Misuse of stimulants may cause serious cardiovascular adverse reactions and has been associated with sudden death. Additionally, educate patients and their families about abuse and proper storage and disposal of CNS stimulants. The least amount reasonable should be prescribed or dispensed at one time in order to limit the potential for overuse or drug diversion. To reduce the risk of substance abuse in patients who are prescribed stimulants, prescribers should take special care to 1.) confirm an accurate diagnosis of ADHD, 2.) screen older children and adolescents for use of alcohol, marijuana, and other drugs, 3.) provide age-appropriate anticipatory guidance (e.g., discuss proper medication use, risk of misuse, diversion, and abuse, safe storage of medication, appropriate transition to self-administration in older children), and 4.) carefully document and monitor prescription records closely. In patients with well-documented ADHD that predates the onset of substance abuse, a careful risk/benefit assessment must be conducted and appropriate consultation (e.g., a psychiatrist or addiction specialist) is suggested. The American Academy of Pediatrics recommends an active substance abuse disorder be treated appropriately before beginning stimulant medication. Children and adolescents with attention-deficit hyperactivity disorder (ADHD) are more prone to substance abuse compared to those without ADHD, and those with co-occurring mental health conditions (e.g., depression, disruptive behavior disorders) are at even greater risk however, appropriate treatment of ADHD with medication and behavior therapy may reduce the risk of developing a substance abuse disorder. Assess the risk of abuse prior to prescribing and monitor for signs of abuse while on therapy. Caution is recommended in patients with a known history of substance abuse, including alcoholism.
Dexmethylphenidate has a high potential for abuse.
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