Questions to ask before starting ADHD medication: a checklist for adults

A medication decision is easier when you walk in with your questions written down. This checklist covers what to tell the prescriber, what to ask about the medication itself, and the practical details that catch many adults off guard in New York and New Jersey. It is built from FDA labels, which list what prescribers are told to check, and from state prescription rules. It contains no dosing information. It does not replace the evaluation, and you do not need to ask every question in one visit.

If you have not yet had an evaluation, start with questions to ask before booking an ADHD evaluation. For what the first weeks on medication look like, see starting ADHD medication: the first three months.

Part 1: What to tell the prescriber

FDA labels tell prescribers to screen for specific risks before starting. You can make that screening accurate by bringing the facts.

• Heart history. Any heart condition, fainting, chest pain with exercise, high blood pressure, and any family history of sudden death or ventricular arrhythmia. Stimulant labels tell prescribers to take this history, and advise avoiding use in people with known serious heart disease.
• Mood history. Depression, bipolar disorder, psychosis or suicide attempts, in you or close relatives. Labels tell prescribers to screen for risk factors for a manic episode.
• Substance use. Alcohol, cannabis, other drugs, and any past misuse of prescription medication. The stimulant boxed warning tells prescribers to assess each patient's risk of abuse, misuse and addiction.
• Every medication and supplement. Include over-the-counter products. ADHD medication labels list MAO inhibitors, including linezolid and intravenous methylene blue on amphetamine labels, as contraindicated within 14 days. Amphetamine labels also warn of serotonin syndrome risk with drugs such as SSRIs, SNRIs and triptans.
• Eye and other conditions. Glaucoma, tics or Tourette's syndrome, seizures, and Raynaud's phenomenon are all named in label warnings for some ADHD medications. The Strattera label lists narrow-angle glaucoma as a contraindication.
• Pregnancy and breastfeeding plans. Including plans for the next year.
• Your daily schedule. When your day starts and ends, and which hours matter most.
• Caffeine and sleep. How much and when. See ADHD medication and caffeine.

Part 2: Questions about the medication

1. What class is it: a stimulant, a nonstimulant, or an off-label option?
2. Is it FDA-approved for adults with ADHD, or is it used off-label?
3. Is it a controlled substance, and what schedule? (See ADHD medication schedules.)
4. What form is it, and can it be opened, chewed or crushed? Some extended-release tablets must be swallowed whole.
5. About how long should the effect last, and does that fit my day?
6. How soon should I expect to notice a benefit?
7. Is a generic available, and would a change of manufacturer matter?
8. Why this one for me, rather than the alternatives? (See how doctors choose an ADHD medication.)

Part 3: Questions about side effects and safety

1. What are the most common side effects, and which usually ease with time?
2. What does the boxed warning on this medication say, and how does it apply to me?
3. Which side effects mean I should call you, and which mean I should go to an emergency department?
4. Do I need blood pressure and pulse checks, and should I measure them at home? Stimulant labels tell prescribers to monitor both.
5. How could it affect my sleep, appetite, anxiety and mood? (See ADHD medication and mood changes.)
6. Can I drink alcohol on it? (See ADHD medication and alcohol.)
7. Which of my current medications or supplements could interact with it?
8. What should I do if I miss a dose?

Common side effects in adults vary by medication. As examples, the Adderall XR label lists dry mouth, loss of appetite, insomnia, headache, weight loss, nausea, anxiety, agitation, dizziness and a fast heart rate among the most common adult reactions, and the Concerta label lists decreased appetite, headache, dry mouth, nausea, insomnia, anxiety, dizziness, weight loss, irritability, fast heart rate and excessive sweating. More is in ADHD medication side effects in adults.

Part 4: Pregnancy and breastfeeding

• What does the label say about pregnancy, and is there a pregnancy exposure registry? Stimulant labels describe one.
• What should I do if I become pregnant while taking it? Stimulant labels advise patients to tell their health care provider.
• Is it compatible with breastfeeding? Labels differ. Amphetamine labels such as Adderall XR and Vyvanse advise not breastfeeding, while the Concerta and Strattera labels ask clinicians to weigh the benefits of breastfeeding against the mother's need for the medication and possible effects on the child.

The National Library of Medicine's LactMed database summarizes published data on medications in breast milk. The NY guide's ADHD in pregnancy and postpartum covers planning.

Part 5: Practical questions for New York and New Jersey

For cost, ask the office about current fees and how insurance works with the practice. For the medication itself, ask your pharmacy or plan what it will cost before the first fill. The state rules are explained in ADHD medication rules in New York and ADHD medication rules in New Jersey.

Part 6: Questions about the plan

1. How will we decide whether it is working, and when?
2. How often will we follow up, and how do I reach you between visits?
3. What happens if it does not help or the side effects are not acceptable?
4. If I want to stop later, how should that be done? (See stopping ADHD medication.)
5. How should I store it and dispose of leftover tablets? Stimulant labels advise a safe place, preferably locked.

Read the Medication Guide

Many ADHD medications come with an FDA-approved Medication Guide. The FDA requires one when patient information could help prevent serious adverse reactions or when a drug has serious risks patients should know about, and pharmacies must hand it out in paper form when the medication is dispensed. It is written for patients and is worth reading before the first dose. Current labels and guides are on DailyMed. If you have a side effect, you or your prescriber can report it to the FDA through MedWatch.

When to call the prescriber, and when to get emergency care

• Call the prescriber for side effects that worry you, new anxiety or low mood, poor sleep that does not settle, or problems getting the prescription filled.
• Call 911 for chest pain, fainting, seizures, or signs of a severe allergic reaction such as swelling of the face or trouble breathing.
• Call or text 988 at any hour for thoughts of harming yourself.

Dr. Shershow, a psychiatrist licensed in New York and New Jersey who focuses on adult ADHD, discusses treatment options at the end of the evaluation and provides medication management when medication is appropriate. See information for new patients or contact the office.