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# 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, viloxazine). Stimulants act by increasing synaptic levels of dopamine and norepinephrine.
## Primary Indications
* ADHD (Attention-Deficit/Hyperactivity Disorder)
* Narcolepsy (stimulants specifically)
* Binge Eating Disorder (lisdexamfetamine)
## Adult Dosing
* **Methylphenidate (Immediate Release):** 5 mg PO BID–TID; Max: 60 mg/day.
* **Methylphenidate (Extended Release/Concerta):** 18–36 mg PO daily; Max: 72 mg/day.
* **Lisdexamfetamine:** 30 mg PO daily; Titrate by 20 mg increments; Max: 70 mg/day.
* **Atomoxetine:** 40 mg PO daily; Titrate after 3 days to target 80 mg/day; Max: 100 mg/day.
## Pediatric Dosing
* **Methylphenidate (Children ≥6 yrs):** 5 mg PO BID; Titrate by 5–10 mg weekly; Max: 60 mg/day.
* **Lisdexamfetamine (Children ≥6 yrs):** 30 mg PO daily; Max: 70 mg/day.
* **Atomoxetine (Children ≥6 yrs, <70 kg):** 0.5 mg/kg/day; Titrate to target 1.2 mg/kg/day; Max: 1.4 mg/kg/day or 100 mg/day.
* **Guanfacine ER (Children 6–17 yrs):** 1 mg PO daily; Titrate by 1 mg/week; Max: 4 mg/day (for ADHD).
## Dose Adjustments
* **Renal/Hepatic Impairment:** Atomoxetine requires reduction (50% reduction in moderate hepatic impairment; 75% in severe). Stimulants generally do not require specific renal adjustments but should be used with caution in cardiovascular disease. Always consult current institutional renal dosing guidelines.
## Contraindications
* Known hypersensitivity to sympathomimetic amines.
* Concomitant use with Monoamine Oxidase Inhibitors (MAOIs) within the last 14 days.
* Glaucoma, severe hypertension, or symptomatic cardiovascular disease.
* History of drug abuse (high potential for misuse with stimulants).
## Adverse Effects
* **Common:** Insomnia, decreased appetite, xerostomia (dry mouth), headache, irritability.
* **Serious:** Cardiovascular events (tachycardia, hypertension), psychiatric symptoms (new-onset psychosis or mania), growth suppression in children, and priapism.
## Key Drug Interactions
* **MAOIs:** Risk of hypertensive crisis; contraindicated.
* **Antihypertensives:** Alpha-2 agonists (clonidine/guanfacine) may cause additive hypotension/bradycardia.
* **CYP2D6 Inhibitors:** May increase plasma concentrations of atomoxetine.
* **Serotonergic agents:** Risk of serotonin syndrome when combined with stimulants.
## Monitoring
* Baseline and periodic blood pressure and heart rate.
* Monitor weight and height in pediatric patients.
* Monitor for emergence or worsening of psychiatric symptoms (anxiety, aggression, depression).
* Monitor for signs of misuse or diversion.
## Clinical Pearls
* Non-stimulants (Atomoxetine) require 2–4 weeks for therapeutic effect; they are not controlled substances.
* Stimulants should be taken early in the day to minimize insomnia.
* "Drug holidays" may be considered under physician supervision to assess ongoing need and manage growth concerns in children.
* Switching between methylphenidate-based and amphetamine-based products is common if side effects persist or efficacy is inadequate.
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**Educational Disclaimer:** This information is for educational purposes only. Drug dosing, contraindications, and interaction profiles are subject to change. Always verify current prescribing information via the FDA label, the package insert, or institutional clinical support tools before prescribing or administering medication.
