ADHD Medication
Medication may be an important part of your treatment plan for attention deficit hyperactivity disorder. Doctors can choose from many types of drugs to control your symptoms. Whichever ADHD medication you and your doctor choose, they mostly work the same – to increase levels of certain chemicals in your brain (called neurotransmitters). These chemicals help reduce symptoms (such as hyperactivity and impulsivity), increase attention span, and help you manage your emotions.
You and your doctor will work together to figure out which medication is right for you, along with the ideal dose (amount) and schedule (how often or when you need to take it). It may take some time to find the best combination.
Medications may not work for all ADHD symptoms or affect everyone the same way. A combination of medication, therapy, behavior changes, and skills training is often the most effective treatment. This is called multimodal treatment.
Types of ADHD medications
The medications most often used to treat ADHD include:
Stimulants. These medicines are called stimulants because they increase the brain chemicals dopamine and norepinephrine. These two chemicals have important effects on your ability to think and pay attention.
Nonstimulants. In cases where stimulants don’t work or cause unpleasant side effects, nonstimulants might help. These medicines take longer to start working than stimulants, but they may help improve your ability to focus, pay attention, and control your impulses. Sometimes, doctors may prescribe these along with a stimulant to improve how both work.
Antidepressants. In the U.S., these aren't approved by the FDA for ADHD treatment, but some people find they help control the symptoms of ADHD. So your doctor may try these if you have side effects from stimulants. Also, people with ADHD often have depression, anxiety, or other mood disorders (such as bipolar disorder). If this is the case for you, your doctor may prescribe an antidepressant to control these other conditions along with a stimulant for ADHD.
Things to think about if you are considering starting medicine for ADHD
ADHD medications can be the cornerstone of ADHD treatment, and they work well for many people. An estimated 4 out of 5 children with ADHD benefit from medication. For many adults, the best approach to treatment combines medication with education, skills training, and psychological therapy.
If you decide to try medication, it could take some time to find the right medication and dose for you. Your doctor may prescribe different ADHD medications in different doses to find out which controls your symptoms best and which has the fewest side effects.
These medications will not cure your ADHD. They only manage your symptoms as long as you take them. If you stop taking them, your ADHD symptoms will return. That means that medication could be a lifelong commitment for you.
Another important thing to consider is that certain drugs and substances can interact with medications for ADHD. Make sure your doctor knows what other medications you take, including over-the-counter drugs. For example, some OTC decongestants can make you jittery when taken with stimulant medications prescribed for ADHD.
Also, tell your doctor whether you drink coffee or other caffeinated beverages and if you take any supplements.
Though medications work well for many people, they aren't the only option. Take your time to weigh your options. If you're not ready to try medicine, behavior therapy works well for many people. Behavior therapy will help you learn positive behaviors and reduce negative behaviors.
Stimulant ADHD Medications
This group of drugs is the most commonly prescribed to treat ADHD. They have been used to treat ADHD in children and adults for several decades. These drugs increase the levels of the neurotransmitters dopamine and norepinephrine in your brain, which may help you focus your thoughts and ignore distractions. The FDA has approved dozens of brand-name stimulants for ADHD. Most of these medications fall into one of two categories of stimulant drugs: methylphenidates and amphetamines.
Doctors don't recommend stimulants for people with:
- Heart defects or heart disease
- Uncontrolled high blood pressure
- Hyperthyroidism
- Glaucoma
- High levels of anxiety
- A history of drug or alcohol misuse
- Anorexia nervosa
There are two kinds of stimulants: short-acting (immediate-release) and intermediate or long-acting (extended-release).
Short-acting stimulants
These medicines usually begin working within 30-45 minutes of taking them and their effects generally last about 3-4 hours. You usually take them two to three times a day. Some short-acting stimulants come in liquid form and as chewable tablets.
Amphetamines may be a little stronger than methylphenidate, and their effects may last a little longer. But in general, the two kinds of medicines are very similar.
