ADD and ADHD Medications

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While there are really only three main types of medications for ADD and ADHD, there is a nearly dizzying array of options. The main questions to consider are:

Whether one is going to use methylphenidate (which prevents re-uptake of norepinephrine and dopamine at the synapse) or dextroamphetamine (which prevents re-uptake of norepinephrine and dopamine at the synapse but also may increase release of these neurotransmitters into the synapse, and therefore may have a greater effect)
What duration of action one needs (e.g. immediate release with short duration of action, or long acting for the entire day)
What delivery method is best-either direct, via patch (less abuse potential), or via a pro-drug (converted in the body to the active drug, therefore there is a delayed action, but less abuse potential)

These groups of medications include the following subcategories:

Stimulants (either of the methylphenidate type or the Dexedrine type). These have a high abuse potential, are frequently sold on the street and snorted, like cocaine, unless delivered in unusual forms such as the Daytrana patch, or as a pro-drug (Vyvance). They can increase tics, and if given in excess doses cause hyper-focusing, and induce agitation, mania, and insomnia, and raise blood pressure.

Disturbingly, the long-term effects of these medications on the brain or the heart have not been studied, despite the fact that they are given to millions of children. Stimulants have been associated with sudden cardiac death in children and adolescents (at usual doses) with structural heart abnormalities, or other heart abnormalities. Sudden death, stroke, and heart attacks have been reported in adults taking stimulants at normal doses for ADHD, although a causal role has not been proven. Increased blood pressure is a risk. Growth in children on stimulants should be monitored, as there is a well documented slowing in growth rate.
Anti-depressant like medications (atomoxetine and buproprion), and
Blood pressure medications (clonidine and guanfacine), which act to increase activity at the prefrontal cortex.

Trade Name	Generic Name	Dose sizes	Side Effects	Comments
Adderall	Dextro Amphetamine mixed salts	5, 7.5,10,12.5, 15, 20, 30 mg	Loss of appetite, insomnia, irritability	Can exacerbate tics, Tourette’s, easily abused
Adderall XR	Dextro Amphetamine mixed salts	5,10, 15, 20, 25, 30 mg	Loss of appetite, insomnia, irritability	Can exacerbate tics, Tourette’s, easily abused
Dexedrine	dexedrine	5 mg	Loss of appetite, insomnia, irritability	High Abuse Potential
Dextrostat	dexedrine	5,10 mg	Loss of appetite, insomnia, irritability	High Abuse Potential

Wellbutrin	buproprion	75-450mg	Agitation	Also anti-depressant
Stratera	atomoxetine	Based on weight in children, 40-100 mg in adults	Decreased appetite, sedation, Light-headednessinsomnia, increased blood pressure, sexual side effects	Mildly beneficial; important drug interactions with CYP450 2D6 inhibitors such as fluoxetine and paroxetine

Focalin	Dexmethyl-phenidate	2.5, 5, 10mg	Loss of appetite, insomnia, irritability
Focalin XR	Dexmethyl-phenidate	5,10,15,20,30 mg	Loss of appetite, insomnia, irritability	50% immediate release; abuse potential high

Vyvanse	lisdexamfetamine	20, 30, 40, 50, 60, 70mg	Loss of appetite, insomnia, irritability	Once daily, delayed onset
Desoxyn	methamphetamine	5mg	Above plus weigh loss	High abuse potential;

Ritalin, Methylin, Metadate	Methylphenidate	5,10,20mg	Loss of appetite, insomnia, irritability	High abuse potential
Metadate CD	Methylphenidate	10,20,30mg	Loss of appetite, insomnia, irritability	30% immediate release; 70% delayed release
Metadate ER	Methylphenidate	10,20mg	Loss of appetite, insomnia, irritability	Gradually wears off
Ritalin LA	Methylphenidate	10,20,30,40mg	Loss of appetite, insomnia, irritability	Once daily use
Concerta	Methylphenidate	18,27,36,54mg	Loss of appetite, insomnia, irritability	22% immediate release, 78% delayed
Daytrana	Methylphenidate	10, 15, 20, 30 mg PATCH worn for 9 hours	Loss of appetite, insomnia, irritability	Can cause skin irritation

Tenex	Guanfacine (immediate release)	1mg-2mg	Sedation	Lowers blood pressure, can cause depression; no abuse potential
Intuiv	Guanfacine XR (slow release)	0.5mg very slowly increased every 6 weeks to a max of 1 three times per day	Sedation low blood pressure, dry mouth, nausea	Reports of fainting (low blood pressure); no abuse potential
Catapres	clonidine	0.1, 0.2, 0.3 mg	Sedation, low blood pressure, dry mouth, nausea	Lowers blood pressure, can cause depression; no abuse potential