Managing Medications

ADHD Medication Side Effects No One Should Tolerate

Common side effects of ADHD medication include sleeplessness, loss of appetite, and tics — problems that no child should have to tolerate. Learn what to expect and how to adjust your child’s ADD treatment plan for the best results.

Child tired on bench

The right ADHD medication can make life much easier for children and adults who have attention deficit hyperactivity disorder (ADHD or ADD). But ADHD medications can also make things worse and cause severe side effects, including headaches, sleep problems, and a blunted appetite.

Some people (including more than a few doctors) seem to assume that ADHD medication side effects are merely the price to pay for taking a prescription. I couldn’t disagree more. No one should have to put up with side effects of ADHD meds. Often, a simple adjustment in the way a medication is used is all it takes to remedy the problem.

In this article, I’ll explain the strategies that I’ve found particularly effective at controlling ADHD medication side effects in children — which, by the way, also work for adults with ADHD. Try the strategies with your own child, or yourself. Tell your doctor what you are doing — to see what additional help he or she can provide.

What Are the ADHD Medication Side Effects for Stimulants?

Methylphenidate (Ritalin), dextro-amphetamine (Dexedrine, Evekeo), and dextro-amphetamine/levo-amphetamine (Adderall, Adzenys) have similar side-effect profiles, and the strategies that curb side effects for one medication generally work for the other two, as well.

Side Effect: Loss of Appetite

Along with difficulty falling asleep at night (see below), loss of appetite is the most common side effect of stimulant meds. This problem often clears up on its own within a few weeks, so I usually recommend a wait-and-see approach. If the problem persists, don’t delay taking action — especially if the appetite loss is severe enough to trigger decrease in total body mass, or, in a growing child, failure to grow appropriately.

[Get This Free Resource: A Parent’s Guide to ADHD Medications]

First, observe your child’s eating patterns. Breakfast often goes well because the first dose of the day hasn’t yet kicked in. Lunch is likely to be a lost cause, nutrition-wise. Ditto for dinner. Your child probably becomes very hungry around 8:00 p.m., when the evening dose wears off.

There may be little you can do to boost your child’s appetite in the middle of the day (when medication is at maximum effectiveness). So instead of worrying about what gets eaten at lunch, create nutritional “windows of opportunity” at other times of the day.

For example, get a good, healthful breakfast into your child before the first dose of the day kicks in. Hold off on the 4:00 p.m. dose until 5:00 or 6:00 p.m. (During this time, you’ll have to provide more structure and supervision — and don’t expect homework to be done.) Your child’s appetite may return in time for dinner. Then give the third dose.

Does your child eat lots of sweets? If so, getting him to cut back should boost his appetite for more nutritious fare.

[Read: The Sugar Wars: How Food Impacts ADHD Symptoms]

Another way to make sure your child is getting adequate nutrition is to offer a food supplement drink instead of nutritionally empty snacks — or in place of a meal that is likely to go uneaten. These tasty beverages, such as Pediasure and Ensure, come in different flavors. They can be made into milk shakes or frozen to make pops.

If these approaches don’t work, ask your doctor about trying a different stimulant. For reasons that remain poorly understood, some children who experience a loss of appetite while taking one stimulant medication experience no such loss on another.

If switching stimulants doesn’t help, ask your doctor about moving on to a non-stimulant.

Side Effect: Sleeplessness

For some kids, difficulty falling asleep is truly a side effect of stimulant medication. But other kids are kept awake at night by a lack of medication. That is, once the last dose of the day wears off, these children return to “being” ADHD. They feel restless, hear every sound, and find it impossible to “turn off” their brain.

There’s no easy way to tell which of these scenarios explains your child’s sleep problem. To find out, you’ll have to do a little trial-and-error: Pick an evening when sleeplessness is unlikely to prove disastrous (that is, when your child can sleep late the following morning). Have your child take an additional dose of her usual stimulant around 8:00 p.m.

If your child goes right to sleep, it’s a safe bet that her sleeplessness has been caused by a lack of medication. You should be able to remedy this problem simply by continuing with the extra evening dose.

Sometimes even the stimulant medications are not strong enough to overcome the severe restlessness that sometimes comes with ADHD.  The standard response when this happens is to directly lower the hyperarousal component of ADHD using medications called alpha agonists.  The medications guanfacine and clonidine are FDA-approved to lower the hyper-active component of ADHD and can be very effective for both hyperarousal during the day and sleep problems at night. Talk with your clinician about whether a trial on an alpha agonist might be helpful.

