Side-effects and monitoring treatment

Overall, ADHD medications are well-tolerated. Most side-effects occur during initiation and with dose increases but tend to subside after a week or two. It is therefore very important that these side-effects are explained to parents and the patient and advice given on what to do if they occur.  

Suicide related behaviour was reported more frequently in patients taking atomoxetine (although still an uncommon occurrence). Parents and patients should be warned to look out for any worrying thoughts or behaviour and seek help immediately. 

There have been some very rare reports of liver injury. Liver function tests are not routinely carried out before initiation of atomoxetine but parents and patients should know to look out for signs of potential liver injury (e.g. unexplained nausea, vomiting, abdominal pain, dark urine, yellow discoloration) and report any suspicious findings immediately.  

Patients on a stable medication dose need their weight, height, blood pressure and pulse monitoring and plotting on centile charts. The frequency varies depending on age and other clinical needs but typically tends to be three to six months. Those having their medication or dose adjusted will need to be monitored more closely – ideally within four weeks of a change but in reality, it will be longer due to the availability of appointments.