monitoring side effects and the potential for misuse of ADHD drug treatment in children, young people and adults

Last edited 08/2018 and last reviewed 09/2022

All medication for ADHD should only be initiated by a healthcare professional with training and expertise in diagnosing and managing ADHD

  • height and weight:
    • in people taking medication for ADHD:
      • height should be measured every 6 months in children and young people
      • measure weight every 3 months in children 10 years and under
      • measure weight at 3 and 6 months after starting treatment in children over 10 years and young people, and every 6 months thereafter, or more often if concerns arise
      • measure weight every 6 months in adults
      • plot height and weight of children and young people on a growth chart and ensure review by the healthcare professional responsible for treat
      • if weight loss is a clinical concern, consider the following strategies:
        • taking medication either with or after food, rather than before meals
        • taking additional meals or snacks early in the morning or late in the evening when stimulant effects have worn off
        • obtaining dietary advice
        • consuming high-calorie foods of good nutritional value
        • taking a planned break from treatment
        • changing medication
      • if a child or young person's height over time is significantly affected by medication (that is, they have not met the height expected for their age), consider a planned break in treatment over school holidays to allow 'catch-up' growth
      • consider monitoring BMI of adults with ADHD if there has been weight change as a result of their treatment, and changing the medication if weight change persists

  • cardiovascular monitoring:
    • heart rate and blood pressure should be monitored; and compare with the normal range for age before and after each dose change and every 6months
    • if person taking ADHD medication has sustained resting tachycardia (more than 120 beats per minute), arrhythmia or systolic blood pressure greater than the 95th percentile (or a clinically significant increase) measured on 2 occasions, reduce their dose and refer them to a paediatric hypertension specialist or adult physician
    • if a person taking guanfacine has sustained orthostatic hypotension or fainting episodes, reduce their dose or switch to another ADHD medication

  • tics
    • if a person taking stimulants develops tics, think about whether:
      • the tics are related to the stimulant (tics naturally wax and wane) and
      • the impairment associated with the tics outweighs the benefits of ADHD treatment
    • if tics are stimulant related, reduce the stimulant dose, or consider changing to guanfacine (in children aged 5 years and over and young people only), atomoxetine, clonidine, or stopping medication

  • sexual dysfunction
    • monitor young people and adults with ADHD for sexual dysfunction (that is, erectile and ejaculatory dysfunction) as potential adverse effects of atomoxetine

  • seizures
    • if a person with ADHD develops new seizures or a worsening of existing seizures
      • review their ADHD medication and stop any medication that might be contributing to the seizures
      • after investigation, cautiously reintroduce ADHD medication if it is unlikely to be the cause of the seizures

  • sleep
    • changes in sleep pattern (for example, with a sleep diary) should be monitored and adjust medication accordingly
  • worsening behaviour
    • the behavioural response to medication should be monitored, and if behaviour worsens adjust medication and review the diagnosis.

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