What if the sleep problem persists? See what happens if you reduce the 4:00 p.m. dose or give it up entirely. Of course, this might cause your child’s ADHD symptoms to flare up in the evening. If so, ask the doctor about trying a non-stimulant medication.

Some people with ADHD have a paradoxical or reverse response to stimulant medications.  Instead of being further revved up, the stimulant medications shut off the mental and physical restlessness caused by ADHD and allow normal sleep.  Many ADHD clinicians suggest a trial after the optimal dose of medication by asking the patient to nap about 30 minutes later.  People with ADHD who cannot normally nap during the day may find that stimulant medication turns off the chatter in their heads and allows them to fall asleep. For these patients, it is clear that the ADHD medication helps with ADHD-based sleep problems rather than making sleep more difficult. The person may still have difficulty with sleep, but the cause is not the stimulant medication.

Side Effect: Stomachaches or Headaches

No one knows why stimulants cause these problems in some children and adults. But often it’s helpful if the patient eats something before taking the pill. If the problem persists, it may be necessary to try a non-stimulant medication.

Side Effect: Tics

These sudden, involuntary muscular contractions typically involve the eyes, face, mouth, neck, or shoulders. If the muscles in the throat are involved, the tic might cause sniffing, humming, or coughing. In many cases, children start experiencing tics shortly after starting on a particular medication.

The medication that is the most potent trigger for tics is not an ADHD stimulant, but rather caffeine.  If a tic develops, many clinicians do nothing for two weeks since the natural history of tics is to come and go on a 2-week cycle. During that two weeks caffeine is removed from the diet (coffee, tea, energy drinks, No-Doz, etc.).  More than half of people will lose their tics.  If dietary manipulation is not successful, a trial on clonidine that is FDA-approved for both ADHD and tics can often lower the tic to the point that it is no longer disruptive or embarrassing.

If tics continue, stop the medication and try another one. In most cases, the tics will go away within several weeks. If there is a family history of tic disorder, however, the tics may not go away. (That’s why doctors generally avoid giving stimulant meds to kids with a family history of tics.)

Side Effect: Emotional Problems

When the dosage is too high, stimulants can cause children or even adults to seem “spacey” or “zombie-like,” or to be uncharacteristically tearful or irritable (a condition known as emotional lability). In general, the best way to rein in these side effects is simply to lower the dosage.

If reducing the dosage causes your or your child’s ADHD symptoms to reemerge, ask your doctor about trying another stimulant; just because one stimulant causes emotional problems doesn’t mean that others will. If all stimulants cause problems, you’ll have to move on to a non-stimulant.

Side Effect: Rebound

Some children experience 30 to 60 minutes of hyperactivity, impulsivity, and nonstop talking a half hour or so after the last dose of the day wears off. You may be able to avoid this problem by reducing this last dose.

Another helpful strategy is to add another short-acting dose to the regimen at 4:00 or 8:00 p.m. If this additional evening dose fails to help — or if it causes sleep problems — it’s probably best to switch your child to a non-stimulant medication.

Side Effect: Anxiety/Depression

25 studies of childhood comorbidity of ADHD and anxiety showed that anxiety improved when a stimulant to treat the ADHD was added.  Stimulants are similarly added to augment treatment for depression in some cases.  In some cases, however, stimulants may worsen mania and that of a psychosis of unknown etiology in which case stimulant medication should be stopped.

What Are the Side Effects of ADHD Non-Stimulant Medications?

If stimulants cannot be used because their side effects prove uncontrollable, consider using one of the non-stimulant medications. Some patients experience side effects on both stimulants and non-stimulants. In this case, combining much smaller doses of a stimulant and a non-stimulant might be the solution.

Tricyclic Antidepressants

Along with bupropion (Wellbutrin), three tricyclics are used to treat ADHD: Imipramine (Tofranil), desipramine (Norpramine), and nortriptyline (Pamelor). However, the effect size for these medications is barely detectable and for this and the high side effect burden described below these medications are not optimum for ADHD treatment.

