What are the signs your ADHD medication dose is too high? Maybe you’re worried about your child’s response to ADHD medication. Perhaps, you’re concerned about yourself.
Today we’ll discuss signs that an ADHD medication dose may be too high. I’ll dive into the side effects, research, and what to look out for.
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On the ADHD Journey With You
Whether you’re researching for you or your child, please know that I get it and have been there. I’ve spent countless hours researching and reading about the ADHD brain for both my children and myself. One of my biggest concerns was avoiding some of the potential serious side effects of ADHD drugs.
As such, every once in a while, I’ll share insight from my journey with ADHD stimulant medications. In doing so, you’ll be better informed when working with your healthcare provider to find the right ADHD medication at the right dose.
Let’s do this.
What is ADHD?
ADHD (attention deficit hyperactivity disorder) is the most prevalent developmental condition in the United States. Despite its childhood association, ADHD often continues into adulthood.
ADHD is characterized by challenges and delays in executive functioning skills. Executive functioning skills that may be affected include difficulties with:
- inhibition
- disorganization
- planning and foresight
- working memory
- emotional regulation
- task initiation
- and flexible thinking
These skills develop in the prefrontal cortex area of the brain which is often delayed in development.
Three Presentations of ADHD
The current diagnostic criteria define ADHD into three presentations that evolve throughout a person’s lifespan.
- Inattentive
- (Most closely associated with the now retired term Attention Deficit Disorder.)
- Impulsive-Hyperactive
- Combined
Experts are still debating the categories of ADHD because research into the ADHD brain continues to evolve.
For example, psychiatrist Dr. Daniel Amen lays out seven different presentations of ADHD.
“Experts” Don’t Know It All: Executive Functions
To this day, top ADHD specialists classify executive function skills into a broad number of categories. From seven to more than forty-seven!
The point?
Science is NOT static. It’s dynamic and, as such, our understanding is always growing.
Be a part of the process and trust your experience as valid to the larger picture. You’re the expert on your body.
Types of ADHD Medication
If you or your child have been diagnosed with ADHD (attention deficit hyperactivity disorder…terrible name BTW), your doctor has likely recommended medication.
In the United States, the Food and Drug Administration has authorized two classes of ADHD prescription drugs.
- Stimulant medicines
- Nonstimulant drugs
Both medication classes can be further differentiated based on the duration of effectiveness of each dose.
Long vs. Short Acting ADHD Medications
- Long-acting formulas
- Extended-release formulas of ADHD medications can be effective for 12 hours or more.
- Extended-release formulas of ADHD medications can be effective for 12 hours or more.
- Short-acting formulas
- Typically, immediate release formulas begin to take effect in about a half hour and address the symptoms of ADHD for up to 4 hours.
- Short-acting ADHD medicines need to be taken at regular intervals for effective symptom management.
Keep in mind that every person has a unique physiological makeup and will respond to and metabolize medications differently. In the end, a young child may end up taking a higher dose than a 200-lb man.
Seek Professional Medical Advice
This is NOT medical advice. I’m not a doctor, but an educator with a passion for researching, learning, health, and supporting the neurodivergent community. As such, this is for educational purposes only. I encourage you to learn as much as you can by learning, reading, and seeking the insight of multiple experts. Please discuss your healthcare decisions with a trusted healthcare provider.
What’s the Right Dose of ADHD Medication?
So what’s the right dose? Well, it’s complicated.
As such, physicians don’t choose the dose of ADHD medication based on weight or age.
“I have found that response often does not correlate with body weight or age. Rather, trial, supervision, and observation are keys to finding the right dose.”
Dr. Daniel Amen p. 269, Healing ADHD
At the end of the day, each person will have their own unique response to different medicines. Your Vyvanse dose may be too high for you, but that same dose may be perfect for your child.
Listen to Your Own Body
The most important thing is to be tuned into your body’s response to any medication.
