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ADHD Drugs: An Overview

The Bottom Line

"ADHD" stands for "attention deficit hyperactivity disorder". Symptoms include hyperactivity, impulsiveness, and inability to pay attention, manage frustration, stay organized, or focus on tasks. Treatment is based on behavior therapy and/or drug therapy. ADHD drugs can cause side effects; a deliberate overdose of any amount requires immediate medical care.

The Full Story

Poison Control gets several types of calls about ADHD drugs:

  • A child took a double dose of his ADHD medicine.
  • A child swallowed her sister's ADHD medicine.
  • A college student was cramming for exams and took his roommate's medicine.
  • A teen swallowed a handful of her own pills for ADHD.

When is an overdose a problem? As with so much in the Poison Control world, the answer is, "It depends."  webPOISONCONTROL® and poison specialists figure it out, case by case, each time someone logs on or calls.

What is ADHD?

"ADHD" stands for "attention deficit hyperactivity disorder". Children (and adults) with this condition have some combination of symptoms including hyperactivity, impulsiveness, and inability to pay attention, manage frustration, stay organized, or focus on tasks. Their behavior is disruptive at home, in school, and in other settings. Because of this, they may have difficulty learning even though they have normal intelligence. Treatment is based on behavior therapy and/or drug therapy.

Recently, the American Academy of Pediatrics (AAP) recommended that pediatricians screen children as young as four years old if they have symptoms suggestive of ADHD. Previously, most of the focus was on older children.

ADHD is a biological condition and appears to be genetic, at least in part. Symptoms are caused by changes in the activity of certain brain chemicals (neurotransmitters), particularly dopamine and norepinephrine. Drug treatments specifically address the action of these neurotransmitters.

Drugs for ADHD

Drugs to treat ADHD fall into two categories: stimulant and non-stimulant.

  • Stimulant drugs include amphetamine and methylphenidate. Common brand names include Adderall®, Ritalin®, Dexedrine®, Vyvanse®, Focalin®, Metadate®, Concerta®, and Daytrana® (skin patch).
  • Non-stimulant drugs include atomoxetine (Strattera®), guanfacine (Tenex®, Intuniv®), and clonidine (Catapres®), sometimes prescribed for ADHD but not approved by the FDA for this condition.

Short-acting forms are effective for a few hours. Extended-release preparations will last for several hours, for example, during an entire school day. The drugs come in several dosage strengths. Often, a low dose will be used at first and increased as needed. Different patients respond better to different drugs, so there may be some trial-and-error when developing a treatment schedule. Some children need more than one ADHD drug to control their symptoms. If necessary, children can take medicines for other mental health conditions while they are treated for ADHD.

The right drug(s) can be very effective when managing ADHD symptoms. But, like all drugs, ADHD drugs can cause side effects.

  • The most common side effects of stimulant drugs include loss of appetite, stomach pain, and difficulty sleeping. These effects often lessen over time. Changes in dosing times may relieve some of these effects. Children can have a slightly faster heart rate and slightly increased blood pressure. Sometimes, children don't grow quite as fast, but this is usually temporary.
  • There are rare reports of effects on the heart; this is one of many reasons why children will be monitored closely by their doctors. A recent study of ADHD drugs found "no evidence" that using an ADHD drug increased a child's risk of heart attack, stroke, or sudden cardiac death.
  • Atomoxetine can cause drowsiness, stomach upset, and loss of appetite. These side effects usually lessen over time. Children on this drug need blood tests to check their liver function. There are some cases when children on this drug considered suicide; this is rare but must be watched for.
  • Guanfacine and clonidine both are used to treat high blood pressure in adults. Children who take either of these for ADHD need to have their blood pressure monitored. These drugs can also cause fatigue and agitation or nervousness.

Overdose of ADHD drugs

When someone takes an overdose, the effects depend on the exact drug, the amount involved, whether it's the child's own medicine, and whether any other medicines were taken. A child who mistakenly gets his own low-dose medicine twice might not need treatment. On the other hand, if the pills contain a lot of medicine, even a double dose might be too much. The same is true for a child who takes a sibling's medicine. A single low-dose pill might sometimes be all right, while a higher dose might require treatment.

A high school or college student who takes a friend's medicine may or may not have serious effects, depending on the drug and the dose. But, it's NEVER a good idea to take someone else's medicine! Even a "normal" dose could cause harmful effects or interact with other drugs.

A deliberate overdose of any amount requires immediate medical care. Call 1-800-222-1222 right away to reach the poison specialists, even if the person seems OK.

Safe use of ADHD drugs

Preschool children: Some ADHD drugs are FDA-approved for children as young as three. To prevent an overdose:

  • Replace the child-resistant cap tightly after giving the medicine.

  • Lock the bottle high, out of sight and reach of children.

