Treatment of ADHD

Drugs used in the treatment of ADHD

ADHD (attention deficit hyperactivity disorder) is characterized by inattention, hyperactivity, and impulsivity that often begins in childhood. Along with behavioral therapy, medications can help manage ADHD symptoms. The main medication groups are stimulants and non-stimulants.

Stimulants: These drugs increase arousal in the prefrontal cortex. Common stimulants include methylphenidate (Ritalin, Methylin, Concerta, Focalin) and amphetamines (Adderall, Evekeo, Dexedrine, Vyvanse).

• Vyvanse contains lisdexamfetamine.
• Adderall contains a combination of amphetamine and dextroamphetamine.

Mechanism: Stimulants increase dopamine and norepinephrine concentrations in the synaptic cleft in the brain.

Formulations: Methylphenidate is available in multiple forms, including tablets, solutions, chewables, suspension, extended-release tablets, and orally disintegrating tablets.

Adverse effects: Stimulants can cause decreased appetite, nausea, weight loss, sleep disturbances, headache, tics, increased heart rate and blood pressure, irritability, seizures, psychosis, euphoria, mania, and depression.

Safety and prescribing notes:

• Stimulants have a high abuse potential and are classified as DEA Schedule II drugs.
• Stimulants are contraindicated with MAOIs and in glaucoma.
• Use caution in patients with cardiovascular disease, hyperthyroidism, and hypertension.

Non-stimulants: These drugs include atomoxetine (Strattera), clonidine (Catapres, Onyda), and guanfacine (Intuniv).

• Atomoxetine is a norepinephrine reuptake inhibitor. It increases norepinephrine and dopamine concentrations in the prefrontal cortex.
• Clonidine and guanfacine are alpha 2 agonists.

Adverse effects: Non-stimulants can cause suicidal tendency (Strattera), decreased appetite, nausea, vomiting, diarrhea, fatigue, mood swings, dizziness, insomnia, liver damage, and prolongation of the QT interval.

Abuse potential: Non-stimulants do not have abuse potential.