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ADD ADHD Medications

There’s no “one-size-fits-all” drug. But if you’re familiar with some basic information, you’ll know what questions to ask, so that your child receives the treatment that fits best.

Medicine is a tremendous blessing. It not only saves lives; it can help improve the quality of life. Many thousands of children and their families have benefited from the use of medications to control symptoms of ADD / ADHD. Every medicine has its side effects, though. Since prescription drugs are big business, it’s up to you to be a wise consumer when allowing a doctor to prescribe medication for your child. In general, you will want to consider whether the benefits of any medication outweigh its side effects.

When your child is diagnosed with ADD / ADHD, the first thing your doctor will consider is stimulant drug treatment. Some experts believe that ADD / ADHD is caused by a dopamine deficiency in the brain, and stimulant drugs work by affecting dopamine. In 70% of people, s timulants work well to decrease hyperactivity or impulsivity and to improve attention span. However, 5-10% of people who take stimulants get worse. There is some question as to whether stimulants help or interfere with memory and learning, and parents are understandably concerned about giving their children anything that might be addictive.

Here is a summary of stimulant drugs commonly prescribed for ADD, their side effects, and their benefits. Important Note: Medications to treat ADHD and related conditions should only be prescribed by a physician. Information presented here is not intended to replace the advice of a physician and is subject to change based on new findings by researchers and the FDA. The national media have recently reported new findings on such drugs as Strattera. Therefore, please consult your child’s physician to keep informed about the latest findings and reports on these types of medications.

Stimulant Medications

   

METHYLPHENIDATE

COMMON SIDE EFFECTS

BENEFITS

RITALIN
METHYLIN
METADATE
Generic MPH

Insomnia, decreased appetite, weight loss, headache, irritability, stomachache, and when medication wears off, symptoms are worse than ever.

Small study in 2005 suggests higher risk of cancer in those who take Ritalin; further studies expected

Works quickly (within 30-60 minutes). Effective in over 70% of patients.

FOCALIN
(with isolated dextroisomer)

Same as above, but
Focalin may cause less sleep or appetite disturbance.

Works quickly (within 30-60 minutes). Possibly better for use for evening needs when day's long acting dose is wearing off.

RITALIN SR
METHYLIN ER
METADATE ER

Insomnia, decreased appetite, weight loss, headache, irritability, stomachache.

Wears off more gradually than short acting so less risk of rebound. Lower abuse risk because lasts longer.

RITALIN LA
50% immediate release beads
and 50% delayed release beads

METADATE CD
30% immediate release and 70% delayed release beads

Insomnia, decreased appetite, weight loss, headache, irritability, stomachache, and rebound potential.

May swallow whole or sprinkle ALL contents on a spoonful of applesauce. Starts quickly, avoids mid-day gap unless student metabolizes medicine very rapidly.

CONCERTA

22% immediate release
and 78% gradual release

Insomnia, decreased appetite, weight loss, headache, irritability, stomachache.

Works quickly (within 30-60 minutes). Given once a day. Long duration. Doesn't risk mid-day gap or rebound since medication is released gradually throughout the day. Wears off more gradually. Lower abuse risk.

DEXTROAMPHETAMINE

COMMON SIDE EFFECTS

PROS

DEXTROSTAT




________________

DEXEDRINE
*2004 PDR does not list short acting Dexedrine tablets

Insomnia, decreased appetite, weight loss, headache, irritability, stomachache.

Rebound agitation or exaggeration of pre-medication symptoms as it is wearing off.

May also elicit psychotic symptoms.

Approved for children younger than 6 years old.


Good safety record.

Somewhat longer action than short acting methylphenidate.

DEXEDRINE SPANSULE


dextroamphetamine sulfate ER

Same as above.

May avoid need for noon dose. Rapid onset. Good safety record.

MIXED AMPHETAMINE

COMMON SIDE EFFECTS

PROS

ADDERALL

Same as above.

Wears off more gradually than dextroamphetamine alone, so rebound is less likely and milder .

ADDERALL XR
50% immediate release beads
and 50% delayed release
beads

Same as above.