Note unwanted side effects and keep the lines of communication open with your or your child’s doctor.
Now that we’ve gotten an overview of ADHD medication, let’s dive in a bit more deeply.
Next, we’re going to briefly discuss these prescription drugs, how they work, and the most common side effects.
What are the Stimulant ADHD Medications?
Stimulant medications are the most commonly prescribed medications for both children and adults with ADHD. Each stimulant is considered a controlled drug by the FDA which means there are certain legal restrictions on these prescriptions.
Additionally, there are two general categories of stimulants used for the treatment of ADHD. Those are:
1. Methylphenidate
Methylphenidate medications are stimulants that work by blocking the reuptake of both dopamine and norepinephrine in the brain.
Specifically, in the prefrontal cortex (executive function center) and the nucleus accumbens.
Some common brand names of Methylphenidate medications are:
- Ritalin
- Long and short acting formulas
- Concerta
- long-acting
- Quillivant
- long-acting
- chewable tablet or liquid
- Focalin
- Long and short-acting formulas
- Focalin is formulated with the d-isomer of methylphenidate which is believed to be more potent and result in fewer fight-or-flight response side effects.
- Cotempla
- long-acting
- Jornay
- long-acting
2. Amphetamines
Amphetamines, in a different stimulant category, work similarly to methylphenidate medications. They both work by inhibiting dopamine and norepinephrine reuptake transporters.
Again, this means both types of drugs prevent transporters (think of transporters as vehicles) from removing dopamine and norepinephrine.
However, amphetamines also increase dopamine and norepinephrine by an additional mechanism.
This increases the likelihood of addiction at high doses.
Brand name amphetamine medications include:
- Adderall (amphetamine salts)
- Long and short-acting formulas
- Vyvanse
- Long-acting capsule or chewable tablet
- Evekeo
- Long-acting
- Dyanavel
- Long-acting
- Dexedrine
- Long-acting
What are the Non-Stimulant ADHD Medications?
If stimulant medications aren’t effective for your ADHD symptoms, your doctor may prescribe a non-stimulant medication.
The non-stimulants are:
- Strattera
- Provigil
- Wellbutrin
- Clonidine (Catapres, Kapvay)
- Blood pressure medication
- Guanfacine (Intuniv)
- Blood pressure medication
Non-stimulant medications work in a different way from stimulants and don’t have the sympathetic activation associated with stimulants.
How Do ADHD Medications Work for ADHD?
Central nervous system stimulant drugs work by increasing the amount of available brain chemicals. Again, they increase the available supply of neurotransmitters dopamine and norepinephrine.
Stimulant ADHD medications increase a combination of dopamine and norepinephrine in different ways.
- By preventing receptors from sucking up neurotransmitters (dopamine, norepinephrine).
- Increasing available norepinephrine and dopamine levels in the brain leads to an improvement in symptoms of ADHD.
- Increasing available norepinephrine and dopamine levels in the brain leads to an improvement in symptoms of ADHD.
- Some amphetamines push dopamine and norepinephrine out of the cell body into the synapse to increase available neurotransmitter levels. See VMAT (vesicular monoamine transporter) for a deeper dive.
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15 Signs Your ADHD Medication Dose May Be Too High
As mentioned earlier, a high dose for one person may be the perfect dose for another. This makes it extremely important for you to know the side effects of ADHD medications.
Then you can use these clues to tune into your own body’s responses.
Between your personal data and your doctor’s insight, knowing whether your dose is too high, too low, or just right is closer than you think.
Now, let’s go through 15 side effects related to both stimulant and non-stimulant ADHD medications.
1. Rebound effect
The rebound effect results when the effectiveness of the medication wears off and challenging ADHD symptoms flare up. Typically, this occurs in between doses of short-acting ADHD meds or closer to the end of the day when long-acting meds wear off.
