Side effects and monitoring treatment
Side effects and monitoring treatment
Overall, ADHD medications are well-tolerated. Most side-effects occur during initiation and with dose increases but tend to subside after a week or two. It is therefore very important that these side-effects are explained to the parents and patient and advice given on what to do if they occur.
Suicide-related behaviour has been reported more frequently in patients taking atomoxetine (although still an uncommon occurrence). Parents and patients should be warned to look out for any worrying thoughts or behaviours and seek help immediately.
There have been some very rare reports of liver injury. Liver function tests are not routinely carried out before initiation of atomoxetine but parents and patients should know to look out for signs of potential liver injury (e.g. unexplained nausea, vomiting, abdominal pain, dark urine, yellow discolouration) and report any suspicious findings immediately.
Patients on a stable medication dose still need their weight, height, blood pressure and pulse monitored and plotted on centile charts. The frequency of this varies depending on age and other clinical needs but typically tends to be three to six-monthly. Those having their medication or dose adjusted will need to be monitored more closely – ideally within four weeks of a change but, in reality, it will be longer due to the availability of appointments.
| Table 2: Common ADHD medication side-effects & their management | ||
| Side-effect | What the patient/parent may describe | Advice |
| Headache | Head is pounding or painful | If associated with initiation or dose increase, usually diminishes after a week or two. Try paracetamol |
| Loss of appetite | Weight loss, not eating, not feeling hungry | If associated with initiation or dose increase, usually diminishes over time. Loss of appetite is often associated with length of action of the drug. Advise parents to encourage a good breakfast and evening meal (when medication levels are lower). Stress calorie supplementation such as full-fat milk, generous use of butter, double cream, pastry, milkshakes |
| Nausea, vomiting and abdominal pain | Feeling sick, being sick, abdominal pain | If associated with initiation or dose increase, usually diminishes after a week or two. Advise to persevere if possible. Taking medication after food may help. |
| Nervousness | Feeling anxious, nervous, tearful | If associated with initiation or dose increase, usually diminishes after a week or two. Advise to persevere if possible |
| Insomnia | Can't get to sleep or getting to sleep later than before | Provide advice on sleep hygiene and relaxation techniques. If it continues, need to discuss with a clinician |
| Aggression/change in mood | Irritable, hostile, low mood, thoughts of self-harm | Could be related to medication. Ask parent/patient to speak to their secondary care clinician as soon as possible |
NB: While these are common side-effects associated with ADHD medication, if there is a suspicion of an underlying problem, refer parents to the GP or secondary care clinician.
Reflection exercise
Progressing from adolescence into adulthood with ADHD is challenging.
The ADHD Foundation’s ‘ADHD in adults: a guide for successfully living with ADHD' is a useful resource.
Briefly summarise this information for other members of your team and discuss with them how having greater awareness of how ADHD can manifest itself in adults can help you to support patients whose ADHD medication you are supplying.
The ADHD Foundation is a source of comprehensive information on the disorder.