An updated safety review of the current drugs for managing ADHD in children

ABSTRACT

Introduction

Attention-Deficit/Hyperactivity Disorder (ADHD) is a highly prevalent condition that causes persistent problems with attention and/or hyperactivity-impulsivity and often results in significant impairment when left untreated. Medications for this disorder continue to evolve and provide new treatment options. Ongoing review of related medication safety and tolerability remains an important task for prescribers.

Areas Covered

This manuscript provides an updated safety review of medications used to treat ADHD in children and adolescents. PubMed and OneSearch online databases were utilized to search for literature relevant to the topic of ADHD medications and safety. Clinical trials of medications used to treat ADHD, systematic reviews and meta-analyses, and articles covering specific safety issues (adverse or unfavorable events) such as cardiovascular effects, seizures, impact on growth, depression, suicidal ideation, substance use disorders, psychosis, and tics are described.

Expert Opinion

Available pharmacologic treatments for ADHD have favorable efficacy, safety and tolerability and allow many patients to achieve significant improvement of their symptoms. Despite the availability of multiple stimulant and non-stimulant formulations, some individuals with ADHD may not tolerate available medications or attain satisfactory improvement. To satisfy unmet clinical needs, ADHD pharmaceutical research with stimulant and nonstimulant formulations targeting dopamine, norepinephrine, and novel receptors is ongoing.

KEYWORDS:

• Alpha-2 adrenergic agonists
• amphetamines
• attention-deficit/hyperactivity disorder
• atomoxetine
• drug-related adverse reactions
• methylphenidate
• pediatrics
• viloxazine

Article highlights

• ADHD is a common neurodevelopmental disorder that can cause persistent problems with attention and/or hyperactivity-impulsivity and can significantly negatively impact functioning, development, and quality of life.

• The majority of studies examining both types of ADHD medications (stimulants and non-stimulants) find that these medications are tolerable and have no or very low risk of serious adverse events that result in hospitalization, the need for medical intervention, disability, permanent damage, risk to life or death.

• While adverse effects for ADHD medications are common, they are generally mild to moderate; the most common adverse effects for ADHD medications include decreased appetite, insomnia, headache, somnolence, fatigue, and abdominal pain.

• A small minority of individuals may be susceptible to specific risks such as cardiovascular effects (including tachycardia, hypertension, and arrhythmia), suicidal ideation, and psychosis.

• Treatment of ADHD may help to protect children and adolescents from developing some of the common comorbidities associated with ADHD such as major depression and substance use disorders.

Declaration of interest

E Ryst receives support from the Health Resources and Services Administration/Maternal and Child Health Bureau, the Nevada Division of Public and Behavioral Health and the Washoe County School District. Dr. Childress serves as consultant for Aardvark, Arbor, Attentive, Cingulate, Jronshore, Neos Therapeutics, Neurocentria, Otsuka, Purdue, Rhodes, Sunovion, Tris Pharma, KemPharm, Supernus, Jazz, Corium, Tulex, and Lumos. She has served on speaker’s bureau for Corium, Takeda (Shire), lronshore, Tris Pharma, and Supernus. Her research has been supported by Allergan, Takeda (Shire), Emalex, Aki Ii, Arbor, Ironshore, Aevi Genomic Medicine, Neos Therapeutics, Otsuka, Purdue, Adlon, Rhodes, Sunovion, Tris Pharma, KemPharm, Supernus, US Food and Drug Administration, and Servier. She has received writing support from Takeda (Shire), Arbor, lronshore, Neos Therapeutics, Purdue, Rhodes, Sunovion, and Tris Pharma. She has served on advisory boards for Takeda (Shire), Akili, Arbor, Cingulate, Ironshore, Neos Therapeutics, Otsuka, Purdue, Adlon, Sunovion, Tris Pharma, Supernus, and Corium.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

A peer reviewer on this manuscript has received consultant fees or honoraria from Medice, Menarini, Angelini, and Alkermes Pharmaceuticals. A peer review on this manuscript has presented lectures sponsored by Flynn Pharma, which markets ADHD medications.

Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Notes

1. The term ‘decreased appetite’ includes ‘Loss of appetite.’

Additional information

Funding

This paper was not funded.