bed it is only to sleep—not study, watch TV, surf the internet, or engage with social media. Try chamomile tea or warm milk to assist your child’s body to get ready for bed. Using a sound machine or soft music may help as well. If these strategies do not help, talk to your provider about using melatonin or magnesium supplements to assist with sleep onset. If difficulty falling asleep persists after three to four weeks on the medication, talk to your provider about possibly changing the medication as sleep is crucial in maintaining a healthy brain. - IRRITABILITY & MOOD CHANGES
Description: Because these medications increase dopamine to help the brain be more alert and concentrate better, they can also interfere with your child’s mood. They may find themselves feeling more irritable or annoyed while on the medication. They may also experience a “rebound” or “crash” at the end of the day when the medication wears off resulting in an increased level of ADHD symptoms.
Suggestions: This can usually be managed by either changing the medication or adding a short-acting dose of the medication at the end of the day to smooth out the elimination process. No child should feel like a “zombie” or behave like one on ADHD medication. If this occurs the dose is either too high or the medication is not the right fit for your child. If irritability or mood changes persist, it is important to reach out to your clinician to evaluate other potential causes for these behaviors. - HEADACHES
Description: When first starting medication your child may come home from school reporting a headache during the day or at the end of the day. Presuming they ate a full breakfast, the first question to ask is whether they ate or drank anything at school. If the answer is yes, and you feel it was an adequate amount, then the medication may be causing the headaches.
Suggestions: Headaches can be treated with acetaminophen (Tylenol) or ibuprofen (Motrin). If they occur daily or persist after being on the medication for a while, then talk to your clinician about making adjustments to the medication. - DRY MOUTH
Description: The medication can cause a decrease in saliva, which causes a dry mouth with a potentially unpleasant taste and odor.
Suggestions: To avoid this, it is best to stay hydrated, suck on hard candies or chew gum. It is important to keep regular dental cleanings as persistent dry mouth can lead to increased cavities. - ANXIETY
Description: The stimulants can cause some individuals to feel edgy or anxious while taking the medication. They can also increase symptoms of underlying anxiety in some patients.
Suggestions: Often the dose can be adjusted to reduce these symptoms but if they persist, changing the medication is warranted. - INCREASED HEART RATE & BLOOD PRESSURE
Description: There may be a temporary increase in heart rate and blood pressure while taking stimulants. Typically such increases are slight and do not cause any heart-related issues.
Suggestion: If the increase is significant, accompanied by a racing heart, modification to the medication is warranted. - REDUCTION IN HEIGHT
Description: Multiple studies have looked at the long-term effect of stimulants on adult height. The consensus is that the drop in appetite limits bone growth, but this is a short-term process that does not impact adult height.
Suggestion: In most individuals, the use of stimulants does not impair height potential, but in some individuals who are having slow growth, use of stimulants may be contraindicated.
All medications—whether over-the-counter, herbal, or prescribed—come with the potential for side effects. It is important to communicate with your prescriber when side effects arise so they can be addressed appropriately.
Ellen Fahey is a board-certified family nurse practitioner with a doctorate degree from Columbia University in Nursing Practice. She works at Sasco River Group in Darien CT, caring for pediatric and adult patients with ADHD and associated disorders. Dr. Fahey is also full-time faculty and assistant director of the Family Nurse Practitioner Doctor of Nursing Practice program at Columbia University School of Nursing.