What are the best stimulants?

ADHD Medication Treatments: Which Are Best? Adderall XR (amphetamine) Concerta (methylphenidate) Dexedrine (amphetamine) Evekeo (amphetamine) Focalin XR (dexmethylphenidate) Quillivant XR (methylphenidate) Ritalin (methylphenidate) Strattera (atomoxetine hydrochloride) More items... •

additudemag.com - ADHD Medication Treatment Options: Stimulants, Nonstimulants & More

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Stimulants – considered the first-line treatment for ADHD. Amphetamines fall under this category, along with methylphenidate, the most widely used treatment for ADHD, and their derivatives. 1 – considered the first-line treatment for ADHD. Amphetamines fall under this category, along with methylphenidate, the most widely used treatment for ADHD, and their derivatives. Nonstimulants – prescribed to patients who don’t tolerate or see benefits from stimulant medications (up to 30 percent of patients do not respond to stimulants2). Three nonstimulants are approved to treat ADHD: atomoxetine, guanfacine, and clonidine. Nonstimulants, may also be prescribed for use alongside stimulants to treat symptoms that the latter do not alleviate. Selecting the “best” ADHD medication can be a lengthy trial-and-error process of dosage and timing that is often related to a patient’s history, genetics, experienced side effects, and unique metabolism. ADHD medication is also often accompanied by behavioral therapy and other non-pharmacological treatments. Many parents and adults with ADHD remain confused about the distinctions and similarities between these and other treatment choices for ADHD. Our ADHD medication chart offers a side-by-side comparison of the most popular stimulants and nonstimulants in the treatment of ADHD. Other new ADHD medications on the market include Jornay PM and Adhansia XR – stimulant medications approved in 2019 by the Food and Drug Administration (FDA) for use in children and adults. Unlike most stimulants, Jornay PM is taken in the evening; the medication begins working by the time the patient wakes and through the rest of the day. Adhansia XR is available in six extended-release capsules, which include some of the highest dosage strengths currently on the market. ADHD is a neurological disorder, resulting from the deficiency of a neurotransmitter, or a group of neurotransmitters, in specific areas of the brain. Neurotransmitters are chemicals that transmit signals between nerve cells by bridging the synapse (or gap) between them.3 One key neurotransmitter often deficient in individuals with ADHD is norepinephrine, along with its building blocks, dopa and dopamine. In theory, the primary stimulant medications used to treat ADHD stimulate specific cells within the brain to produce more of this deficient neurotransmitter. That’s why these medications are called stimulants — though it’s unknown exactly how they work to relieve ADHD symptoms. The two main classes of stimulant medications, methylphenidate and dextro-amphetamine — both generic names — have been used since the 1930s.4 All brand-name stimulants are variations of these two medications. The ADHD medication Adderall for instance, is a modification of dextro-amphetamine. Methylphenidate, on the other hand comes in many forms (including a chewable tablet, a liquid, and a skin patch) with each variation having its own name. Clonidine (Kapvay) and guanfacine (Intuniv) are alpha2-agonists. The prevailing theory is that these medications work by mimicking the effects of norepinephrine in the prefrontal cortex’s receptors.1 The FDA requires, among other provisions, that a medication be labeled according to its5: Dosage Form/Route of Administration: Capsule, tablet, liquid, patch, etc. The patient information sheet inside the medication’s box or packaging states how much medication is in each unit of liquid; for example, 5 mg per 5 ml of liquid. Another methylphenidate product — Daytrana — is a patch that releases medication through the skin and into the bloodstream. Daytrana 30 mg contains about 30 mg of methylphenidate, and releases about 3.3 mg of it per hour. Capsule, tablet, liquid, patch, etc. The patient information sheet inside the medication’s box or packaging states how much medication is in each unit of liquid; for example, 5 mg per 5 ml of liquid. Another methylphenidate product — Daytrana — is a patch that releases medication through the skin and into the bloodstream. Daytrana 30 mg contains about 30 mg of methylphenidate, and releases about 3.3 mg of it per hour. Dose Quantity/Strength: The specific amount of medication released into the blood over a given period of time. In other words, the number value for each product represents the total amount of the medication in the tablet/liquid/capsule/patch, not the amount in the blood at any one time. If methylphenidate, for example, is in the form of a four-hour tablet, and it releases 5 mg over that time, it is called methylphenidate 5 mg. A capsule of Adderall, on the other hand, that releases 10 mg immediately and 10 mg four hours later is called Adderall XR 20. The specific amount of medication released into the blood over a given period of time. In other words, the number value for each product represents the total amount of the medication in the tablet/liquid/capsule/patch, not the amount in the blood at any one time. If methylphenidate, for example, is in the form of a four-hour tablet, and it releases 5 mg over that time, it is called methylphenidate 5 mg. A capsule of Adderall, on the other hand, that releases 10 mg immediately and 10 mg four hours later is called Adderall XR 20. Release mechanism/Duration of Administration (released immediately or over an extended period of time): The length of time a medication will remain available and active. Stimulants release medications over many time frames, including an hour, four hours, or over eight or 12 hours. Here’s an example: The ADHD medication Ritalin is a tablet that is released immediately into the bloodstream and works for four hours. Ritalin LA, on the other hand, is a capsule that releases over a longer period of time and works for eight hours. Different names, even though both contain the same medicine — methylphenidate. Even with the FDA’s guidelines, the average consumer may find labels on ADHD medications confusing. Take the ADHD medication Concerta. Designed to last 12 hours, Concerta has a “sponge” on the bottom of the capsule, medication on top, and a tiny hole above the medication. As the capsule passes through the gastrointestinal tract and absorbs moisture, the sponge expands and pushes the medication out of the hole.

