It is important for providers to be aware of “red flag” symptoms associated with medication adverse events and to use every visit as an opportunity to do a quick check for potentially severe medication side effects, even if the visit is not medication focused. Within this article, the second in the series, we will cover ADHD stimulant medication “red flags”.
Medication: Stimulants (such as Adderall® (Dextroamphetamine/Amphetamine), Ritalin® (Methylphenidate), and Vyvanse® (Lisdexamfetamine))
Concern: Heart, mood/psychiatric and circulation concerns
Presentation: Differs depending on affected system, see chart below
| Heart | Mood/Psychiatric | Circulation |
| Dramatically increased blood pressure | New or worsening behavioral or thought problems | New numbness in fingers or toes |
| Chest pain at rest or on exertion | New or worsening bipolar illness | New pain in fingers or toes |
| Stroke symptoms (F.A.S.T.) | New or worsening aggressive behavior or hostility | New sensitivity to temperature in fingers or toes |
| New psychotic symptoms (such as hearing voices, or seeing things that aren’t there) | Skin color change in fingers or toes | |
| New or worsening manic symptoms | Unexplained wounds on fingers or toes |
| Severity | Presentation | Recommended Action |
| Precautionary | Current Presentations: Mildly elevated blood pressure, increased heart rate, Headache
History of: heart disease, mental illness, circulatory concerns, abuse or dependence |
Patient should be informed of the “red flags” above. Ensure patient’s blood pressure is taken routinely and consider cardiology consult if not previously done. |
| Symptomatic | Any of the manifestations of severe side effects from the above table | Decrease or hold doses, and consider cardiology consult with EKG. If severe (such as stroke symptoms or suicidal ideation) refer to emergency care. |