background The safety of ADHD medications is not fully known. Concerns have arisen about both a lack of contemporary-standard information about medications first licensed several decades ago, and signals of possible harm arising from more recently researched medications. These relate to both relatively minor adverse effects and extremely serious issues such as sudden cardiac death and suicidality.
aim To perform a systematic review of safety issues around long-term use of ADHD medication, and to provide clinical recommendations.
methods The adhd European guidelines group has reviewed the literature, recruited renowned clinical subspecialists and consulted as a group to examine these concerns. Side-effects studied include cardiac adverse events, suicidality, growth, sleep problems, emergence of tics, substance use and misuse, seizures, and psychotic symptoms.
results In general, many of the effects examined appeared to be minimal in impact or difficult to distinguish from risk to untreated populations. Long-term effects of ADHD medication on growth, blood pressure and heart rate are minor, and the occurrence of suicidality and psychotic and manic symptoms is rare. Animal data about neurotoxic effects of psychostimulants cannot be extrapolated to humans given marked species differences in vulnerability to these neurotoxic effects.
conclusion Long-term safety of ADHD medication is not fully known, and further research is needed. In clinical practice, careful and systematic monitoring of side-effects during acute and long-term treatment is necessary and should be able to detect early alarming signals.