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The number value assigned to each dose is where the confusion tends to lie. Take Concerta 18 mg. If the goal is to release 5 mg consistently every four hours over a 12-hour period, then there needs to be 15 mg in the capsule. However, it takes time for the sponge to become moist enough to start to expand. So an initial release of medication is needed until the sponge starts working. Researchers figured out that it should be 3 mg. Thus, to release 5 mg over 12 hours, one needs the initial 3 mg, plus 5 mg every four hours during the 12 hours. The total amount of medication is 18 mg. That’s why the medication is called Concerta 18.

Generally, stimulant medications have similar side effects that include1

decreased appetite

stomach pain

sleep disturbances

headaches

Some side effects associated with nonstimulants include1:

fatigue

stomach pain

decreased appetite

nausea

It is common for patients to experience side effects when trying and adjusting stimulant medications. Clinicians may start with small doses and increase dosing if the patient does not see benefits and if side effects are tolerable. Many side effects are also temporary until the patient adjusts. The American Academy of Pediatrics (AAP) notes that clinicians should titrate doses of ADHD medication to achieve maximum benefit with tolerable side effects.6 If adverse reactions persist, the clinician can make the switch to another stimulant, or to a nonstimulant.

Methylphenidate

Generic: tablet; immediate release; lasts about four hours; comes in 5, 10, 15 mg dosages : brand name; capsule; extended release; lasts about 16 hours; comes in 25 mg, 35 mg, 45 mg, 55 mg, 70 mg, and 85 mg dosages Aptensio XR: brand name; capsule; immediate and extended release; lasts 12 hours; comes in 10, 15, 20, 25, 30, 40, 50, and 60mg dosages brand name; capsule; immediate and extended release; lasts 12 hours; comes in 10, 15, 20, 25, 30, 40, 50, and 60mg dosages Concerta: brand name; tablet; lasts about 12 hours; comes in 18, 27, 36, 54 mg dosages brand name; tablet; lasts about 12 hours; comes in 18, 27, 36, 54 mg dosages Cotempla XR-ODT : brand name; extended release orally disintegrating table; comes in 8.6mg, 17.3mg, and 25.9mg : brand name; extended release orally disintegrating table; comes in 8.6mg, 17.3mg, and 25.9mg Daytrana: brand name; skin patch; lasts about eight hours; comes in 10, 15, 20, 30 mg Daytrana dosages brand name; skin patch; lasts about eight hours; comes in 10, 15, 20, 30 mg Daytrana dosages Jornay PM: brand name; delayed release extended release capsule; comes in 20mg, 40mg, 60mg, 80mg, and 100mg brand name; delayed release extended release capsule; comes in 20mg, 40mg, 60mg, 80mg, and 100mg Metadate CD: brand name; capsule; lasts eight hours; comes in 10, 20, 30, 40, 50, 60 mg dosages brand name; capsule; lasts eight hours; comes in 10, 20, 30, 40, 50, 60 mg dosages Metadate ER: brand name; tablet; lasts eight hours; comes in 10, 20 mg dosages brand name; tablet; lasts eight hours; comes in 10, 20 mg dosages Methylin: brand name; liquid and chewable tablets; immediate release; lasts four hours; tablets come in 2.5, 5, 10 mg dosages, liquid in 5 mg/tsp and 10mg/tsp dosages brand name; liquid and chewable tablets; immediate release; lasts four hours; tablets come in 2.5, 5, 10 mg dosages, liquid in 5 mg/tsp and 10mg/tsp dosages QuilliChew ER: brand name; chewable tablet; extended release; lasts eight hours; comes in 20, 30, and 40 mg dosages brand name; chewable tablet; extended release; lasts eight hours; comes in 20, 30, and 40 mg dosages Quillivant XR: brand name; liquid; extended release; lasts 12 hours; dosages range from 20 to 60 mg brand name; liquid; extended release; lasts 12 hours; dosages range from 20 to 60 mg Ritalin: brand name; tablet; immediate release; lasts about four hours; comes in 5, 10, 15 mg dosages brand name; tablet; immediate release; lasts about four hours; comes in 5, 10, 15 mg dosages Ritalin LA: brand name; capsule; lasts about eight hours; comes in 10, 20, 30, 40 mg dosages brand name; capsule; lasts about eight hours; comes in 10, 20, 30, 40 mg dosages Ritalin SR: brand name; tablet; lasts about eight hours; comes in 20 mg dosage