Examples of short-acting amphetamine include:
- Adderall (amphetamine and dextroamphetamine mixed salts): lasts 4-8 hours
- Desoxyn (methamphetamine hydrochloride): 4-8 hours
- Dexedrine (dextroamphetamine sulfate): lasts 4-6 hours
- Evekeo (amphetamine sulfate): lasts 4-6 hours
- ProCentra (dextroamphetamine sulfate): lasts 4-8 hours
- Zenzedi (dextroamphetamine sulfate): lasts 4-8 hours
Examples of short-acting methylphenidate include:
- Focalin (dexmethylphenidate hydrochloride): lasts 3-5 hours
- Methylin oral solution (methylphenidate hydrochloride liquid): lasts 3-5 hours
- Ritalin (methylphenidate hydrochloride): lasts 3-5 hours
Intermediate and long-acting stimulants
Intermediate stimulants can last 6-8 hours, while long-acting stimulants can last 8-12 hours and sometimes up to 16 hours. You usually take them once a day. Long-lasting medicines are usually the best option because people with ADHD may have trouble remembering to take their medicine.
They also provide steady symptom relief throughout the day. By contrast, if you use short-acting stimulants, your symptoms may return between doses. Some people “crash” as their short-acting dose wears off, meaning their energy and mood drop and they feel intense hunger. Intermediate stimulants do not have this effect. If your long-acting stimulant does not remain effective for the entire day, your doctor may prescribe a short-acting stimulant to get you through the late afternoon and evening hours.
Examples of intermediate and long-acting amphetamine include:
- Adderall XR (amphetamine and detroamphetamine mixed salts, extended release): lasts 10-12 hours
- Dexedrine Spansule (dextroamphetamine sulfate, extended release): lasts 8-12 hours
- Dyanavel XR (amphetamine, extended-release tablet or oral suspension): lasts 8-12 hours
- Mydayis (mixed salts of a single entity amphetamine product, extended release): lasts about 16 hours
- Vyvanse (lisdexamfetamine dimesylate chewable tablet or capsule): chewable tablet lasts 8-12 hours and capsule lasts 10-12 hours
- Xelstrym (dextroamphetamine transdermal patch): lasts about 4 hours, with a 9 hour wear time
Examples of intermediate and long-acting methylphenidate include:
- Aptensio XR (methylphenidate hydrochloride, extended release): lasts 12 hours
- Concerta (methylphenidate hydrochloride, extended release): lasts 10-12 hours
- Cotempla (methylphenidate, extended release): lasts 12-13 hours
- Daytrana (methylphenidate transdermal patch): lasts about 10 hours, with a 9 hour wear time
- Focalin XR (dexmethylphendate hyrochloride, extended release): lasts 12 hours
- Jornay PM (methylphenidate hydrochloride, extended release): lasts 12+ hours
- Methylin ER (methylphenidate hydrochloride, extended release): lasts 8 hours
- QuilliChew ER (methylphenidate hydrochloride, extended release chewable tablet): lasts 8-12 hours
- Quillivant XR (methylphenidate hydrochloride, extended release): lasts 8-12 hours
- Relexxii ER (methylphenidate hydrochloride, extended release): lasts up to 24 hours
- Ritalin LA (methylphenidate hydrochloride, extended release): lasts 8 hours
Side effects of stimulants
Most of the time, the side effects of stimulants are mild and happen when you first start to take them. They usually get better as your body adjusts to the medication. The three most common side effects of stimulants are:
- Loss of appetite
- Weight loss
- Sleep problems
Other side effects that you may have while taking stimulants include:
- Increased heart rate and blood pressure
- Upset stomach
- Feeling restless or jittery
- Crankiness or mood swings
- Headaches
- Dizziness
- Depression and anxiety
- Tics
- Minor growth delays (which don’t affect your final height)
You also may have what’s called the "rebound effect." This can happen as your medication wears off and causes short-lived fatigue, a bad mood, and increased activity. Changing your medication, your dose, or when you take it may help.
Long-acting ADHD medications may have greater effects on appetite and sleep than short- and intermediate-acting stimulants. Stimulants may also raise your blood pressure and heart rate.
Other safety concerns with stimulants
Aside from their side effects, some experts have a few other concerns about stimulants, including:
The long-term effects on people whose brains are still developing. Researchers don't yet know if stimulants affect the long-term development of the brain in children and teenagers, so some experts are wary of using these drugs in younger people. Some research shows that stimulants may actually help correct abnormalities in the structure of the brain in children with ADHD.
