Attention-Deficit Hyperactivity Disorder - Medications

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Tricyclics are an older type of antidepressant that can be beneficial but have many side effects. Imipramine (Tofranil, generic) and nortriptyline (Pamelor, generic) are the tricyclics most commonly prescribed for ADHD. A third tricyclic, desipramine (Norpramin, generic) should only be used if patients are not helped by other tricyclics. Desipramine has caused sudden death in some children and adolescents and is especially dangerous for patients with a family history of heart rhythm disturbances.

Tricyclic antidepressants can cause disturbances in heart rhythm. Children should have an electrocardiogram when they first begin to take this drug, and after any dose increase.

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[For more information, see In-Depth Report #8: Depression ].

Alpha-2 Agonists (Guanfacine and Clonidine)

Alpha-2 agonists stimulate the neurotransmitter norepinephrine, which appears to be important for concentration. They include clonidine (Catapres, generic) and guanfacine (Tenex, generic). In 2009, Intuniv (a long-acting form of Tenex) was approved for the treatment of ADHD in children and adolescents ages 6 - 17 years.

Alpha-2 agonists are used for Tourette syndrome and may be beneficial when other drugs have failed for ADHD children with tics or those whose primary symptoms are severe impulsivity and aggression. These drugs may be prescribed in combination with a stimulant.

These drugs have a number of side effects. Sleepiness is the most common, followed by headache and fatigue. A clonidine skin patch, which gradually releases the medication, helps reduce the sedative effect. Because clonidine slows the heart down, it can have adverse effects in some children. Discontinuing the drug abruptly or missing doses can cause rapid heartbeats and other symptoms that may lead to severe problems. Doctors strongly recommend that no child be given clonidine without a preliminary examination for heart problems, and no child with existing heart, kidney, or circulatory problems should take it.

Review Date: 01/27/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).