Alternative Medications for ADHD Combined Type with Tachycardia on Adderall

Non-Stimulant Options

Atomoxetine is a selective norepinephrine reuptake inhibitor that provides "around-the-clock" symptom control 3
Typical dosing ranges from 40-100mg daily, with effects typically seen after 6-12 weeks of treatment 2, 3
Not a controlled substance, which may be beneficial for patients with substance use concerns 3

Extended-release guanfacine and extended-release clonidine are effective options for patients who cannot tolerate stimulants 2, 3
These medications may actually lower blood pressure and heart rate, potentially beneficial for a patient with tachycardia 3
Common side effects include somnolence, fatigue, and hypotension 3
Effects typically observed after 2-4 weeks of treatment 3
Clonidine may require twice-daily dosing, while guanfacine is typically once-daily 3

For alpha-2 agonists, monitor for excessive sedation and hypotension 3
All non-stimulant medications have a smaller effect size (approximately 0.7) compared to stimulants (approximately 1.0), so expectations should be managed accordingly 4
The American College of Cardiology/American Heart Association guidelines recommend discontinuing or decreasing the dose of amphetamines when they cause elevated blood pressure 5, 6
Consider behavioral therapies as an adjunctive treatment regardless of medication choice 5, 6
If non-stimulant monotherapy is insufficient, some evidence supports combination therapy (e.g., atomoxetine plus behavioral therapy) 3

Avoid abrupt discontinuation of alpha-2 agonists (guanfacine, clonidine) as this can cause rebound hypertension 7
Remember that non-stimulants typically take longer to show full therapeutic effects (6-12 weeks for atomoxetine, 2-4 weeks for alpha-2 agonists) compared to stimulants 3