Contraindications for Stimulant Medications

Absolute Contraindications

The American Academy of Child and Adolescent Psychiatry recommends that stimulant medications should be absolutely contraindicated in patients with concomitant use of MAO inhibitors, as they can result in severe hypertension and risk of cerebrovascular accident, and MAO inhibitors must be discontinued at least 2 weeks before starting stimulants 1, 2
Stimulants are known psychotomimetics and should not be used in patients with psychosis, as they can exacerbate psychotic symptoms, according to the American Academy of Child and Adolescent Psychiatry 1, 3
The American Academy of Child and Adolescent Psychiatry states that stimulants may increase intraocular pressure due to their sympathomimetic effects, making them contraindicated in patients with glaucoma 1, 2
Stimulants should not be used in patients with severe cardiovascular disorders, as they can cause clinically important increases in heart rate and blood pressure, as recommended by the American Academy of Child and Adolescent Psychiatry 2
Pemoline should not be used in patients with preexisting liver disease or abnormal liver function tests due to documented hepatotoxicity, according to the American Academy of Child and Adolescent Psychiatry 1, 3

The American Academy of Child and Adolescent Psychiatry suggests that while package inserts contain "black box" warnings against using stimulants in patients with recent stimulant abuse or dependence, this may not represent an absolute contraindication, and these patients require much closer monitoring 1
Caution should be exercised when prescribing stimulants to patients with unstable mood disorders, as they can produce dysphoria in vulnerable patients, according to the American Academy of Child and Adolescent Psychiatry 3
Patients with pre-existing seizure disorders should be stabilized on anticonvulsants before initiating stimulant treatment, as recommended by the American Academy of Child and Adolescent Psychiatry 3, 4

Controlled studies have not found that methylphenidate worsens motor tics in Tourette's syndrome or increases motor tics in children with ADHD without Tourette's, according to the American Academy of Child and Adolescent Psychiatry 3, 5
Children with comorbid anxiety disorders have been shown to improve on methylphenidate, as reported by the American Academy of Child and Adolescent Psychiatry 3, 6
While package inserts warn against starting methylphenidate in children under 6 years, there are now published reports finding that methylphenidate is effective in this age range, according to the American Academy of Child and Adolescent Psychiatry 2, 3

The American Academy of Child and Adolescent Psychiatry recommends monitoring for cardiovascular adverse events, especially in patients with pre-existing risk factors, and baseline and follow-up assessments of blood pressure, pulse, and cardiac status are recommended 2