Signs of the rebound effect include:
- hyperactivity
- mood swings
- tears or emotional meltdowns
- anger or irritability
- withdrawal
If these signs of rebound effect sound familiar to you, it’s a good idea to speak with your doctor.
When taking an extended-release medication, your prescriber may suggest a low dose short-acting in the afternoon. This is typically called a booster dose and can be very helpful to cover those few hours before bed.
On the other hand, if you’re taking multiple immediate-release forms of ADHD medication, a third dose may be added.
If that doesn’t work, don’t be afraid to consider a different medication.
2. Insomnia and Other Sleep Problems
If your dose of ADHD medication is too high, one clear sign is difficulties falling asleep or staying asleep. The irony is that those with untreated ADHD also routinely have difficulties with insomnia anyway.
Truthfully, most research into sleep disturbances has been done on the methylphenidate class of stimulants.
However, parents and adults with ADHD (raising my hand here) also complain that other stimulant medications also cause sleep disturbances.
In one study, parent-reported side effects revealed additional insight into amphetamine drugs and trouble sleeping.
Researchers compared children taking methylphenidate and those taking an amphetamine-based stimulant.
In this study, parents reported insomnia in those children taking the amphetamine-based, dexamphetamine (brand name Dexedrine).
Bottom line?
If you’re struggling with insomnia and taking ADHD medication, touch base with your doctor to determine if your dose is too high.
3. Daytime Sleepiness
On the other hand, non-stimulant medications, Clonidine and Guanfacine, can cause daytime sleepiness.
In fact, Clonidine is often used at night to help with sleep.
If your child is struggling to stay awake while taking one of these medications, talk to your doctor about a lower dose.
4. Increased Resting Heart Rate
Researchers in the previous study also wrote this in their conclusion,
“Both stimulant and nonstimulant catecholaminergic* medications used in adults with ADHD are associated with minor, but statistically significant, changes in heart rate and blood pressure…
*Note that catecholamines include dopamine, norepinephrine, and epinephrine.
5. High Blood Pressure
Another common sign that your medication dose is too high is an increase in blood pressure.
Interestingly, these cardiovascular side effects are seen in those taking both stimulants and non-stimulant medications for their ADHD.
In one study of 125 adults with ADHD, researchers found that subjects taking the non-stimulant, Wellbutrin (Bupropion), had a blood pressure increase almost equal to that of Methylphenidate.
6. Weight Loss
Of the possible adverse side effects associated with the wrong stimulant dose, this next one is often a big complaint of parents.
Appetite suppression is a very common side effect of stimulant medications. However, this effect often wears off once the body adjusts to the medication.
If you’re concerned about your child’s weight loss due to loss of appetite, speak with your child’s doctor.
Binge-Eating, ADHD, and Vyvanse
Ironically, one stimulant ADHD medication, Vyvanse, is also approved for the treatment of binge eating disorder.
Binge eating is a very common sign of untreated ADHD in adults and teens (particularly ADHD in women and girls).
7. Weight Gain
On the other hand, some non-stimulant ADHD medications can lead to weight gain.
Those medications tend to be antidepressants such as Wellbutrin.
8. Constipation
Stimulants such as Adderall are commonly associated with brutal constipation.
This is associated with the increased fight-or-flight response of the sympathetic nervous system.
Constipation is not simply a nuisance, but a serious health concern. Gut health matters. Fortunately, nutritional supplements such as quality probiotics and digestive enzymes may help.
9. Dry Mouth
Dry mouth (xerostomia) is an extremely common side effect of ADHD medications.
Many of these medications cause a disruption in saliva production likely related to the increase in sympathetic tone that accompanies stimulant medications.
Remember that the role of stimulant medications is to activate the sympathetic (fight-or-flight) nervous system for increased focus.
10. Increased Sweating
Some medications such as Strattera can lead to the uncomfortable side effect of increased perspiration.
11. Headaches
Some people report migraine headaches when taking ADHD medications.
