Physicians were more likely to believe that side effects are easily managed if they were child and adolescent psychiatrists, which suggests that those who have more experience in treating children and adolescents with attention deficit disorder are more confident in managing stimulant side effects.

Longer-acting drug formulations used once daily are often preferred, to avoid the need to take medication during the daytime, and to minimize side effects. Lisdexamfetamine, sold as Vyvanse, is a new amphetamine which has been shown to work for up to ten hours in children and adults with ADHD. It has a side effect profile similar to other longer-acting amphetamine drugs.

Dr. Brian J. Cowles from the Albany College of Pharmacy and Health Sciences, Vermont, believes that owing to its unique composition, lisdexamfetamine “may lead to a possible reduction of abuse potential.” He says that side effects linked to lisdexamfetamine include decreased appetite, insomnia, irritability, weight decrease, headache, and upper abdominal pain. These tend to occur most at the start of treatment, or following an increase in dose.

A further study confirmed that over 95 percent of side effects occurrences for all doses of lisdexamfetamine are mild or moderate. But nine percent of the 272 children in the study discontinued treatment due to the drug’s side effects.

Research has also looked at the long-term side effects of ADHD medications. A 2007 review examined the evidence and found possible links to appetite and growth, both height and weight. Loss of appetite has been reported in up to 60 percent of children on stimulant drugs. Two major reviews examined all the available data and both concluded that stimulants may be associated with a reduction in expected height gain, at least in the first three years of treatment.

But Dr. Willemijn M. Meijer of the PHARMO Institute in Utrecht, The Netherlands, says the deficits in height and weight “do not appear to be a clinical concern for most children treated with stimulants.” He adds that, “The importance of good nutrition should be pointed out to parents.”

Fears have also been raised about potential long-term effects of stimulant drugs on the heart and on the child’s developing brain. But the available data on these outcomes is limited, so the true effects are still unknown. So far, long-term studies have been inconclusive or contained methodological flaws, so further information is needed. Drugs used to treat attention deficit disorder are generally considered safe and effective.

References

Cascade, E., Kalali, A. H. and Wigal, S. B. Real-World Data on: Attention Deficit Hyperactivity Disorder Medication Side Effects. Psychiatry (Edgmont), Vol. 4, April 2010, pp. 13-15.

Stockl, K. M. et al. Physician perceptions of the use of medications for attention deficit hyperactivity disorder. Journal of Managed Care Pharmacy, Vol. 9, September-October 2003, pp. 416-23.

Cowles, B. J. Update on the management of attention-deficit/hyperactivity disorder in children and adults: patient considerations and the role of lisdexamfetamine. Therapeutics and Clinical Risk Management, Vol. 5, 2009, pp. 943-48.

Domnitei, D. and Madaan, V. New and extended-action treatments in the management of ADHD: a critical appraisal of lisdexamfetamine in adults and children. Neuropsychiatrtric Disease and Treatment, Vol. 6, May 25, 2010, pp. 273-79.

McDonagh, M. S. et al. Drug Class Review on Pharmacologic Treatments for ADHD: Final Report. Portland Oregon Health & Science University, December 2007.

Meijer, W. M. et al. Current issues around the pharmacotherapy of ADHD in children and adults. Pharmacy World and Science, Vol. 31, October 2009, pp. 509-16.

Side Effects of ADHD Medications