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
Stimulants
Non-Stimulants
Methylphenidates -
 Atomoxetine
 Ritalin, Ritalin LA,
Daytrana, Metadate ER,
Metadate CD Concerta,
 Intuniv, Kapvay
Focalin IR, Focalin XR
Off-Label meds
Amphetamines-
 Wellbutrin SR, XL
 Adderall IR, Adderall XR,
 Provigil
Dexedrine
 Vyvanse (prodrug)
 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
Brain Neurotransmitters
Dopamine
Norepinephrine
Serotonin
Diet and Nutrition
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
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Mechanism of Action of medication
Length of Action of medication
Patient’s daily schedule
FDA approval vs. off label use of medication
The Upside
ADHD Medications Can •
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Improve Focus and Concentration
Increase productivity
Calm Hyperactivity
Increase attention to details
Improve communication/listening skills
Enhance executive functioning (organization,
time management, problem solving)