title: Are there any potentially dangerous pharmacological effects of combining ADHD medication with alcohol and drugs of abuse? A systematic review of the literature.
abstract: BACKGROUND
  Among young people up to 18 years of age, approximately 5% have attention deficit hyperactivity disorder (ADHD), many of whom have symptoms persisting into adulthood. ADHD is associated with increased risk of co-morbid psychiatric disorders, including substance misuse. Many will be prescribed medication, namely methylphenidate, atomoxetine, dexamphetamine and lisdexamfetamine. If so, it is important to know if interactions exist and if they are potentially toxic.
  
  
  METHODS
  Three databases (Medline, EMBASE and PsychINFO) from a 22 year period (1992 - June 2014) were searched systematically. Key search terms included alcohol, substance related disorders, methylphenidate, atomoxetine, dexamphetamine, lisdexamfetamine, and death, which identified 493 citations (344 after removal of duplicates). The eligibility of each study was assessed jointly by two investigators, leaving 20 relevant articles.
  
  
  RESULTS
  We identified only a minimal increase in side-effects when ADHD medication (therapeutic doses) was taken with alcohol. None of the reviewed studies showed severe sequelae among those who had overdosed on ADHD medication and other coingestants, including alcohol.
  
  
  CONCLUSIONS
  The numbers across all the papers studied remain too low to exclude uncommon effects. Also, studies of combined effects with novel psychoactive substances have not yet appeared in the literature. Nevertheless, no serious sequelae were identified from combining ADHD medication with alcohol/illicit substances from the pre-novel psychoactive substance era.
authors.affiliation: Children and Young People's Service, Villa 9, Northgate Hospital, Morpeth, Northumberland, UK. Xanthe.Barkla@ntw.nhs.uk.
authors.forename: Xanthe M
authors.initials: XM
authors.lastname: Barkla
authors.affiliation: Children and Young People's Service, Villa 9, Northgate Hospital, Morpeth, Northumberland, UK. Paul.McArdle@ntw.nhs.uk.|Institute of Health & Society, Newcastle University, Newcastle, UK. Paul.McArdle@ntw.nhs.uk.
authors.forename: Paul A
authors.initials: PA
authors.lastname: McArdle
authors.affiliation: School of Health & Social Care, University of Teesside Middlesbrough, Middlesbrough, UK. Dorothy.Newbury-Birch@tees.ac.uk.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Newbury-Birch
mesh_terms: D000293:Adolescent; D018759:Adrenergic Uptake Inhibitors / Q000009:adverse effects*; D000428:Alcohol Drinking / Q000009:adverse effects*; D000069445:Atomoxetine Hydrochloride / Q000009:adverse effects; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000009:adverse effects; D003913:Dextroamphetamine / Q000009:adverse effects; D004347:Drug Interactions; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects*; D000069478:Lisdexamfetamine Dimesylate / Q000009:adverse effects; D008774:Methylphenidate / Q000009:adverse effects; D019966:Substance-Related Disorders / Q000150:complications
chemical_list: D018759:Adrenergic Uptake Inhibitors; D000697:Central Nervous System Stimulants; D013287:Illicit Drugs; D008774:Methylphenidate; D000069445:Atomoxetine Hydrochloride; D000069478:Lisdexamfetamine Dimesylate; D003913:Dextroamphetamine