May swallow whole or sprinkle ALL contents on a spoonful of applesauce. May last longer than most other sustained release stimulants. Less likely rebound than with long acting dextroamphetamine.

The stimulant Cylert is no longer recommended for children, due to its effect on the liver.

If a stimulant works well to control ADD symptoms, but has unpleasant side effects, talk to your doctor before stopping the medicine. Often, your doctor can treat side effects so that you can still keep the medicine and its benefits.

For children who don’t respond well to stimulants, or whose parents absolutely don’t want to use them, there are some non-stimulant medications that have been used with some success in controlling ADD. However, be aware that some doctors believe that if some of these medications work, then the problem is not ADD, but some other medical issue, such as depression or bipolar disorder. Important Note: Medications to treat ADHD and related conditions should only be prescribed by a physician. Information presented here is not intended to replace the advice of a physician.

Non-Stimulant Medications    

ATOMOXETINE

COMMON SIDE EFFECTS

PROS

STRATTERA

In children: decreased appetite, GI upset (can be reduced if medication taken with food), sedation (can be reduced by dosing in evening), and lightheadedness.

A newer medication, so if often m ore expensive than stimulants.

 

FDA alerted public about potential for liver injury after two cases arose in 2004

Avoids problems of rebound and gaps in coverage.

Doesn't cause a "high," thus it does not lead to abuse, and so a) it is not a controlled drug and b) may be used by patients with history of substance abuse.

 

Less irritability in some patients than stimulants.

 

Slight anti-depressant effect.

BUPROPRION

COMMON SIDE EFFECTS

PROS

WELLBUTRIN IR

Irritability, decreased appetite, and insomnia.

Helpful for ADHD patients with comorbid depression or anxiety. May help after school until home.

WELLBUTRIN SR

 

Same as Wellbutrin IR

Same for Wellbutrin IR.
Lower seizure risk than immediate release form. Avoids noon dose.

WELLBUTRIN XL

Same as Wellbutrin IR

Same for Wellbutrin IR.
Single daily dose. Smooth 24-hour coverage. Lower seizure risk than immediate release form.

ALPHA-2 AGONISTS

COMMON SIDE EFFECTS

PROS

CATAPRES
(clonidine)


------------------------------
CLONIDINE

Sleepiness, hypotension, headache, dizziness, stomachache, nausea, dry mouth, depression, nightmares.

Helpful for ADHD patients with comorbid tic disorder or insomnia. Good for severe impulsivity, hyperactivity and/or aggression. Stimulates appetite. Especially helpful in younger children (under 6) with ADHD symptoms associated with prenatal insult or syndrome such as Fragile X.

CATAPRES Patch

Same as Catapres tablet but with skin patch there may be localized skin reactions.

Same as above.

TENEX
(guanfacine)


-----------------------
guanfacine tablets

Compared to clonidine, lower chances/severity of side effects, especially fatigue and depression. Also less headache, stomachache, nausea, dry mouth. Unlike clonidine, minimal problem of rebound hypertension if doses are missed.

Can provide for 24/7 modulation of impulsivity, hyperactivity, aggression and sensory hypersensitivity. This covers most out of school problems, so stimulant use can be limited to school and homework hours. Improves appetite. Less sedating than clonidine.


Other medicines to know about are those billed as “natural” diet or mineral supplements. Even though you can get them without a prescription, these products can still have powerful drug-like effects, which can be risky for people who are on other medicines or have other medical conditions. As with any other medicine, you’ll want to consult your doctor before giving them to your child. In general, you should ask yourself, “If this supplement is so wonderful for treating ADD (or anything else,) why am I reading about it for the first time in a sales ad?”

As you sort through all the medical options and information, remember that you are not looking for a magic pill. Even experts who strongly favor medication will tell you that the best treatment for ADD/ADHD includes education, therapy, and community support.

Please remember to consult a physician about any ADD ADHD medications to discuss the most recent findings and information about these prescriptions drugs. Any child taking these medications should be regularly monitored by their physician and parents should consult their physician immediately if they notice any changes in their child's behavior or health or have concerns about reports of side effects issued by the FDA or researchers.

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