Child Psychology and Psychiatry

Table 46.2
Specific side effects of stimulants.
Side effect
Precautions
Comment
Seizure
No evidence of decreasing
seizure threshold; can be used
in well-controlled epilepsy
If seizures appear or worsen, change to
dexamfetamine; avoid atomoxetine
Growth retardation
Reduced height and weight
centiles possible over time
Advisable not to start stimulants in
children who are short or biologically
predisposed to short stature
Cardiovascular
problems
Increases heart rate and blood
pressure - monitor regularly
High risk in those with structural cardiac
defects; monitor with ECG. Avoid
Adderall in cardiac high-risk groups
Abuse potential
Possible abuse of stimulants by
others with access
Self-initiated increase in dose by
emotionally unstable patients with
substance use disorders is possible, and
should be monitored; atomoxetine,
bupropion or Concerta XL, (drug-delivery
system makes it difficult to abuse) can be
used
Psychotic symptoms
Can induce or worsen psychotic
experience
Avoid in those who have first-degree
relatives with a psychotic disorder or in
children who have psychotic or
quasi-psychotic experiences;
atomoxetine, tricyclic antidepressants,
clonidine, bupropion or risperidone can
be used
ECG, electrocardiography.
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