ADHD Medications (cont.)

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What are the precautions for ADHD drugs?

Precautions that are often taken when ADHD drugs are prescribed usually involve either reviewing recent lab work or requesting new lab work to make sure the person is healthy. The prescribing doctor might also ask that an electrocardiogram (EKG, ECG) or full evaluation by a cardiologist be done if the person has a personal history of heart problems or a family history of early heart disease near or under 50 years of age. The person taking the medication should be monitored for side effects. When stimulant medications are prescribed, the weight and blood pressure of the person should be monitored to ensure that excessive weight loss or significant increase in blood pressure has not occurred. For nonstimulant medications, precautions involve monitoring blood pressure to ensure that a significant decrease does not occur. If Wellbutrin is being considered to treat ADHD, the prescribing doctor will inquire about any history of eating disorder or seizures, since the risk of having seizures is significantly higher for those individuals if given Wellbutrin.

Are ADHD medications associated with drug interactions?

As with nearly every other kind of medication, ADHD medications can be associated with certain interactions with other medications. The amount of stimulant ADHD medication in the system can be particularly sensitive to how acidic substances are. Acidic substances like orange juice, tomato juice, and acidic medications decrease the amount of some stimulant medications in the system, and more basic substances like some diuretic antihypertensive medications can increase the levels of some stimulants.

Stimulants may cause blood thinners and antiseizure medications to remain at a higher level for longer and have an additive effect on medications used to treat psychosis. Fortunately, stimulant medications do not tend to change or be changed in terms of how they work or what they do when given with other, nonstimulant ADHD medications, like guanfacine, clonidine, or atomoxetine. However, other substances and medications that stimulate the nervous system can add to the effects of the stimulants. Examples of this are caffeine, ephedrine, and antidepressants like monoamine oxidase inhibitors (MAOIs). Stimulants should not be taken within 14 days of an MAOI.

Because of the way in which guanfacine is eliminated (metabolized) by the body, it can tend to increase the amount of medications like the antiseizure/mood stabilizer medication valproate. As with clonidine, that also is used as a blood pressure (antihypertensive) medication, caution is used when it is being given with other antihypertensives. Since both tend to slow down the nervous system, they also should be used with caution in people taking any sedative.

It is recommended that Wellbutrin never be combined with MAOIs or taken within 14 days of an MAOI because the result can be serious and even fatal reactions such as high body temperature, muscle rigidity, twitching, and agitation, resulting in delirium, and coma. If Wellbutrin or Effexor is taken with other drugs, the effects of either could be increased, decreased, or altered. Therefore, it is important that the prescribing doctor be informed of any other medications being taken.

REFERENCES:

Bussing, R., D.M. Mason, L. Bell, P. Porter, and C. Garvan. "Adolescent outcomes of childhood attention-deficit/hyperactivity disorder in a diverse community sample." Journal of the American Academy of Child and Adolescent Psychiatry 49.6 June 2010: 595-605.

De Sousa, A., and G. Kalra. "Drug therapy of attention deficit hyperactivity disorder: current trends." Mens Sana Monographs 10.1 January-December 2012: 45-69.

Docherty, J.R. "Pharmacology of stimulants prohibited by the world anti-doping agency (WADA)." British Journal of Pharmacology 154.3 June 2008: 606-622.

Jernigan, M.G., G.M. Kipp, A. Rather, et al. "Clinical implications and management of drug-drug interactions between antiretroviral agents and psychotropic medications." Mental Health Clinics 2.9 (2013): 70.

Mao, K. "Can medical cannabis stop the ADHD epidemic?" Waking Times Apr. 11, 2013.

National Institute on Drug Abuse 1. "Drug facts: is marijuana medicine?" National Institute on Drug Abuse 2012 July.

National Institute on Drug Abuse 2. "Regular marijuana use by teens continues to be a concern." National Institute on Drug Abuse 2012 December.

Physicians' Desk Reference Network. Physicians' Desk Reference, 67th ed. Montvale, New Jersey, 2013.

Roesch, B., M. Corcoran, M. Haffey, et al. "Pharmacokinetics of coadministration of guanfacine extended release and methylphenidate extended release." Drugs Research and Development 13.1 Mar. 2013: 53-61.

Wilens, T.E., N.R. Morrison, and J. Prince. "An update on the pharmacotherapy of attention-deficit/hyperactivity disorder in adults." Expert Review in Neurotherapy 11.10 Oct. 2011: 1443-1465.


Medically Reviewed by a Doctor on 8/21/2014


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