ADHD MEDICATIONS

Myths and Facts

ADHD Awareness Day, Oct 2011

by

Theresa Cerulli, M.D.Neuropsychiatrist

ADHD Medication Categories

1. Stimulants

a. Methylphenidates

b. Amphetamines

2. Non-Stimulants

ADHD Medications

StimulantsMethylphenidates -

Ritalin, Ritalin LA,

Daytrana, Metadate ER,

Metadate CD Concerta,

Focalin IR, Focalin XR

Amphetamines-

Adderall IR, Adderall XR,

Dexedrine

Vyvanse (prodrug)

Non-Stimulants Atomoxetine

Intuniv, Kapvay

Off-Label meds Wellbutrin SR, XL

Provigil

Tenex, Clonidine

TCA’s

Stimulants

Methylphenidate Products Ritalin, Methylin Ritalin SR Concerta Metadate ER and CD Methylin ER Ritalin LA Focalin Focalin XR Daytrana (patch)

Amphetamines Dexedrine Dexedrine Spansules Adderall Adderall XR

Vyvanse (Prodrug)

Stimulant Medication Side Effects

Short Term Stimulant Side Effects: Loss of appetite Weight loss Insomnia Headache Irritability Feeling jittery Dry mouth Anxiety Tachycardia Nausea/GI side effects Exacerbation of Tics

Long Term Stimulant Side Effects: Possible Delayed Growth Spurt Possible decrease in height Possible Tic Disorders Most recent studies show no

evidence of growth problems or

tic disorders compared with

ADHD patients who never took

stimulant medications

Stimulants: FDA Warning Label

Non-Stimulants

FDA approved for treating ADHD -

•Strattera (atomoxetine)

•Intuniv (long-acting guanfacine),

•Kapvay (long-acting clonidine)

Off Label meds, not FDA approved for ADHD -

•Provigil, Wellbutrin XL, tenex, clonidine, Tricyclic

antidepressants (TCA’s)

Non-Stimulant Side Effects

Strattera- Sedation, GI side effects, dizziness, liver, SI Intuniv, Kapvay - Sedation, lightheadedness/dizziness

Wellbutrin- HA, dry mouth, sweating, nausea,

decreases seizure threshold TCA’s- Sedation, wt gain, dry mouth, postural

hypotension, sexual dysfunction, cardiac (Check EKG) Provigil- Insomnia, HA

Medications

Diet and Nutrition

Brain NeurotransmittersDopamine

NorepinephrineSerotonin

Neurotransmitters

Degree of Action on Neurotransmitter

Proposed mechanism of action based on animal studies

Delivery Systems

How is your medication released?

How does your medication get to where its going?

OROS Delivery System (Concerta)

SODAS Delivery Adderall XR, Ritalin LA, Focalin XR

ADHD Medications

Adderall

Intuniv

Focalin

Strattera

How Do You Choose?

Medication Considerations

Consider: Family history Genetic subtype of ADD Mechanism of Action of medication Length of Action of medication Patient’s daily schedule FDA approval vs. off label use of medication

The UpsideADHD Medications Can -

•Improve Focus and Concentration•Increase productivity•Calm Hyperactivity•Increase attention to details•Improve communication/listening skills•Enhance executive functioning (organization, time management, problem solving)