Journal of the Korean Academy of Child and Adolescent Psychiatry : eISSN 2233-9183 / pISSN 1225-729X

Table. 2.

Table. 2.

Monitoring and management of methylphenidate side effect

Side effectMonitoringManagement
Appetite loss or weight lossCheck body weight:before and every 3-6 months after the treatment Compare weight with normal growth curveRecommend psychostimulant intake after meals Education regarding diet
Height growth delayCheck height:before and every 3-6 months after the treatment Compare height with normal growth curveConsider taking drug holidays Consider dosage reduction or interruption of medication when clear evidence of growth delay is present
Sleep problemsCompare sleep patterns before and after the treatmentConsider dosage reduction or change of medication taking time Consider changing to atomoxetine treatment
Cardiovascular problemsCheck history of heart problems or cardiovascular symptoms(fainting, dizziness, or irregular heart rate)before the treatment with psychostimulants Check family history of major heart problems or sudden death in young relatives before the treatment Check heart rate, blood pressure, and heart murmur periodically in adult patientsNot routinely recommended ECG screening in healthy children Consult a cardiologist before the treatment if there is suspicion of high cardiovascular risk Stop medication and consult a cardiologist if the blood pressure is higher than 95 percentile (or if a clinically significant increase is observed), or in case of arrhythmia/tachycardia after the treatment with psychostimulantshas started Children with known cardiac conditions should be monitored by their own physicians
SeizureCheck past history and symptoms of seizures; and assess developmental delay Explain seizures risk to guardiansSeizures disorders should be stabilized with anticonvulsants before the start of the treatment with psychostimulants Slow dosage titration Consider dosage reduction or interruption of psychostimulant Consider changing to atomoxetine treatment
Tic symptomCompare tic symptoms before and afterthe treatment Inform guardians that ADHD medications do not cause tics;however, some medications may increase or reduce ticsConsider dosage reduction or interruption of psychostimulant if tic symptoms are caused, or aggravated, by psychostimulants treatment Consider changing to atomoxetine treatment
Behavioral reboundCompare irritability and ADHD symptoms before and after the treatmentSlow dosage titration Take a long-acting psychostimulant in the morning to curb this late-day effect Consider changing to atomoxetine treatment
Psychotic symptomsCompare psychotic symptoms before and after the treatmentStop psychostimulants if psychotic symptoms are caused by psychostimulants treatment Treat psychotic symptoms using antipsychotics if psychotic symptoms continue after stopping the psychostimulants treatment Consider changing to atomoxetine treatment
Abuse or misuseCheck abuse potential before starting the treatment Check family history of alcohol or drug abuse before starting the treatmentEducate parents or guardians about the necessity to [1]store the psychostimulants in a secure place, and [2]monitor psychostimulants usage Consider changing to atomoxetine treatmentif there is suspicion of high abuse potency

ADHD:attention-deficit hyperactivity disorder, ECG:electrocardiography

J Korean Acad Child Adolesc Psychiatry 2017;28:70-83 https://doi.org/10.5765/jkacap.2017.28.2.70
© 2017 J Korean Acad Child Adolesc Psychiatry