ADHD MEDICATIONS Myths and Facts ADHD Awareness Day, Oct 2011 by Theresa Cerulli, M.D. Neuropsychiatrist.

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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 Off-Label meds Atomoxetine Methylphenidates - Ritalin, Ritalin LA, Daytrana, Metadate ER, Metadate CD Concerta, Focalin IR, Focalin XR Amphetamines- Adderall IR, Adderall XR, Dexedrine Vyvanse (prodrug) Non-Stimulants Atomoxetine Intuniv, Kapvay Off-Label meds Wellbutrin SR, XL Provigil 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

Brain Neurotransmitters 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

Adderall Intuniv Focalin Strattera ADHD Medications Adderall Intuniv Focalin Strattera How Do You Choose?

Medication Considerations Family history Genetic subtype of ADD 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 - Improve Focus and Concentration Increase productivity Calm Hyperactivity Increase attention to details Improve communication/listening skills Enhance executive functioning (organization, time management, problem solving)