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ADHD Prescription Drugs (cont.)

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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. These medications may exacerbate psychosis in patients. Stimulants, as mentioned earlier are potential drugs of abuse.

Atomoxetine 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.

Painful and prolonged erections may occur in 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.

Guanfacine can cause drowsiness. Patients should use caution if driving or engaging in activities that require alertness. It should also be used in caution in patients with pre-existing cardiac or renal disease, or severe hepatic disease.

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 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. Bupropion should not be used in patients abruptly stopping alcohol or sedative use.

Contraindications and Black Box Warnings for Stimulants

Contraindications
Administration of stimulants can lead to physical and psychological drug dependence. Therefore methamphetamine is contraindicated in patients with a history of alcoholism.

Dexmethylphenidate and methylphenidate are contraindicated in patients with anxiety since they can worsen this condition.

Dextroamphetamine/amphetamine, dextroamphetamine and methamphetamine are contraindicated for use in patients with arteriosclerosis due to the risk of sudden death.

Methamphetamine and methylphenidate are contraindicated for use in patients with cardiac disease. These stimulants can cause an increase in blood pressure and heart rate and can lead to myocardial infarction and sudden unexplained death (SUD). Methamphetamine also has a Black Box Warning for this reason.

Dextroamphetamine/amphetamine, dextroamphetamine, dexmethylphenidate, methamphetamine and methylphenidate are contraindicated in people with glaucoma due to the risk of visual disturbances and blurred vision. This is because stimulants can block the outflow of aqueous humor (eye fluid) and increase intraocular pressure.

Atomoxetine is contraindicated in closed-angle glaucoma due to the risk of mydriasis (pupil dilation).

Methylphenidate (Metadate CD) contains sucrose and is contraindicated in patients with hereditary fructose intolerance, glucose-galactose malabsorption, and sucrase-isomaltase insufficiency.

Stimulation of the sympathetic nervous system by dextroamphetamine/amphetamine, dextroamphetamine, methamphetamine and methylphenidate can cause cardiac arrhythmias. Therefore, they are contraindicated for use in patients with hyperthyroidism.

Atomoxetine, dextroamphetamine/amphetamine, dextroamphetamine, dexmethylphenidate, lisdexamfetamine and methamphetamine are contraindicated with concurrent use or use within 14 days of MAOI therapy since the increase of norepinephrine in neuronal storage sites can cause hypertensive crisis. (MAOI – monoamine oxidase inhibitors) such as selegiline.

Atomoxetine is contraindicated in patients with pheochromocytoma. Atomoxetine can cause serious reactions, including increased blood pressure and tachyarrhythmia in these patients.

Dextroamphetamine/amphetamine, dextroamphetamine and methamphetamine are contraindicated in patients with a history of substance abuse since stimulants can cause physical and psychological drug dependence. Dextroamphetamine/amphetamine and dextroamphetamine also have a Black Box Warning for this reason.

Dexmethylphenidate and methylphenidate are contraindicated in patients with tics or Tourette's syndrome (including a family history of Tourette's syndrome) since they may worsen these conditions.

Black Box Warnings
Dexmethylphenidate and methylphenidate should be used cautiously in patients with a history of alcoholism because prolonged administration can lead to physical and psychological drug dependence.

Dextroamphetamine/amphetamine, dextroamphetamine and methamphetamine should not be used in patients with cardiac disease. These stimulants can increase blood pressure and heart rate and lead to myocardial infarction and sudden unexplained death (SUD).

Dextroamphetamine/amphetamine, dexmethylphenidate, lisdexamfetamine and methylphenidate should be used cautiously in patients with a history of substance abuse because prolonged administration can lead to physical and psychological drug dependence. Dextroamphetamine/amphetamine has a high potential for abuse and is contraindicated for use in this setting.

General
Methylphenidate and atomoxetine have been associated with priapism. Patients should be counseled on the signs and symptoms of priapism and seek immediate medical attention if an erection lasts more than 4 hours.

Medically Reviewed by a Doctor on 10/24/2014


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