Child Health/ADHD medication

ADHD drugs

also: methylphenidate · lisdexamfetamine · atomoxetine · guanfacine · stimulant

Overview

Pharmacological treatment of ADHD (after environmental modifications). Stimulants are first-line; cardiac screening and growth monitoring are the key safety points.

Mechanism

Methylphenidate and lisdexamfetamine (stimulants) increase synaptic dopamine and noradrenaline (reuptake inhibition ± release) in prefrontal circuits → improved attention/impulse control. Atomoxetine is a selective noradrenaline reuptake inhibitor (non-stimulant). Guanfacine is a central α₂-agonist (non-stimulant).

Indications

ADHD (children ≥5 and adults, when symptoms cause persistent significant impairment)

The agents

Methylphenidatestimulant (1st-line)

immediate/modified release

NICE NG87 first-line in children.

Lisdexamfetaminestimulant

prodrug

Option if methylphenidate inadequate.

AtomoxetineNRI (non-stimulant)

Suicidal ideation warning; hepatotoxicity.

Guanfacineα₂-agonist (non-stimulant)

Hypotension, sedation.

Adverse effects

Appetite suppression + growth restrictionclassic

Plot height/weight; consider drug holidays.

Insomnia, anxiety, ticscommon

↑Heart rate & blood pressureserious

Baseline cardiac assessment; monitor HR/BP.

Atomoxetine: suicidal ideation, hepatotoxicityserious

Cautions & contraindications

Pre-existing structural cardiac disease / arrhythmia (stimulants)all

Sympathomimetic — cardiac screening first.

Phaeochromocytoma, uncontrolled hyperthyroidismall

Interactions

Stimulants + MAOIs (hypertensive crisis)
Additive sympathomimetic effects

Monitoring & kinetics

Height + weight every 6 months (growth),Heart rate + BP at each dose change,Psychiatric review (mood, tics)

Oral. Baseline ECG/cardiac history before stimulants.

Source: NICE NG87 — ADHD · BNF for Children — CNS stimulants