One 2021 meta-analysis of the relationship between ADHD and migraine headaches found that three commonly prescribed ADHD medications were associated with increased headaches.
- atomoxetine (Straterra)
- clonidine
- methylphenidate
It’s important to note that, in general, those with ADHD suffer from headaches as part of ADHD and as a side effect of medications.
Further, stimulant medications increase the activation of the sympathetic nervous system (stress-related). Because migraines are stress-related conditions, it only makes sense that headaches are a possible side effect of stimulants.
Discuss these with your doctor if you’re concerned that ADHD medications are contributing to your discomfort.
12. Anxiety
Because of their stimulating effects, ADHD medications can increase sensations of anxiety.
This can be a tricky one to tease out, however, because those with ADHD often struggle with anxiety anyway.
However, as a result of increased sympathetic response to stimulants, anxiety is a common side effect of medications. If it becomes a problem, please discuss it with your doctor.
Like many women with ADHD, I personally experienced a significant amount of anxiety when taking stimulant medication.
13. Irritability and Emotional Outbursts
According to Dr. Daniel Amen of the Amen Clinics,
“When stimulants are used with tricyclic antidepressants, an occasional side effect may occur. (These are) confusion, irritability, hallucinations, or emotional outbursts.”
p. 272, Healing ADD
Caution About Antihistamines and ADHD Meds
In his book, Healing ADHD, Dr. Amen also recommends avoiding combining antihistamines with stimulants, He says the combination can increase irritability and hyperactivity.
This is significant as many neurodivergent (ADHD, Autism) children struggle with allergies.
If you or your child struggles with allergies or asthma, ask your healthcare provider to prescribe an antihistamine that doesn’t enter the brain.
14. Mania
While mania is often associated with bipolar disorder, it can also be artificially induced. According to Stanford’s Dr. Andrew Huberman, a brain that is saturated with too much dopamine can lead to euphoria or even mania.
As mentioned earlier, in addition to disrupting the dopamine and norepinephrine reuptake transporters, amphetamines increase dopamine by another strategy.
Basically, they displace dopamine within VMAT vesicles in the neuron (brain cell) body. In other words, amphetamines take over dopamine’s space in the neuron cell. As such, dopamine is pushed out into the synapse increasing available dopamine levels further.
In the end, this can lead to euphoria and mania.
15. Addiction
This makes some stimulants (amphetamines specifically) highly addictive.
More recently, it’s contributed to the trend of young adults and college students taking Adderall without a prescription.
If you or your child are showing signs of euphoria, mania, or addiction your Adderall dose (or any stimulant) may be too high. Get medical attention as soon as possible and consider a different medication.
Recap: Signs Your ADHD Medication Dose is Too High
You’ve researched ADHD treatment options and have decided to try an ADHD medication.
Maybe you’ve noticed these signs in your child and are concerned that their dose is too high or not enough.
Or, perhaps you’re still contemplating your options and want to know the potential side effects to look out for.
Hopefully, you’ve gained some clarity about the potential signs that an ADHD medication dose is too high. Now take your next best step. Whatever that may be.
Remember, what works for one person may not work for the other. So be sure to work with a TRUSTED healthcare practitioner and know that one step at a time, you’ll get there.
Questions? Thoughts? In this together!
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About the Author:
Lindsay is a trauma-informed educator with a Master’s Degree in Teaching. Her mission is to support moms to equip neurodivergent kids (ADHD, Autism, Dyslexia, Anxiety) to thrive as exactly who they’ve been created to be. Wait until you hear the story that led to it all…
Seek Professional Medical Advice
This is NOT medical advice. I’m not a doctor, but an educator with a passion for researching, learning, health, and supporting the neurodivergent community. As such, this is for educational purposes only. I encourage you to learn as much as you can by learning, reading, and seeking the insight of multiple experts. Please discuss your healthcare decisions with a trusted healthcare provider.
