Psych · Psychopharmacology — stimulants and ADHD medications
Stimulants and ADHD medications
Also known as ADHD stimulants · Methylphenidate · Amphetamines ADHD · Lisdexamfetamine · Atomoxetine · Guanfacine · Clonidine ADHD · ADHD pharmacotherapy
Exam-exhaustive fellowship pharmacology of ADHD medications — methylphenidate and amphetamine formulations with doses and monitoring, atomoxetine, guanfacine and clonidine, DAT/NET mechanisms, MTA and Cortese NMA, cardiovascular safety (Cooper/Habel/Hennissen/Farhat), diversion and misuse, switching, adult versus child pathways. FRANZCP-primary, globally tagged.
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Target exams
FRANZCPMRCPsychABPNMD-DNBNEET-SS
Red flags
- Personal or family history of sudden cardiac death, unexplained syncope, or structural heart disease — cardiac review before stimulants or atomoxetine; do not dose-escalate through chest pain or syncope
- New manic, mixed or psychotic symptoms after stimulant start or dose increase — stop the agent, medicalise, reassess bipolar spectrum and substances
- Active substance use disorder with diversion — prefer supervised long-acting formulations or non-stimulants; treat SUD in parallel
- Significant growth faltering on stimulants — plot height and weight; adjust timing, consider holidays or switch, involve paediatrics when needed
- MAOI within washout window — absolute contraindication to stimulants and atomoxetine pathways
- Abrupt stop of prolonged guanfacine or clonidine — rebound hypertension risk; taper
Meet the patient
A 14-year-old boy is referred because his teachers say he "cannot concentrate". His mother wants "something for his ADHD". He has had no structured assessment, sleeps five hours a night on his phone, and his father was hospitalised last year for a stimulant-induced psychotic episode.[22][24]
The exam question this vignette plants is the one that fails stations: before you reach for a controlled drug, what must be true? A multi-informant, multi-setting diagnosis; sleep, anxiety, learning disorder and bipolar spectrum excluded or named; cardiac and family history taken; and a diversion risk plan. This topic is the prescribing spine behind that decision.[3][22][24]
References28ShowHide
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- [2]Molina BSG, Hinshaw SP, Swanson JM, et al. The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study J Am Acad Child Adolesc Psychiatry, 2009.PMID 19318991
- [3]Cortese S, Adamo N, Del Giovane C, et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis Lancet Psychiatry, 2018.PMID 30097390
- [4]Volkow ND, Wang G, Fowler JS, et al. Therapeutic doses of oral methylphenidate significantly increase extracellular dopamine in the human brain J Neurosci, 2001.PMID 11160455
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- [9]Jain R, Segal S, Kollins SH, et al. Clonidine extended-release tablets for pediatric patients with attention-deficit/hyperactivity disorder J Am Acad Child Adolesc Psychiatry, 2011.PMID 21241954
- [10]Kollins SH, Jain R, Brams M, et al. Clonidine extended-release tablets as add-on therapy to psychostimulants in children and adolescents with ADHD Pediatrics, 2011.PMID 21555501
- [11]Wilens TE, Faraone SV, Biederman J, et al. Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature Pediatrics, 2003.PMID 12509574
- [12]Wilens TE Attention deficit hyperactivity disorder and substance use disorders Am J Psychiatry, 2006.PMID 17151154
- [13]Adler LA, Zimmerman B, Starr HL, et al. Efficacy and safety of OROS methylphenidate in adults with attention-deficit/hyperactivity disorder: a randomized, placebo-controlled, double-blind, parallel group, dose-escalation study J Clin Psychopharmacol, 2009.PMID 19440077
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- [17]Habel LA, Cooper WO, Sox CM, et al. ADHD medications and risk of serious cardiovascular events in young and middle-aged adults JAMA, 2011.PMID 22161946
- [18]Hennissen L, Bakker MJ, Banaschewski T, et al. Cardiovascular Effects of Stimulant and Non-Stimulant Medication for Children and Adolescents with ADHD: A Systematic Review and Meta-Analysis of Trials of Methylphenidate, Amphetamines and Atomoxetine CNS Drugs, 2017.PMID 28236285
- [19]Farhat LC, Lannes A, Del Giovane C, et al. Comparative cardiovascular safety of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis Lancet Psychiatry, 2025.PMID 40203844
- [20]Graham J, Banaschewski T, Buitelaar J, et al. European guidelines on managing adverse effects of medication for ADHD Eur Child Adolesc Psychiatry, 2011.PMID 21042924
- [21]Cortese S, Holtmann M, Banaschewski T, et al. Practitioner review: current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents J Child Psychol Psychiatry, 2013.PMID 23294014
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