ADHD medications Flashcards
Dextro-amphetamine/Adderall
Use: ADHD, narcolepsy exogenous obesity. Tx
resistant depression
- IR: 5 mg day, max 40 mg,
Split dose on waking, then 4-6 hours later (increase by 5 weekly) - XR: 10mg day, max 30mg (increase 5-10 mg week)
Dosage forms:
- Adderall tablet IR: 5, 7.5, 10, 12.5, 15, 20, 30
- IR Evekeo 5, 10
- XR: 5, 10, 15, 20, 25, 30
-ER disintegrating (Adzenys) 3.1, 6.3, 9.4, 15.7, 18.8
Side effects:
- Careful with foster children and children
exposed to drugs in utero
● Useful in depressive symptoms in elderly, post
CVA depression, cognitive functioning and fatigue as residual effects in MDD when unresponsive multiple prior tx
- High abuse potential
- Do not give if extreme anxiety, agitation, Tourette’s
Methylphenidate/Ritalin SR/LA
ADHD
- 6 years and older up to 2 mg/kg per day with a maximum daily dose of 60 mg/day
- Ritalin IR: 5mg am, 5mg lunch, max 60mg daily (2-4 hour duration)
- Ritalin SR, Methylin SR, and Metadate ER: 20-30mg daily, 2 doses (4-6 hour duration)
- Transdermal: 10-30 mg/9 hours
- IR tab: 5mg, 10mg, 20mg (Ritalin, generic methylphenidate)
- Oral solution: 5 mg/mL, 10 mg/5mL (Methylin)
-Older SR tab (Ritalin SR, Metadate ER): 10mg, 20mg (Methylin ER); 20mg *4-6 hours)
- Ritalin LA newer sustained release cap: 10 mg, 20mg, 30mg, 40mg, 60mg
- Metadate CD: 10 mg, 20 mg, 30mg, 40mg, 50mg, 60mg
Side effects
- Transdermal applied to hip
- Metadate CD and Ritalin LA are similar to each other, both with an early peak and duration of action of about 8 hours
- Metadate CD and Ritalin LA may be preferable for those ADHD patients who lose their appetite for dinner or have insomnia with Concerta
- Some patients may benefit from an occasional addition of 5-10 mg of immediate-release methylphenidate to their daily base of sustained-release methylphenidate
- Useful in depressive symptoms in elderly, post CVA depression, cognitive functioning and fatigue as residual effects in MDD when unresponsive to multiple prior tx
- High abuse potential
- Do not give if extreme anxiety, agitation, Tourette’s
Methylphenidate/Concerta
ADHD
- Start 18, max 72 (12 hours)
- ER tabs in 18, 27, 36, 54 mg
Side effects:
- Concerta has less of an early peak but
a longer duration of action (up to 12 hours)
● Concerta may be preferable for those ADHD
patients who work in the evening or do
homework up to 12 hours after morning dosing
Dexmethylphenidate/Focalin/Focalin XR
Age 6-17
ER capsules can be sprinkled over applesauce
- Start 2.5 mg bid, dose every 4hr, max 20 mg
Last 4-5hr - TAB: 2.5, 5, 10
- XR: start 10 mg qam, max 40 mg
Duration: 8-12hr
-ER CAP: 5, 10, 15, 20, 25,
30, 35, 40
*to convert from IR, use
same total daily dose
*to convert from
methylphenidate, start at
50% of current
methylphenidate daily dose
Side effects
- Avoid dosing late in the day because of the
risk of insomnia
● Taking with food may delay peak actions for
2–3 hours
● Half-life and duration of clinical action tend to
be shorter in younger children
- Some patients may benefit from an occasional addition of an immediate release dose of d-methylphenidate to the daily base dose of extended-released-methylphenidate
Lisdexamfetamine/Vyvanse
ADHD, Binge eating, tx-resistant depression
- start 30 mg qam,max 70
mg
Duration: 10-14 hr
CAP: 10, 20, 30, 40, 50, 60,
70
CHEW: 10, 20, 30, 40, 50,
60
Open in 1 oz fluid if can’t swallow pills
● Less likely to abuse, must be activated into its
active form in GI tract
● No cardiovascular disease, glaucoma, hyperthryoidism
● Special dosing renal
Atomoxetine/Strattera
Non-stimulate for ADHD
- Kids: 70 kg or less Initial:
0.5 mg/kg per day, increase
1.2 mg/kg weekly, morning
or divided
Max dose 1.4 mg/kg day or
100 mg, whichever is less
Over 70 kg & adults: 40
mg, max 100 mg (may
divide dose)
CAP: 10 ,18 ,25, 40, 60,
80,100
Side effects:
- Sedation, fatigue, decreased appetite, increased HR and BP, dry mouth, constipation,
dysmenorrhea, urinary retention
● No cardiovascular disease, glaucoma
● Monitor BP
-
Guanfacine/Intuniv ER/Tenex IR
Class: alpha-2 Receptor Agonist
Use: ADHD, ODD, conduct, developmental d/o,
motor tics, Tourette’s
● Not for adults
● Can also be used to treat tic disorders,
including Tourette’s syndrome
Side efffects:
- Some reports of mania and aggressive
behavior in ADHD patients taking guanfacine
● May be used as monotherapy or in
combination with stimulants for the treatment
of oppositional behavior in children with or
without ADHD
● CYP 450 3A4
Class: Alpha-2 Receptor Agonists
Use: ADHD, Tourette’s, anxiety d/o (PTSD, social
anxiety)
Not for adults
ER: 0.1 mg bedtime, max .4
mg divided dose
Side effects:
- Children with GI illness- risk of hypertensive
episode r/t sudden d/c
● Children more likely to experience CNS
depression & toxicity symptoms as low as 0.1
mg. Monitor closely
● Monotherapy & combo with methylphenidate
for ADHD with conduct or ODD- improve
aggression, oppositional, and conduct
symptoms
● Combine with stimulants to reduce side
effects, enhance therapeutic effects on motor
hyperactivity
● SE: dry mouth, constipation, weakness,
fatigue, loss of libido
● Taper- prevent rebound
● Caution renal, hepatic, cardiac