Fatigue is the most frequent side effect of these four drugs. Fortunately, this problem typically diminishes over the first several weeks. If not, ask your doctor about reducing the daily dosage, or dividing one large dose into three smaller doses — one to be taken in the morning, another at about 4:00 p.m., and the third at bedtime. If divided doses don’t help, your doctor may wish to prescribe another tricyclic.

Bupropion and the tricyclics can also cause constipation, dry mouth, or blurred vision. These “cholinergic” effects often respond to symptomatic treatment. That is, eating high-fiber foods or taking a fiber supplement might eliminate constipation, throat lozenges might help moisten a dry mouth, and so on.

If these approaches fail, try another medication. Unlike the stimulant medications, tricyclic medications must be tapered off slowly. Stopping abruptly can cause aches and other flu-like symptoms.

Very rarely, these medications cause the patient to wake up at 4:00 to 5:00 a.m. and be unable to go back to sleep. If reducing the evening dose or giving it a bit earlier fails to ease this “early morning wakefulness,” try another non-stimulant medication.

In some children, tricyclics can affect brain wave activity. If your child has a seizure disorder, a tricyclic might exacerbate the problem. Discuss this matter with your doctor before starting your child on a tricyclic.

Tricyclics have also been known to affect the electrical conduction pattern within the heart, triggering a rapid pulse. The Am Acad. of Pediatrics recommends that a child have an ECG before starting a Tricyclic Antidepressant and another ECG one month after achieving a steady blood level.  If you are concerned, discuss this with your family doctor.

Alph agonists

The blood-pressure drugs clonidine (Catepres) and guanfacine (Tenex) help control impulsivity in certain people with ADHD.  The alpha agonists compliment the stimulants and are usually added to a finely tuned stimulant rather tha used as a stand-alone medication. The alpha agonists lowering hyperarousal that is manifested both in physical behavior and in the mental hyperarousal that is experienced as having multiple simultaneous thought constantly.  Finally, they can also be very effective for emotional over-reaction and vulnerability to rejection and criticism.

However, these alpha agonists can cause daytime sedation. If this occurs, reducing the dose or spreading it out over the day may solve the problem. If not, ask your doctor about trying another non-stimulant medication.

Atomoxetine (Strattera)

It can cause stomachaches, decreased appetite, nausea, vomiting, dizziness, fatigue, and mood swings. These problems often go away over time. If not, try lowering the dosage or replacing a once-a-day dosing regimen with several smaller doses during the day.

If these steps fail, try a different non-stimulant medication.

Side Effects of ADHD Medication: Next Steps

16 Comments & Reviews

  1. You wrote that guanfacine and clonidine are beta-blockers. They are alpha2-agonists, not beta-blockers. It is an important distinction to make. Beta-blockers should not be taken alongside stimulant medication because they may lead to hypertension.

  2. It should be noted that just because an individual has issues on one stimulant doesn’t mean they will on the other. It should also be noted that there are things that can be done to get the body to over ride some side effects. Like appetite loss. Stick to an eating schedule, if you aren’t hungry eat an apple or something small but healthy. Over time, you can train your body to have an appetite. Some anti-depressants also cause appetite loss. At least with sleeplessness and appetite loss, unless it is severe (no longer eating/sleeping) give it a couple weeks to a month. Sometimes the body just needs to adjust and will build up a bit of a buffer against the side effects.

  3. You really seem to think that just throwing medication at all of these things will help solve problems. “Give the kid Benadryl, something not approved for this use,” when you could supply melatonin pills(or even gummies special made for kids!) which is already produced by your body to make you sleepy. Sometimes these problems aren’t caused by ADHD or the medication by the way(such as sleeplessness. I don’t sleep because I don’t want to sleep, I still get tired, but it’s blamed on my ADHD), and certain things like rebound should just be ridden out instead of just drugging your kid again.
    I’m not anti-ADHD medication, but you seem to recommend solving any problem the kid has with their disorder by throwing more medication at it, which doesn’t seem healthy to me.

    1. I agree that medicine isn’t the ultimate or only answer. Treating your ADD/ADHD with medicine may be necessary howerever, you can’t rely on the medicine alone — it’s not a miracle fix-all. The psychologist who first diagnosed me with ADD suggested what she called ‘Coping and Compensating.’ She said you had to learn strategies to implement in your life to help control your ADD. Things like having a schedule, finding ways to hold yourself accountable for tasks, writing down things you need to remember and setting alarms/reminders for them. She said the meds would make it easier for me to control my ADD, but that it was ultimately my choices and lifestyle that controlled my ADD. That’s not to say I don’t still struggle with it though — I do! It’s easy to say I need to implement changes and strategies in my life, but it’s much harder to actually do so and to figure out which strategies work for me and which ones don’t.

