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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 NameGeneric NameDose sizesSide EffectsComments
AdderallDextro Amphetamine mixed salts5, 7.5,10,12.5, 15, 20, 30 mgLoss of appetite, insomnia, irritabilityCan exacerbate tics, Tourette’s, easily abused
Adderall XRDextro Amphetamine mixed salts5,10, 15, 20, 25, 30 mgLoss of appetite, insomnia, irritabilityCan exacerbate tics, Tourette’s, easily abused
Dexedrinedexedrine5 mgLoss of appetite, insomnia, irritabilityHigh Abuse Potential
Dextrostatdexedrine5,10 mgLoss of appetite, insomnia, irritabilityHigh Abuse Potential
     
Wellbutrinbuproprion75-450mgAgitationAlso anti-depressant
StrateraatomoxetineBased on weight in children, 40-100 mg in adultsDecreased appetite, sedation, Light-headednessinsomnia, increased blood pressure, sexual side effectsMildly beneficial; important drug interactions with CYP450 2D6 inhibitors such as fluoxetine and paroxetine
     
FocalinDexmethyl-phenidate2.5, 5, 10mgLoss of appetite, insomnia, irritability 
Focalin XRDexmethyl-phenidate5,10,15,20,30 mgLoss of appetite, insomnia, irritability50% immediate release; abuse potential high
     
Vyvanselisdexamfetamine20, 30, 40, 50, 60, 70mgLoss of appetite, insomnia, irritabilityOnce daily, delayed onset
Desoxynmethamphetamine5mgAbove plus weigh lossHigh abuse potential;
     
Ritalin, Methylin, MetadateMethylphenidate5,10,20mgLoss of appetite, insomnia, irritabilityHigh abuse potential
Metadate CDMethylphenidate10,20,30mgLoss of appetite, insomnia, irritability30% immediate release; 70% delayed release
Metadate ERMethylphenidate10,20mgLoss of appetite, insomnia, irritabilityGradually wears off
Ritalin LAMethylphenidate10,20,30,40mgLoss of appetite, insomnia, irritabilityOnce daily use
ConcertaMethylphenidate18,27,36,54mgLoss of appetite, insomnia, irritability22% immediate release, 78% delayed
DaytranaMethylphenidate10, 15, 20, 30 mg PATCH worn for 9 hoursLoss of appetite, insomnia, irritabilityCan cause skin irritation
     
TenexGuanfacine (immediate release)1mg-2mgSedationLowers blood pressure, can cause depression; no abuse potential
IntuivGuanfacine XR (slow release)0.5mg very slowly increased every 6 weeks to a max of 1 three times per daySedation low blood pressure, dry mouth, nauseaReports of fainting (low blood pressure); no abuse potential
Catapresclonidine0.1, 0.2, 0.3 mgSedation, low blood pressure, dry mouth, nauseaLowers blood pressure, can cause depression; no abuse potential