ADHD-Medication Types and My Thoughts

18 Apr

If you have issues with children being on medicine for ADHD, please see my previous post…ADHD-Medical Management Concepts.

In this post I want to discuss the different classes of medications for ADHD including how they work and how they are used.

Stimulants

Stimulants are the most commonly used class of medicines for ADHD.  They have the longest track record because they have been around the longest.  The most famous (or infamous) in the class is methylphenidate (or Ritalin).  Many people have some experience with some family member or friend who was on methylphenidate and hated it for one reason or another.

Fortunately, we have a better understanding of ADHD and its treatment than when it was the only option available.  One of the major advancements we have made is in the development of longer acting medicines that require only a single morning dose (Ritalin required taking a dose twice per day.).

Some of the other major players in the stimulant class of medicine are Concerta, Vyvanse, Adderall XR Daytrana and Focalin XR.  In my practice, I most commonly use Concerta and Vyvanse because those are the ones I picked early and have become very comfortable with.

One of the great things about these medicine is that they are given in the morning, peak around lunch time and are gone by the afternoon/evening.  You can see the discussion about the benefits of this by clicking the link above to the previous medication post.

I generally have my parents start by giving the medicine seven days a week and through the holidays but after the dose has been established and things are going well, I will allow them to take drug “holidays”, which is where the child doesn’t have to take the medicine on days when focus is less important. This is not true for all doctors, so please ask your doctor before you do this.  I often find that parents realize how significantly these medicines help their children and continue to give them every day.

One of the major factors in determining which medication to start with is the delivery method.  Many of the medicines come only in pill form.  Daytrana comes in a patch form and can be placed each morning and removed at the end of the day.  I find that getting the child to keep the patch on is difficult and for this reason I tend not to use it very commonly.  For my children who cannot swallow pills, I tend to recommend Vyvanse because the capsules can be opened and sprinkled.  There is a new liquid version of a stimulant medicine being released but I am still researching and learning about it at this time.

Non-Stimulants

There are three major medicines in this class that I will discuss here: atomoxetine (Straterra), Intuniv (guanficine) and clonidine (Kapvay).

Straterra was initially developed to be an anti-depressent but it was a terrible anti-depressent and got a second life as an ADHD medication.  It works very similarly to a group of antidepressants called SSRIs and needs to be taken every day.  You cannot take days off because the level of medicine in your body drops and you start over at the bottom when you start to take it again.  I personally have found this medicine to be more effective in children with mild ADHD or with mostly inattentive subtype of ADHD but generally not as effective as the stimulants for either.  I find myself using it most commonly in children who cannot tolerate stimulants because of side effects or in children whom their parents choose not to use a stimulant.

Intuniv and Clonidine are both old blood pressure medicines that are currently used for ADHD. They can both be used individually as treatment for ADHD but I most commonly use them as add-on therapy for children who need a little more help than their stimulants are providing.  Kapvay (long acting clonidine) and Intuniv are both long acting and provide benefit through the whole day.  Short acting clonidine can be used at bed time to help children go to sleep who are having difficulties with this on their stimulants.

Now that we’ve looked at the different cases, here’s my summary on dosages:

  • My preference is to start with a stimulant unless there is a concern from the family or myself about how the child will tolerate the medicine.
  • If there is an issue with the stimulants, I will switch to non-stimulants.
  • If I cannot increase the dose of stimulant medicine because of side effects, I will add on a non-stimulant such as Intuniv or Kapvay.
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