ADD and ADHD Medications

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

Want to find out more?

Achieving good health results from a partnership of a thoughtful skilled medical practitioner and a motivated patient with a vision of wellness. Contact us for information on how we can help you.

Newsletter & Workshop Alerts

Enter your email address to join our mailing list.