Dextro-Methylphenidate

Focalin: brand name; tablet; lasts four hours; immediate release; comes in 2.5, 5, 10 mg dosages brand name; tablet; lasts four hours; immediate release; comes in 2.5, 5, 10 mg dosages Focalin XR: brand name; capsule; lasts eight hours; immediate release followed by second delayed release; comes in 5, 10, 15, 20, 30, 40 mg dosages

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Dextro-Amphetamine/Modified Amphetamine Mixture

Adderall: brand name; tablet; immediate release; lasts four hours; comes in 5, 7.5, 10, 12.5, 15, 20, 30 mg dosages brand name; tablet; immediate release; lasts four hours; comes in 5, 7.5, 10, 12.5, 15, 20, 30 mg dosages Adderall XR: brand name; capsule; immediate and delayed release; lasts eight hours; comes in 5, 10, 15, 20, 25, 30 mg dosages : brand name; extended release oral suspension; 1.25 mg/ml Adzenys XR-ODT: brand name; orally-disintegrating tablet; immediate and delayed release; lasts up to 12 hours; comes in 3.1 mg, 6.3 mg, 9.4 mg, 12.5 mg, 15.7 mg, and 18.8 mg dosages brand name; orally-disintegrating tablet; immediate and delayed release; lasts up to 12 hours; comes in 3.1 mg, 6.3 mg, 9.4 mg, 12.5 mg, 15.7 mg, and 18.8 mg dosages Dexedrine Spansule: brand name; capsule; immediate release followed by gradual release; lasts eight hours; comes in 5, 10, 15 mg dosages brand name; capsule; immediate release followed by gradual release; lasts eight hours; comes in 5, 10, 15 mg dosages Dyanavel XR: brand name; liquid; extended release; lasts 13 hours; dosages range from 2.5 mg to 10 mg per day brand name; liquid; extended release; lasts 13 hours; dosages range from 2.5 mg to 10 mg per day Evekeo: brand name; tablet; immediate release; lasts four fours; comes in 5 and 10 mg dosages brand name; tablet; immediate release; lasts four fours; comes in 5 and 10 mg dosages Generic; tablet; immediate release; lasts four hours; comes in 5, 10 mg dosages tablet; immediate release; lasts four hours; comes in 5, 10 mg dosages Mydayis : brand name; long-acting capsule; comes in 12.5mg, 25mg, 37.5 mg, and 50mg dosages : brand name; long-acting capsule; comes in 12.5mg, 25mg, 37.5 mg, and 50mg dosages ProCentra: brand name; liquid; immediate release; lasts four hours; comes in 5 mg/tsp dosage brand name; liquid; immediate release; lasts four hours; comes in 5 mg/tsp dosage Vyvanse: brand name; capsule and chewable tablet; lasts 10 to 12 hours; comes in 20, 30, 40, 50, 60, 70 mg dosages brand name; capsule and chewable tablet; lasts 10 to 12 hours; comes in 20, 30, 40, 50, 60, 70 mg dosages Zenzedi: brand name; immediate release tablet; 2.5mg, 5mg, 7.5mg, 10mg, 15mg, 20mg, and 30mg

Atomoxetine

Strattera: brand name; capsule; long acting; 24-hour duration; 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg

Clonidine

Kapvay: brand name; extended release tablets; 24-hour duration; 0.1mg and 0.2 mg

Guanfacine

Intuniv: brand name; extended-release tablets 1mg, 2mg, 3mg, 4mg; 24-hour duration

Qelbree

Qelbree: (active ingredient, viloxazine hydrochloride) 100mg or 200mg once daily.

Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you. 1 Briars, L., & Todd, T. (2016). A Review of Pharmacological Management of Attention-Deficit/Hyperactivity Disorder. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 21(3), 192–206. https://doi.org/10.5863/1551-6776-21.3.192 2 Mohammadi, M. R., & Akhondzadeh, S. (2007). Pharmacotherapy of attention-deficit/hyperactivity disorder: nonstimulant medication approaches. Expert review of neurotherapeutics, 7(2), 195–201. https://doi.org/10.1586/14737175.7.2.195 3 Curatolo, Paolo et al. “The neurobiological basis of ADHD.” Italian journal of pediatrics (Dec. 2010) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016271/ 4 Kolar, Dusan et al. “Treatment of adults with attention-deficit/hyperactivity disorder.” Neuropsychiatric disease and treatment (Apr. 2008) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518387/ 5 General Labeling Provisions, 21 CFR §201.5. https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=&SID=3023b9178a21af215b85e0f947c64c74&mc=true&n=pt21.4.201&r=PART&ty=HTML#se21.4.201_15 6Wolraich ML, Hagan JF, Allan C, et al; Subcommittee on Children and Adolescents with Attention-Deficit/Hyperactive Disorder. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 2019;144(4):e20192528; https://doi.org/10.1542/peds.2019-2528

additudemag.com - ADHD Medication Treatment Options: Stimulants, Nonstimulants & More