236 The Explosive Childtially cause an increase in agitation. Antihypertensive
medications, including clonidine (Catapres) and guan-
facine (Tenex) are also sometimes used to reduce hyper-
activity and impulsivity, but they may be less effective
for inattention. Antihypertensives can also be effective at
reducing tics. In addition, because of their sedating ef-
fect, antihypertensives have been used to help children
sleep at night. However, in some children, this sedation
may be a problem during daytime hours and is some-
times manifested in the form of heightened irritability.
In those explosive children whose difficulties involve the
emotion regulation pathway, increased irritability is un-
desirable. Side effects can include headache, dizziness,
nausea, constipation, and dry mouth.
The tricyclic antidepressants, which include agents
such as nortriptyline (Pamelor), desipramine (Nor-
pramin), imipramine (Tofranil), and clomipramine
(Anafranil), may also be prescribed to reduce hyperac-
tivity and impulsiveness in children. An advantage of
tricyclic medications is that they provide twenty-four-
hour coverage and typically do not interfere with sleep.
One of the rare but more serious side effects of the tri-
cyclic medications is cardiac toxicity, which often ne-
cessitates that children medicated with such agents
undergo initial and then periodic electrocardiograms.
There are a variety of additional potential side effects
that may not be well tolerated by children, including