ADHD drugs

Question 1

ADHD: 1st line Tx?

Answer 1

Unless there is a reason to not prescribe a stimulant, most patients should be tried on an immediate-acting stimulant as a first-line medication.

Question 2

Non-stimulant ADHD Tx (2)

Answer 2

Atomoxetine (STRATERRA, selective norepinephrine reuptake inhibitor)
Bupropion (WELLBUTRIN, norepinephrine dopamine reuptake inhibitor)

Question 3

Stimulant ADHD meds: side FX

Answer 3

Common side effects: insomnia, anorexia. Nervousness, irritability, headache, blurred vision. May temporarily slow normal growth (controversial). Rare: psychotic episodes (esp. if taken parentally), seizures, manic/hypomanic sx, sudden cardiac death in patients with preexisting cardiac structural abnormalities.

Large studies have not found an increased risk of cardiovascular events (both adult and child). However, stimulants and atomoxetine should not be used in patients with serious heart problems or in patients who should avoid increased blood pressure or heart rate.
Discontinue the stimulant periodically to re-evaluate symptoms or if no improvement occurs within 1 month.

Question 4

2 “classes” of stimulant ADHD meds

Answer 4

1) Methylphenidate (Ritalin, Ritalin LA, Concerta, Biphentin)
2) Amphetamines or dextroamphetamines (Dexedrine, Adderall, Adderall XR)

Question 5

Methylphenidate

Answer 5

• RITALIN 5mg qAM, 5mg qlunch initially. Increase by 5-10mg each week. Max 2mg/kg per day in children 6 years and older. Maximum daily dose 60mg/day
• Ritalin LA: up to 8 hours duration of action; initial 20 mg/day q a.m., may adjust by weekly increments of 10-20mg, maximum dose 60 mg/day

Question 6

Methylphenidate hydrochloride extended release tablets by Janssen

Answer 6

CONCERTA: up to 12 hours duration of action; initial 18 mg/day q a.m., May be adjusted at weekly intervals. Maximum dose 72 mg/day

Question 7

Methylphenidate hydrochloride controlled release capsule by Purdue

Answer 7

BIPHENTIN: Start at 10-20mg QAM. May be adjusted weekly in increments of 10mg/day to a maximum of 60mg/day.

Question 8

Dextroamphetamine

Answer 8

DEXEDRINE: 5mg QD or BID, may increase in 5mg/d weekly increments until optimal response is reached. Usual range 0.1-0.5mg/kg/dose (5-20mg per day). Maximum dose 40mg.

Question 9

Dextroamphetamine and levoamphetamine racemic mixture (regular and extended release)

Answer 9

ADDERALL: 5mg QD or BID, increase in weekly 5mg increments until optimal response. Maximum dose 40mg/day given in 1-3 divided doses.

Adderall XR: 20mg QAM. Higher doses have been evaluated but no evidence of additional benefit.