Medications for Attention-deficit/hyperactivity Disorder (ADHD)
Medications for Attention-deficit/hyperactivity Disorder (ADHD)
The mechanism by which both stimulant and non-stimulant medications work for ADHD appears to be by modulation of dopamine (DA) and norepinephrine (NE) systems.
Both stimulants and atomoxetine commonly cause anorexia, abdominal pain, and irritability. Headaches are also a common adverse effect of stimulants. In general, while stimulants appear to cause insomnia, atomoxetine and the other non-stimulants cause drowsiness, sedation, or fatigue. Additionally, clonidine and guanfacine commonly cause dry mouth. Initial drug selection depends on drug-specific and patient-specific factors. Both categories of medications are effective in reducing core ADHD symptoms, however the body of evidence supporting stimulants is larger and the effect size is larger as compared to non-stimulants.
DRUG CATEGORY Amphetamines
Methylphenidates
Selective Norepinephrine Reuptake Inhibitor (SNRI)
MEDICATIONS
Amphetamine (IR, ODT, XR-ODT, XR-liq)* Dextroamphetamine/ Amphetamine (IR, ER) Dextroamphetamine (IR, ER, Liq) Lisdexamfetamine (IR, chew) Methamphetamine (IR) Dexmethylphenidate (IR, ER)
Methylphenidate (IR, ER, chew, XR-chew, XRODT, Liq, XR-liq, patch)
Atomoxetine (IR)
COMMON SIDE EFFECTS
MONITORING PARAMETERS
CNS STIMULANTS
Cardiovascular: elevated blood Targeted cardiac history and cardiac
pressure, tachycardia, palpitations exam: monitor heart rate and blood
pressure, consider ECG
CNS: headache, insomnia
Height, weight, and growth rate in
Endocrine: weight loss, slowing of children
growth rate in children
CNS activity
GI: decreased appetite,
xerostomia
Behavioral changes
May lower the convulsive threshold in patients with a history of seizures
Signs of peripheral vasculopathy Assess for risk of abuse or addiction
May exacerbate anxiety
NON-CNS STIMULANTS
Cardiovascular: elevated blood Targeted cardiac history and cardiac
pressure and tachycardia
exam; monitor heart rate and blood
CNS: drowsiness, fatigue,
pressure, consider ECG
headache, insomnia
Height, weight, and growth rate in
GI: abdominal pain, xerostomia,
children
decreased appetite, nausea, vomiting
Behavioral changes
ADDITIONAL COMMENTS Black Box Warnings: Amphetamines have a high potential for abuse and dependence Misuse of amphetamines may cause sudden death and serious cardiovascular adverse reactions
Black Box Warning: Increased risk of suicidal ideation in children and adolescents
GU: erectile dysfunction
Centrally Acting Alpha2 Agonists
Clonidine (ER) Guanfacine (ER)
Norepinephrine/ Dopamine Reuptake Inhibitor (NDRI)
Bupropion (IR, ER)
Dermatologic: hyperhidrosis Cardiovascular: hypotension
CNS: drowsiness, fatigue, headache, sedation,
Targeted cardiac history and cardiac Only the extended-release forms of these exam; monitor heart rate and blood medications are indicated for ADHD pressure, consider ECG
GI: constipation, xerostomia
SELECT MEDICATIONS USED OFF-LABEL FOR ADHD
Cardiovascular: tachycardia
Targeted cardiac history and cardiac
CNS: agitation, anxiety, headache, insomnia
exam; monitor heart rate and blood pressure, consider ECG
Endocrine: weight loss
Weight and BMI
GI: nausea, constipation, xerostomia
Data from a meta-analysis of controlled trials support the use of bupropion in the treatment of ADHD in adults
There is evidence supporting its use in the setting of ADHD and comorbid depression, as well as comorbid bipolar disorder as an adjunct to mood stabilizers
Contraindicated in history of seizures, bulimia, and/or anorexia
Contraindicated with MAOIs
Black Box Warning: Increased risk of suicidal ideation in children and adolescents
*Dosage forms available: IR = Immediate Release Oral Formulation, ER= Extended Release Oral Formulation, Chew= Chewable Tablet, XR-chew= Extended Release Chewable Tablet, ODT= Orally
Disintegrating Tablet, XR-ODT= Extended Release Orally Disintegrating Tablet, Liq= Oral Liquid, XR-liq= Extended Release Oral Liquid, Patch= Patch
Special Populations: - Non-stimulants with the exception of atomoxetine may be preferred in patients with pre-existing psychotic disorder, bipolar disorder, or depression due to the
concern for possible induction of a mixed/manic episode or exacerbation of behavior disturbance and thought disorder symptoms. - Non-stimulants are preferred in patients with tics or Tourette's syndrome, patients with a history of substance abuse, or patients with anxiety. - Stimulants and atomoxetine are not recommended for use by patients with cardiac problems that may place them at increased vulnerability to the
sympathomimetic effects of these drugs.
Facts and Comparisons [database online]. St. Louis, MO: Wolters Kluwer Health, Inc; 2017. Accessed May 8, 2019 Clinical Pharmacology powered by ClinicalKey. Tampa (FL): Elsevier. c2018- [cited 2019 May 8]. Available from:
MAPR-FY64684-1019
Revised 1/2/2020
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