  4. I have same problem I take add meds I take concerta I get heart racing and loss hunger and I get hungry at dinner time one I’m off the pill I feel happy I get my hunger up I gain 15 pounds off the meds I only weigh 100 now up to 15 pounds I just worried if I go back to lose weight

      1. Have you thought about either not taking the med every day or taking the med only part of the day? Sometimes that works, and sometimes the meds cause extended loss of appetite after the meds wear off. My friend noticed I wasn’t eating properly, or much at all, last year. She had the same issue with her meds and weight that you have. She found that sometimes she had to remind her body that it was actually hungry and did indeed want food. This may sound really strange, but when she and I weren’t hungry but needed to eat she would get us ice cream bars. I don’t know why, but a little bit after we ate the ice cream bars we would start to get a little bit hungry and actually be interested in eating. So we ended up getting ice cream bars then lunch pretty frequently that semester, and it seemed to help us with that side effect. It also helps just to have someone or something to remind you to eat (even if it’s just a couple of small but nutritious snacks instead of a meal) like an alarm set for certain times of the day or a co-worker who reminds you to eat. (My boss is ADD and knows that I’ll ignore eating in favor of working on a project, so he reminds me to take a lunch break, sometimes he makes me stop and eat right then if it looks like I’m going to forget altogether.) I hope this helps you somewhat!

  5. Why was no mention made of rashes as a side effect. Those are uncommon and severe side effects. This happened with all of my medications. What options are left if all the medications cause an eczema type rash? Please ensure you have all information as to assist everyone who reads these.

    1. We’re you taking a stimulant? I’m wondering if it was causing your skin to be hypersensitive. I have hypersensitivity and I’ve noticed if I haven’t taken my meds in a bit, my hypersensitivity is worse until I readjust to being on the meds. The rash is a cross between an eczema-like rash and a hives-like rash. Usually I can just avoid certain fabrics and not itch my skin for a bit but I tend to have to stay away from wool. I see how this could be a serious problem if your meds are the only thing causing your hypersensitivity and you aren’t used to having to deal with this problem! Also, have you noticed that almost no one ever mentions that several of the ADD meds can cause poor circulation in the extremities? That can be a big problem in the winter, and thoroughly annoying the rest of the year. My hands and feet are almost always cold!

  6. My medication (methylphenidate ER; the generic version of Concerta) is an appetite suppressant. For me, the appetite suppression is a good thing. I eat way more when I’m off my medication, which is only on Saturdays. If I weren’t on my medication, I would likely be severely overweight.

  7. Hi, I just found this article today, but it appears to be a bit older. I am wondering about severe side effects that Doctors don’t recognize. I was taking stimulant ADHD meds for many years and would stop taking them when I got bad headaches or tics. (Taking out caffeine did not stop the tics.) I took Adderall during law school and then tried different things and went back to Adderall. At the time I suffered from muscle and joint pain that I, and my doctor, attributed to age and old sports injuries. Then, last October the pain got so bad I started going to acupuncture. My acupuncturist told me I had something kidney-related I should check into. By the end of the month I was sick with Rhabdomyolysis. My doctor was baffled. I found Rhabdomyolysis listed as a possible side effect of Adderall on the package insert. My doctor insisted the Rahbdo was caused by crush injuries, but I found out from other sources that it can be caused by a breakdown in muscle from a variety of causes. Adderall was causing my muscle tissue to break down. I stopped taking stimulants and the Rhabdo went away and so did the joint and muscle pain. However, my ADHD is killing me.

  8. I would like to thank the author of this article for giving me clarity. I was on Mydayis for six months, and was experiencing awful side effects. First I thought I was having heart issues, which turned out to be persistent GERD. Then, I started having severe abdominal distress, ultimately ending me up in the ER. The Doctors just dealt with the GERD by prescribing me more pills–Prilosec–but then it just moved onto the next issue. Sure, the Mydayis worked for me, but at the expense of my overall health. I appreciate the advice that no side effects should be tolerated, and to keep looking. Switched back to Adhansia XR and am happy.

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