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ADHD Prescription Drugs (cont.)

Medical Editor:

What are the warnings/precautions when using ADHD drugs?

Before starting any medication, a doctor should know a patient's full medical history such as drug allergies, medical conditions, current medication use, and whether the patient is pregnant, trying to get pregnant, or nursing.

With stimulants there is the risk of sudden cardiac death, especially in patients with existing structural abnormalities. Stimulants may be linked to suppression of growth in children, thus height and weight should be monitored during treatment. These medications may exacerbate psychosis in patients. And stimulants are potential drugs of abuse.

Atomoxetine may cause suicidal thinking in children and adolescents. It can also cause severe liver injury. Signs of liver injury include abnormal liver function tests, jaundice, dark urine, itching, and tenderness in the liver area of the abdomen. Patients with high blood pressure or cardiac abnormalities should be closely observed while on atomoxetine as it can increase blood pressure and heart rate.

Atomoxetine may inhibit growth in children. Therefore, height and weight of pediatric patients should be monitored while this drug is in use. Painful and prolonged erections may occur in pediatric and adult male patients using atomoxetine. Prompt medical attention is needed for this condition, known as priapism. Using atomoxetine may cause urinary retention or hesitancy. Patients taking atomoxetine should be monitored for possible drug-induced changes in perception and behavior, including hallucinations, delusions, mania, aggressiveness, or hostility. Caution is especially advised in patients with bipolar disorder.

Withdrawing clonidine suddenly may result in severe “rebound” high blood pressure, as well as other symptoms, including nervousness, agitation, tremor and headache. Doses should be reduced over two to four days. Of particular concern are children who are unable to take prescribed doses of clonidine because of acute gastrointestinal illnesses with vomiting. Clonidine may cause drowsiness. Patients should use caution if driving or engaging in activities that require alertness. Clonidine should be used with caution in patients with pre-existing cardiac or renal disease.

Guanfacine carries warnings similar to clonidine, although sudden withdrawal of the drug is not as likely to lead to severe hypertension.

Tricyclic antidepressants (TCAs) may increase suicidal thinking and behavior, and death may occur with an overdose of these drugs. TCAs should not be used in patients immediately following a heart attack and should always be used with caution in those with pre-existing cardiac issues. TCAs may affect blood sugar levels. Some TCAs heighten sensitivity to sunlight, and so patients should avoid excessive exposure.

When taking bupropion, patients, especially younger ones, should be monitored for changes in behavior, worsening of their conditions, and/or suicidal thoughts. Bupropion may trigger seizures, especially at higher doses. It may also trigger seizures in normal doses in patients who have or have had anorexia nervosa or bulimia. Its use in those patients is contraindicated. Doses of bupropion should be reduced in patients with kidney or liver disease. And bupropion should not be used in patients abruptly stopping alcohol or sedative use.

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