The risk of sudden death in people with heart conditions. The American Heart Association recommends that all people, including children, have their heart evaluated before starting stimulants. They recommend doctors ask about the patient's medical and family history, specifically about symptoms that could suggest a heart condition.
Also, they recommend a physical exam to look for evidence of a heart condition, including an electrocardiogram (EKG) if the medical and family history or physical exam suggested a reason to suspect a heart condition. An EKG is a quick, painless test that measures your heart’s electrical activity. It’s used to test for potentially dangerous abnormal heart rhythms, or arrhythmias, and other heart problems. But experts don’t yet fully understand the links between stimulant use and heart health, and it’s not clear that stimulants boost the risk of heart attacks, stroke, or sudden cardiac death.
The increased risk of other psychiatric problems. Some people may have personality changes on stimulant medicines. For instance, stimulants may trigger or worsen symptoms of hostility, aggression, anxiety, depression, or paranoia. People who have a personal or family history of suicide, depression, or bipolar disorder may be at higher risk of this than other people and will likely be followed closely by their doctor while they're taking stimulants.
In general, though, people taking stimulants as prescribed appear to have a decrease in thoughts of suicide. Researchers estimate that about 1 in every 660 patients taking stimulants for ADHD may get symptoms of psychosis, but those symptoms typically disappear after stopping the medication. And it’s not clear that the medications caused those symptoms.
The potential for abuse. When properly prescribed and taken, stimulant drugs for ADHD do not increase the risk of drug abuse. In fact, kids with ADHD who don't get treated are more likely to abuse alcohol or drugs as adults. But kids with conduct disorders may be more likely than others to abuse substances as they get older. That’s something your doctor should be aware of when prescribing stimulants.
A growing problem in schools and colleges is that teens and college students who don’t have ADHD may abuse stimulants when they study for exams or when they want to lose weight. Kids with prescriptions may share or sell their stimulant medicine to classmates. Make sure your child is taking their medicine and not sharing or selling it. Most people who abuse stimulant medications get them from family members and friends, according to the FDA.
Nonstimulant ADHD Medications
About 15%-30% of kids don't get help from stimulants, and this is probably the case for adults, too. If stimulants don't work for you or you can't tolerate their side effects, nonstimulants may be an option. Your doctor may also prescribe these to take with stimulants because they can boost the effects. Nonstimulants are not controlled substances, so there's less chance of abuse. These may also be a good option for you if you have had problems with drug abuse before.
Nonstimulant medications usually take a while to start working, so it could be several weeks before you feel the full effects. Also, they may not work as well as stimulants.
In the U.S., the FDA has approved four nonstimulants to treat ADHD:
- Atomoxetine
- Clonidine
- Guanfacine (Intuniv)
- Viloxazine (Qelbree)
Atomoxetine and viloxazine (Qelbree)
These two drugs are selective norepinephrine reuptake inhibitors (SNRIs). They increase your brain's level of a neurotransmitter called norepinephrine. They may help you concentrate better and control your impulses. You may not feel the effects until you’ve been taking them regularly for several weeks: as long as 6 weeks for atomoxetine and up to 4 weeks for viloxazine. Both remain effective for 24 hours.
Because these medicines are also used in people with depression, they may be a good option if you also have anxiety or depression. Atomoxetine and viloxazine are both approved for children ages 6 and older as well as for adults. One benefit of these is that they don’t cause or worsen tics or other symptoms of Tourette’s syndrome.
Guanfacine (Intuniv) and clonidine
These two drugs belong to a class of high blood pressure drugs called alpha-2 adrenergic agonists. These were initially used “off-label” for ADHD for many years. Off-label is the term used when a doctor prescribes a medication for a condition for which it has not received approval from the FDA for treatment. Drugmakers eventually made extended-release versions, and the FDA approved them as a treatment for ADHD.
Because these drugs are meant to lower high blood pressure, they have a calming effect, which may help you with symptoms such as hyperactivity, your ability to control your impulses, and feelings of aggression. They also help you concentrate.
