Att%2525252525252525252520drugs

# Attention-Deficit/Hyperactivity Disorder (ADHD) Medications ## Overview ADHD medications are primarily classified into stimulants (methylphenidate and amphetamine derivatives) and non-stimulants (atomoxetine, alpha-2 agonists). They modulate neurotransmission of dopamine and norepinephrine in the prefrontal cortex. ## Primary Indications * Attention-Deficit/Hyperactivity Disorder (ADHD) * Narcolepsy (select stimulants only) * Binge Eating Disorder (lisdexamfetamine only) ## Adult Dosing * **Methylphenidate (IR):** 5 mg PO BID-TID; Max: 60 mg/day. * **Methylphenidate (Extended Release):** Varies by formulation (e.g., Concerta 18–36 mg daily); Max: 72 mg/day. * **Amphetamine/Dextroamphetamine (Mixed salts IR):** 5 mg once or twice daily; Max: 40 mg/day. * **Lisdexamfetamine:** 30 mg daily; Max: 70 mg/day. * **Atomoxetine:** 40 mg daily; may increase to 80–100 mg/day after 3 days. ## Pediatric Dosing * **Methylphenidate (Age ≥6):** Start 5 mg daily/BID (IR) or 18 mg daily (ER); Max: 60 mg/day (IR) or 54–72 mg/day (ER). * **Amphetamine/Dextroamphetamine (Age ≥3):** Start 2.5–5 mg daily; increase by 2.5–5 mg weekly; Max: 40 mg/day. * **Lisdexamfetamine (Age ≥6):** 30 mg daily; Max: 70 mg/day. * **Atomoxetine (Age ≥6):** 0.5 mg/kg/day; target 1.2 mg/kg/day; Max: 100 mg/day or 1.4 mg/kg/day (whichever is lower). ## Dose Adjustments * **Renal/Hepatic Impairment:** Atomoxetine requires 50% dose reduction in moderate hepatic impairment (Child-Pugh Class B) and 75% in severe impairment (Class C). Stimulants generally do not require specific renal adjustments but caution is advised. ## Contraindications * Known hypersensitivity. * Advanced arteriosclerosis, symptomatic cardiovascular disease. * Moderate-to-severe hypertension. * Hyperthyroidism. * Glaucoma. * History of drug abuse. * Concurrent use or within 14 days of MAO inhibitors. ## Adverse Effects * **Common:** Decreased appetite, insomnia, weight loss, dry mouth, headache, irritability. * **Serious:** Cardiovascular events (tachycardia, hypertension), psychiatric emergence (hallucinations, aggression), peripheral vasculopathy (Raynaud’s phenomenon), growth suppression in children. ## Key Drug Interactions * **MAOIs:** Risk of hypertensive crisis. * **Antihypertensives:** Stimulants may antagonize effects. * **CYP2D6 Inhibitors:** Atomoxetine plasma concentrations significantly increased by potent inhibitors (e.g., fluoxetine, paroxetine). * **Serotonergic Agents:** Risk of serotonin syndrome when combined with stimulants/atomoxetine. ## Monitoring * Baseline and periodic blood pressure and heart rate. * Growth (height/weight) in pediatric patients. * New or worsening psychiatric symptoms. * Efficacy using validated rating scales (e.g., Vanderbilt, Conners). ## Clinical Pearls * **Drug Holidays:** Some clinicians suggest planned periodic breaks to monitor symptom severity and manage growth effects. * **Formulation Differences:** Generic substitution for specific ER formulations (e.g., Concerta oral delivery system) may not be therapeutically equivalent. * **Non-Stimulants:** Atomoxetine and alpha-2 agonists (guanfacine, clonidine) are preferred for patients with history of substance use or stimulant-related anxiety. *** **EDUCATIONAL DISCLAIMER:** This information is for educational purposes only. Clinical guidelines and local prescribing protocols vary; always verify currently recommended dosages, safety data, and contraindications via official manufacturer labeling (FDA package inserts) or institutional pharmacy resources before prescribing or administering medications.