  • Teach the child that this is medicine, not candy. Children should take it ONLY from a parent or caregiver.

  • Read the label before giving the medicine, each and every time.

  • If more than one adult gives medicine to a child, develop a system to prevent double-dosing.

Elementary school children:

  • Parents and adult caregivers should give medicine to a child. Children should not be allowed to take their own medicine until parents are certain that the child understands how to take medicine safely.
  • Secure medicines between doses. Children as young as middle school age have distributed their own ADHD drugs to friends and classmates.

High school and college students, young adults: Abuse of ADHD drugs in this age group is rampant and well documented. Sometimes, the drugs are taken without a prescription in an attempt to improve academic or athletic performance. Some students take these drugs recreationally in large amounts, often combined with alcohol, cocaine, or methamphetamine. Such poisonings can cause a very high body temperature, seizures, heart attack, stroke, and death.

Parents and health care providers must teach that prescription drugs for ADHD (and other conditions) cannot be shared safely or legally. Medical consequences can be catastrophic and legal consequences can be severe, as well.

Rose Ann Gould Soloway, RN, BSN, MSEd, DABAT emerita
Clinical Toxicologist


For More Information

Information for parents about ADHD and its treatment (AAP)

References

American Academy of Pediatrics. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011;128(5):1007-1022.

Antshel KM, Hargrave TM, Simonescu M, Kaul P, Hendricks K, Faraone SV. Advances in understanding and treating ADHD. BMC Medicine. 2011;9:72 [12 pages]. 

Cooper WO, Habel LA, Sox CM, Chan KA, Arbogast PG, Cheetham TC, Murray KT, Quinn VP, Stein CM, Callahan ST, Fireman BH, Fish FA, Kirshner HS, O’Duffy A, Connell FA, Ray WA. ADHD drugs and serious cardiovascular events in children and young adults. NEJM. 2011;365:1896-1904.

Kaplan G, Newcorn JH. Pharmacotherapy for child and adolescent attention –deficit hyperactivity disorder. Pediatr Clin N Am. 2011;58:99-120.

National Institute on Drug Abuse. NIDA DrugFacts: Stimulant ADHD medications - methylphenidate and amphetamines. January 2014.

Novak SP, Kroutil LA, Williams RL, Van Brunt DI. The nonmedical use of prescription ADHD medications: results from a national internet panel. Substance Abuse Treatment, Prevention, and Policy. 2007;2:32.

Wilens TE, Adler LA, Adams J, Sgambati S, Rotrosen J, Sawtelle R, Utzinger L, Fusillo S. Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature. J Am Acad Child Adolesc Psychiatry. 2008;47:21-31.

Poisoned?

Call 1-800-222-1222 or

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Prevention Tips

Preschool children: Some ADHD drugs are FDA-approved for children as young as three. To prevent an overdose:

  • Replace the child-resistant cap tightly after giving the medicine.
  • Lock the bottle high, out of sight and reach of children.
  • Teach the child that this is medicine, not candy. Children should take it ONLY from a parent or caregiver.
  • Read the label before giving the medicine, each and every time.
  • If more than one adult gives medicine to a child, develop a system to prevent double-dosing.

Elementary school children:

  • Parents and adult caregivers should give medicine to a child.
  • Secure medicines between doses.

High school and college students, young adults:

  • Parents and health care providers must teach that prescription drugs for ADHD (and other conditions) cannot be shared safely or legally.

This Really Happened

Case 1: A 13-year-old boy was brought to the emergency room by his mother with heart palpitations and anxiety. He admitted that he bought Adderall® (a combination of amphetamines, central nervous system stimulants that affect brain chemicals that contribute to hyperactivity and impulse control) 60 mg from a friend and took it several hours before. In the emergency room, in addition to his complaint of heart palpitations, he was vomiting and had a fast heart rate. A urine drug screen confirmed the presence of amphetamines. His symptoms resolved with supportive care, including intravenous fluids.

Case 2: A 26-year-old man was prescribed Adderall® (a combination of amphetamines, central nervous system stimulants that affect brain chemicals that contribute to hyperactivity and impulse control) 20 mg 3 times a day but was chronically abusing the medication. He reportedly was taking up to 180 mg a day. He was brought in to the emergency room by his family who were concerned about his strange behavior. He was agitated, having abnormal muscle movements, and complaining of chest pain. His blood pressure (BP) was initially 183/113 and his heart rate (HR) was in the 120s. Poison Control provided drug toxicity information to the emergency physician and recommended liberal use of sedation and intravenous fluids (IVFs). He was treated with both lorazepam (one of a group of drugs called benzodiazepines, used to treat anxiety and in such a case as this, agitation) and IVFs. He became calmer and his BP and HR came down. A heart attack was ruled out and he was admitted to the psychiatric unit.