Graham Johnny, Coghill David
Child and Adolescent Psychiatry, University of Dundee, Section of Psychiatry, Division of Pathology and Neuroscience, Ninewells Hospital, Dundee, Scotland.
CNS Drugs. 2008;22(3):213-37. doi: 10.2165/00023210-200822030-00003.
Medication for the treatment of attention-deficit hyperactivity disorder (ADHD) is in widespread use globally. There is considerable data suggesting that overall, the adverse effect burden from this use is dose dependent and is in the mild to moderate category, but few comprehensive reviews exist of the epidemiology of adverse effects alone. This review provides a general and systems-specific summary of the scientific literature regarding adverse effect data for the drugs in general use for the treatment of ADHD. Although several areas lack definitive data, current evidence suggests that, for the majority of those treated for ADHD, the medications currently available pose little in the way of risk of significant harm. Epidemiological data suggest a low incidence of serious adverse effects, whilst the less serious adverse effects, such as insomnia and anorexia, are relatively common. Also, some specific areas of study suggest lower risks of harm than previously thought, e.g. tic disorders and seizures. However, pre-existing conditions and other interindividual differences may raise the risk of harmful adverse effects, which adds emphasis to the need for careful pretreatment assessment and monitoring. Potential but unlikely long-term treatment effects need to be investigated as carefully as possible, particularly with regard to cardiac sequelae and carcinogenesis. There are both overlaps and differences between the adverse effects of stimulants and nonstimulants, such as atomoxetine. For example, the latter shares the stimulant group's potential for changing cardiovascular parameters, but may not cause insomnia.
用于治疗注意力缺陷多动障碍（ADHD）的药物在全球广泛使用。有大量数据表明，总体而言，这种药物使用带来的不良反应负担具有剂量依赖性，且属于轻度至中度，但单独关于不良反应流行病学的全面综述很少。本综述对治疗ADHD常用药物的不良反应数据的科学文献进行了一般性和系统特定性的总结。尽管几个领域缺乏确切数据，但目前的证据表明，对于大多数接受ADHD治疗的人来说，现有药物造成重大伤害的风险很小。流行病学数据表明严重不良反应的发生率较低，而不太严重的不良反应，如失眠和厌食，则相对常见。此外，一些特定的研究领域表明危害风险比以前认为的要低，例如抽动障碍和癫痫发作。然而，既往疾病和其他个体差异可能会增加有害不良反应的风险，这进一步强调了治疗前仔细评估和监测的必要性。潜在但不太可能出现的长期治疗效果需要尽可能仔细地研究，特别是关于心脏后遗症和致癌作用方面。兴奋剂和非兴奋剂（如托莫西汀）的不良反应既有重叠也有差异。例如，后者与兴奋剂组一样有改变心血管参数的可能性，但可能不会导致失眠。
