While there are really only three main types of medications for ADD and ADHD, there is a nearly dizzying array of options. The main questions to consider are:
- Whether one is going to use methylphenidate (which prevents re-uptake of norepinephrine and dopamine at the synapse) or dextroamphetamine (which prevents re-uptake of norepinephrine and dopamine at the synapse but also may increase release of these neurotransmitters into the synapse, and therefore may have a greater effect)
- What duration of action one needs (e.g. immediate release with short duration of action, or long acting for the entire day)
- What delivery method is best-either direct, via patch (less abuse potential), or via a pro-drug (converted in the body to the active drug, therefore there is a delayed action, but less abuse potential)
These groups of medications include the following subcategories:
- Stimulants (either of the methylphenidate type or the Dexedrine type). These have a high abuse potential, are frequently sold on the street and snorted, like cocaine, unless delivered in unusual forms such as the Daytrana patch, or as a pro-drug (Vyvance). They can increase tics, and if given in excess doses cause hyper-focusing, and induce agitation, mania, and insomnia, and raise blood pressure.
Disturbingly, the long-term effects of these medications on the brain or the heart have not been studied, despite the fact that they are given to millions of children. Stimulants have been associated with sudden cardiac death in children and adolescents (at usual doses) with structural heart abnormalities, or other heart abnormalities. Sudden death, stroke, and heart attacks have been reported in adults taking stimulants at normal doses for ADHD, although a causal role has not been proven. Increased blood pressure is a risk. Growth in children on stimulants should be monitored, as there is a well documented slowing in growth rate. - Anti-depressant like medications (atomoxetine and buproprion), and
- Blood pressure medications (clonidine and guanfacine), which act to increase activity at the prefrontal cortex.
| Trade Name | Generic Name | Dose sizes | Side Effects | Comments |
|---|---|---|---|---|
| Adderall | Dextro Amphetamine mixed salts | 5, 7.5,10,12.5, 15, 20, 30 mg | Loss of appetite, insomnia, irritability | Can exacerbate tics, Tourette’s, easily abused |
| Adderall XR | Dextro Amphetamine mixed salts | 5,10, 15, 20, 25, 30 mg | Loss of appetite, insomnia, irritability | Can exacerbate tics, Tourette’s, easily abused |
| Dexedrine | dexedrine | 5 mg | Loss of appetite, insomnia, irritability | High Abuse Potential |
| Dextrostat | dexedrine | 5,10 mg | Loss of appetite, insomnia, irritability | High Abuse Potential |
| Wellbutrin | buproprion | 75-450mg | Agitation | Also anti-depressant |
| Stratera | atomoxetine | Based on weight in children, 40-100 mg in adults | Decreased appetite, sedation, Light-headednessinsomnia, increased blood pressure, sexual side effects | Mildly beneficial; important drug interactions with CYP450 2D6 inhibitors such as fluoxetine and paroxetine |
| Focalin | Dexmethyl-phenidate | 2.5, 5, 10mg | Loss of appetite, insomnia, irritability | |
| Focalin XR | Dexmethyl-phenidate | 5,10,15,20,30 mg | Loss of appetite, insomnia, irritability | 50% immediate release; abuse potential high |
| Vyvanse | lisdexamfetamine | 20, 30, 40, 50, 60, 70mg | Loss of appetite, insomnia, irritability | Once daily, delayed onset |
| Desoxyn | methamphetamine | 5mg | Above plus weigh loss | High abuse potential; |
| Ritalin, Methylin, Metadate | Methylphenidate | 5,10,20mg | Loss of appetite, insomnia, irritability | High abuse potential |
| Metadate CD | Methylphenidate | 10,20,30mg | Loss of appetite, insomnia, irritability | 30% immediate release; 70% delayed release |
| Metadate ER | Methylphenidate | 10,20mg | Loss of appetite, insomnia, irritability | Gradually wears off |
| Ritalin LA | Methylphenidate | 10,20,30,40mg | Loss of appetite, insomnia, irritability | Once daily use |
| Concerta | Methylphenidate | 18,27,36,54mg | Loss of appetite, insomnia, irritability | 22% immediate release, 78% delayed |
| Daytrana | Methylphenidate | 10, 15, 20, 30 mg PATCH worn for 9 hours | Loss of appetite, insomnia, irritability | Can cause skin irritation |
| Tenex | Guanfacine (immediate release) | 1mg-2mg | Sedation | Lowers blood pressure, can cause depression; no abuse potential |
| Intuiv | Guanfacine XR (slow release) | 0.5mg very slowly increased every 6 weeks to a max of 1 three times per day | Sedation low blood pressure, dry mouth, nausea | Reports of fainting (low blood pressure); no abuse potential |
| Catapres | clonidine | 0.1, 0.2, 0.3 mg | Sedation, low blood pressure, dry mouth, nausea | Lowers blood pressure, can cause depression; no abuse potential |