Side effects of nonstimulants
Atomoxetine and viloxazine side effects in adults and kids include:
- Stomach pain or upset
- Nausea or vomiting
- Mood swings
- Headaches
- Dizziness
- Sleepiness
These may cause insomnia and may suppress your appetite, but that's less common than with stimulants. Adults may also have dry mouth, trouble peeing, and sexual side effects such as erectile dysfunction. Atomoxetine may also cause high blood pressure, an increased heart rate, and liver problems.
Rarely, SNRIs may increase the risk of suicidal thoughts and actions, especially in kids and young adults who have bipolar disorder or depression.
Guanfacine and clonidine side effects include:
- Nausea, stomach pain, or vomiting
- Loss of appetite
- Headaches
- Dizziness
- Sleepiness, fatigue
- Dry mouth
Don't stop taking these suddenly because this can cause your blood pressure and heart rate to rise quickly.
Off-Label Antidepressant ADHD Medications
Besides the two SNRIs already mentioned, the FDA has not approved any other types of antidepressants for ADHD treatment. But some are used off-label for this purpose, especially for people who have ADHD as well as depression or anxiety. This may also be an option for you if stimulants don't work, if you can't tolerate stimulants, or if you have a history of drug abuse. Your doctor also may prescribe them along with a stimulant.
The most common antidepressant prescribed off-label for ADHD is bupropion (Wellbutrin). Bupropion belongs to a class of antidepressants known as norepinephrine and dopamine reuptake inhibitors (NDRIs). It works by increasing the neurotransmitters norepinephrine and dopamine in your brain, which can help you concentrate better.
If other ADHD drugs haven’t worked out for you, your doctor may suggest a tricyclic antidepressant such as imipramine (Tofranil) or nortriptyline (Aventyl, Pamelor). Tricyclics are an older class of antidepressants. They can have challenging side effects, so your doctor will usually try these only if you have no other options left to try.
Selective serotonin reuptake inhibitors (SSRIs), a popular class of antidepressants, have not been shown to be effective for ADHD. But your doctor may prescribe one of them for you if you have depression or anxiety.
Off-label antidepressant side effects
Bupropion side effects include:
- Nausea, stomach pain, or constipation
- Weight loss
- A dry mouth or sore throat
- Headaches
- Dizziness
- Insomnia
- Increased heart rate
Some people may have more challenging side effects, such as anxiety, ringing in the ears, and changes in vision or heart and lung function. Adults may also rarely have sexual side effects. Bupropion may also increase the risk of suicidal thoughts in children, adolescents, and young adults.
Imipramine and nortriptyline side effects include:
- Constipation
- Increased appetite and weight gain
- Dry mouth
- Dizziness
- Blurred vision
- Confusion
- Seizures
- Increased heart rate
- Not being able to empty your bladder fully when you pee; peeing a little bit, many times over the day; or feeling like you have to pee but not being able to
- Increased sweating
- Sexual dysfunction, including libido changes and impotence
Like all tricyclic antidepressants, imipramine and nortriptyline can change your heart rhythm. Both may also increase the risk of suicidal thoughts in children, adolescents, and young adults. Don't stop taking nortriptyline suddenly because you can have withdrawal symptoms such as nausea, vomiting, anxiety, headaches, dizziness, and restlessness. If you want to stop taking it, your doctor will decrease your dose over time to wean you off safely.
New ADHD Medications
New ADHD medications are always in development, and governing agencies continue to approve new brand-name ADHD medications. Most of these are drugs that have been used for other conditions and have been tested and approved for use in ADHD. For instance, viloxazine (Qelbree) was approved by the FDA in 2021 for use in kids and teenagers with ADHD, but in Europe, it had been used since 1971 as an antidepressant. Other recent ADHD medications include:
- Serdexmethylphenidate and dexmethylphenidate (Azstarys), a stimulant approved in 2021
- Dextroamphetamine (Xelstrym), the first stimulant in patch form, approved in 2022
Also, generic versions of brand-name drugs become available over time. For instance, in 2023, the FDA approved generic versions of lisdexamfetamine dimesylate (Vyvanse), which is a brand-name stimulant medicine approved in 2007. In 2017, a generic version of atomoxetine became available.
Are ADHD Medications Safe?
