Azstarys Side Effects: What You Should Know

Every medication comes with potential side effects, and Azstarys is no exception. As a Schedule II stimulant used to treat ADHD in patients 6 years and older, Azstarys shares many side effects with other methylphenidate-based medications — but there are a few things worth understanding before you start or switch to this medication.

This guide covers the most common side effects, serious reactions to watch for, and practical tips for managing them.

What Is Azstarys?

Azstarys is a brand-name prescription medication containing Serdexmethylphenidate and Dexmethylphenidate. It's made by Corium (a Sun Pharmaceutical company) and was FDA-approved in 2021 for treating ADHD in patients aged 6 and older. The serdexmethylphenidate component is a prodrug that gradually converts to dexmethylphenidate in your body, providing extended symptom control throughout the day.

For a deeper look at how this medication works, see our guide on how Azstarys works.

Common Side Effects

The following side effects are the most frequently reported in clinical trials. Most are mild to moderate and often improve as your body adjusts to the medication over the first few weeks:

• Decreased appetite — This is the most common side effect. Many patients notice they're not as hungry, especially during the day while the medication is active.
• Insomnia or trouble sleeping — Because Azstarys is a stimulant, it can make it harder to fall asleep, particularly if taken later in the day.
• Nausea — Some patients feel mildly nauseous, especially when first starting the medication.
• Vomiting — Less common than nausea, but possible in the first few days.
• Stomach pain — Abdominal discomfort is reported by some patients.
• Weight loss — Often related to decreased appetite. Your doctor may monitor your weight, especially in children.
• Anxiety — Stimulants can sometimes increase feelings of nervousness or worry.
• Dizziness — Usually mild and temporary.
• Irritability — Some patients experience mood changes, particularly as the medication wears off.
• Mood swings — Emotional ups and downs may occur, especially during dose adjustments.
• Fast heartbeat — A mild increase in heart rate is common with stimulant medications.
• Increased blood pressure — Your doctor will monitor this at follow-up visits.

Most of these side effects are dose-related, meaning they may be worse at higher doses. If side effects are bothersome, your doctor may adjust your dose or try a different timing strategy.

Serious Side Effects

While rare, some side effects require immediate medical attention. Call your doctor right away or go to the emergency room if you experience any of the following:

• Signs of a heart problem — Chest pain, shortness of breath, fainting, or a very fast or irregular heartbeat. Azstarys can cause serious cardiovascular events, especially in patients with pre-existing heart conditions.
• Psychiatric symptoms — New or worsening psychosis (seeing or hearing things that aren't there), mania, paranoia, or aggressive behavior.
• Signs of circulation problems — Unexplained wounds on fingers or toes, numbness, coolness, pain, or skin color changes. This could be a sign of Raynaud's phenomenon or peripheral vasculopathy.
• Priapism — A prolonged, painful erection lasting more than 4 hours. This is a medical emergency that requires immediate treatment.
• Severe allergic reaction — Swelling of the face, lips, tongue, or throat; difficulty breathing; hives; or rash. Seek emergency care immediately.
• New or worsening tics — Motor or vocal tics that develop or get worse after starting the medication.

Boxed Warning: Abuse and Addiction

Azstarys carries an FDA boxed warning about the potential for abuse, misuse, and addiction. As a Schedule II controlled substance, it has a high potential for dependence. Take it only as prescribed, never share it with others, and store it securely. If you have a history of substance use disorder, discuss this with your doctor before starting Azstarys.

Side Effects in Specific Populations

Children and Adolescents

In addition to the side effects listed above, children taking Azstarys should be monitored for slowed growth. Stimulant medications can reduce the rate of weight gain and height growth in pediatric patients. Your child's doctor should track growth at regular check-ups.

Pregnancy and Breastfeeding

Azstarys has not been well studied in pregnant or breastfeeding women. If you're pregnant, planning to become pregnant, or nursing, talk to your doctor about whether the benefits outweigh the potential risks.

Patients with Heart Conditions

Azstarys should be used with caution in patients with pre-existing heart problems, high blood pressure, or a family history of sudden cardiac death. Your doctor should evaluate your cardiovascular health before prescribing this medication.

How to Manage Common Side Effects

Here are some practical strategies for dealing with the most common Azstarys side effects:

• Decreased appetite: Eat a good breakfast before your medication kicks in. Have nutrient-dense snacks available for when the appetite-suppressing effect wears off in the evening.
• Insomnia: Take Azstarys in the morning as directed. Avoid caffeine, especially in the afternoon. Establish a consistent bedtime routine.
• Nausea or stomach pain: Taking the medication with food may help. If you use the sprinkle method (opening the capsule onto applesauce), make sure to eat it immediately.
• Irritability or mood swings: These often improve after the first few weeks. If they persist, your doctor may adjust the dose.
• Fast heartbeat or blood pressure changes: Stay hydrated and avoid excessive caffeine. Report persistent changes to your doctor.

Never stop taking Azstarys suddenly without talking to your doctor first. While stimulants don't cause dangerous physical withdrawal, stopping abruptly can lead to fatigue, depression, or a return of ADHD symptoms.

Final Thoughts

Most people who take Azstarys tolerate it well, with side effects that are manageable and often improve over time. The key is staying in close communication with your prescriber, especially during the first few months of treatment.

If you're weighing whether to try Azstarys, learn more about what Azstarys is and how it's used, or explore alternatives to Azstarys if side effects become a concern. And when you're ready to fill your prescription, Medfinder can help you find a pharmacy with Azstarys in stock.