Please check your internet connection and try again.
# Attention Deficit Hyperactivity Disorder (ADHD) Medications
## Overview
ADHD medications primarily consist of stimulants (amphetamines, methylphenidate) and non-stimulants (atomoxetine, alpha-2 agonists). They target catecholamine neurotransmission (dopamine and norepinephrine) in the prefrontal cortex.
## Primary Indications
* Attention-Deficit/Hyperactivity Disorder (ADHD)
* Narcolepsy (select stimulants)
* Binge Eating Disorder (lisdexamfetamine only)
## Adult Dosing
* **Methylphenidate (Immediate Release):** Start 5 mg BID–TID; titrate weekly. Maximum 60 mg/day.
* **Methylphenidate (Extended Release):** Start 18–36 mg once daily. Maximum 72–108 mg/day depending on formulation.
* **Lisdexamfetamine:** Start 30 mg once daily. Maximum 70 mg/day.
* **Mixed Amphetamine Salts (XR):** Start 20 mg once daily. Maximum 60 mg/day.
* **Atomoxetine:** Start 40 mg daily; increase to 80 mg after 3 days. Maximum 100 mg/day.
## Pediatric Dosing
* **Methylphenidate (Ages 6+):** Start 5 mg BID. Titrate by 5–10 mg/week. Maximum 60 mg/day.
* **Lisdexamfetamine (Ages 6+):** Start 30 mg once daily. Maximum 70 mg/day.
* **Atomoxetine (Children/Adolescents <70 kg):** Start 0.5 mg/kg; target 1.2 mg/kg per day.
* *Note: Always verify specific product labeling (e.g., Concerta vs. Ritalin LA) as dosing varies significantly by formulation.*
## Dose Adjustments
* **Renal/Hepatic:** Atomoxetine requires 50% dose reduction in patients with moderate hepatic impairment (Child-Pugh Class B) and 75% for severe (Class C). No standard adjustments for most stimulants, but initiate at lower doses.
## Contraindications
* Known hypersensitivity to sympathomimetic amines.
* Current or recent (within 14 days) use of Monoamine Oxidase Inhibitors (MAOIs) due to hypertensive crisis risk.
* Symptomatic cardiovascular disease, moderate-to-severe hypertension, or hyperthyroidism.
* Glaucoma, history of drug abuse, or severe anxiety/agitation.
## Adverse Effects
* **Common:** Decreased appetite, insomnia, headache, dry mouth, irritability.
* **Serious:** Cardiovascular events (tachycardia, elevated BP), psychiatric emergence (psychosis, mania), growth suppression in children, peripheral vasculopathy (Raynaud’s phenomenon).
## Key Drug Interactions
* **MAOIs:** Fatal hypertensive crisis.
* **Antihypertensives:** Stimulants may antagonize BP-lowering effects.
* **CYP2D6 Inhibitors:** Atomoxetine levels significantly elevated; reduce atomoxetine dose.
* **Serotonergic agents:** Increased risk of Serotonin Syndrome when combined with other stimulants or antidepressants.
## Monitoring
* **Baseline:** Cardiovascular history, baseline BP and heart rate, weight/height (pediatrics).
* **Ongoing:** BP and HR at every dose adjustment; periodic screening for psychiatric symptoms and growth velocity (pediatrics).
## Clinical Pearls
* **Formulation Matters:** Extended-release formulations (e.g., Vyvanse, Concerta) minimize peak-to-trough variability and reduce abuse potential.
* **Non-Stimulants:** Atomoxetine and alpha-2 agonists (guanfacine/clonidine) carry no abuse potential but have a slower onset of therapeutic effect (2–4 weeks).
* **Titration:** "Start low, go slow" is the universal rule for stimulants to minimize GI and cardiovascular adverse effects.
***
**Educational Disclaimer:** This information is for educational purposes only. Clinical practice guidelines vary by region and institution. Always verify specific dosing, safety precautions, and current prescribing information via official manufacturer labels or verified databases like Lexicomp or Micromedex before prescribing.