Experts generally consider these medicines safe when they are monitored properly by a professional. Serious problems are rare. Discuss the risks and benefits of these drugs with your doctor.
ADHD medication abuse
The most common ADHD medicines are stimulants, and they have a high potential for misuse, abuse, and addiction. People who don’t have ADHD may misuse the medicines to feel more alert, curb their appetite to lose weight, or to feel “high.” When people with ADHD receive the proper treatment for the condition, stimulant medications don't cause addictions to develop.
Some people may intensify the effects of the drug by taking higher doses or even crushing and injecting, smoking, or snorting them. This can cause serious side effects, including:
- Dangerously high body temperature
- A fast heartbeat
- High blood pressure
- Panic attacks
- Paranoia
- Psychosis
- Violent behavior
- Seizures
Because of the risk of misuse and abuse, the U.S. Drug Enforcement Administration (DEA) classifies stimulants as Schedule II controlled substances. This means that while there's a medical use for them, there's also a high potential for them to be abused. To help cut down on the misuse of these drugs, Schedule II controlled medicines are harder to get because they can't be refilled. Your doctor must write a new prescription for the medicine each time.
As of May 2023, the FDA requires makers of stimulant drugs to put “boxed warnings” on the labels to warn people of the risk of abuse, misuse, addiction, and overdose. Boxed warnings, previously called black box warnings, are the most serious warning given by the FDA for an approved medicine. These warnings let the public and health care providers know they may cause serious side effects such as injury or death.
Treatment for ADHD and Other Conditions
Up to 100% of children and 80% of adults with ADHD also have another condition. Some disorders are more common in people with ADHD. In adults, the most common are:
- Substance use disorder
- Mood disorders such as depression
- Anxiety disorders
- Antisocial personality disorder
In children with ADHD, common disorders include:
- Autism spectrum disorder
- Learning disorders
- Tic disorders
- Depression
- Bipolar disorder
- Anxiety disorders
- Conduct disorder and oppositional defiant disorder
If you have ADHD and another condition, you and your doctor may choose to treat your ADHD symptoms first. The medicine you use to treat your ADHD symptoms may improve your attention, which can improve the symptoms of your other condition.
But in some cases, your ADHD medicine may worsen your other condition. For example, some stimulant medications can make your anxiety symptoms worse. Your doctor may be able to combine treatments to help with all your symptoms, although they may need to try different combinations to find what’s best for you.
ADHD Medication Side Effects
ADHD medications increase the levels of neurotransmitters in your brain. These chemicals help reduce symptoms like hyperactivity and impulsivity, increase your ability to pay attention, and manage your emotions. Here are some articles for further reading to understand your ADHD medication options:
- ADHD Medication Chart
- Long-Term Effects of Stimulants
- ADHD Stimulants and Your Weight
- ADHD and Exercise
Often, the side effects of ADHD medications go away once your body has adjusted to the new medication. The side effects that do happen generally don’t last more than a few weeks and are mild.
If your side effects continue, don’t worry. There are plenty of options. Your doctor may try one or more of the following:
- Changing the dose of your medication
- Changing when you take your medication
- Switching you to a different stimulant medication
- Switching you to a nonstimulant medication
Takeaways
Medications help most people with ADHD. Though not without side effects, they’re generally considered to be safe. There are many types of ADHD medications, so if one doesn't work for you, you and your doctor have many other options to try. Just be patient. Finding the right medication and the right dose can take time.
ADHD Medication FAQs
- What is the most popular medication for ADHD? Stimulant medications are the most commonly prescribed type of medication for ADHD. Among them, methylphenidate (Ritalin) is used the most.
- How does ADHD medication affect you? Medications for ADHD help curb symptoms of the disorder, including inattention and hyperactivity. They do this by acting on brain chemicals called neurotransmitters. But their effects are temporary; they do not cure ADHD.
- What are the pros and cons of ADHD medication? The big pro is their ability to reduce your ADHD symptoms. The cons include their side effects, the need to take them on a daily basis, and, for some ADHD medications, their cost.
- Does ADHD medication work in adults? Yes! Medications for ADHD, including stimulants and nonstimulants, have been approved for use in adults and can effectively treat the disorder.
