Att%25252525252525252525252525252525252525252520drugs

# Attention Deficit/Hyperactivity Disorder (ADHD) Medications ## Overview ADHD medications are primarily categorized into **stimulants** (methylphenidate and amphetamine derivatives) and **non-stimulants** (atomoxetine, alpha-2 agonists, and viloxazine). Stimulants act by increasing synaptic concentrations of dopamine and norepinephrine. ## Primary Indications * ADHD (Attention Deficit/Hyperactivity Disorder) * Narcolepsy (select stimulants only) * Binge Eating Disorder (lisdexamfetamine only) ## Adult Dosing * **Methylphenidate (IR):** 5 mg PO BID–TID. Max: 60 mg/day. * **Methylphenidate (ER):** Dosage varies by formulation (e.g., Concerta 18–36 mg daily). Max: 72 mg/day. * **Amphetamine/Dextroamphetamine (Mixed Salts):** 5 mg PO daily or BID. Max: 40 mg/day. * **Lisdexamfetamine:** 30 mg PO daily. Max: 70 mg/day. * **Atomoxetine:** 40 mg daily (titrate to 80 mg). Max: 100 mg/day. ## Pediatric Dosing * **Methylphenidate (Children ≥6 yrs):** Start 5 mg PO BID. Max: 60 mg/day. * **Amphetamine/Dextroamphetamine (Children ≥6 yrs):** 2.5–5 mg PO daily or BID. Max: 40 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; target 1.2 mg/kg/day. Max: 1.2 mg/kg or 100 mg/day. ## Dose Adjustments * **Renal/Hepatic:** Atomoxetine requires dosage reduction in hepatic impairment (Child-Pugh B: 50% reduction; C: 75% reduction). Stimulants generally do not have formal renal dose adjustments, but titrate cautiously in comorbid cardiovascular disease. * **Note:** Always consult facility-specific protocols for complex comorbidities. ## Contraindications * Known hypersensitivity to sympathomimetic amines. * Concurrent use of MAOIs (within 14 days). * Symptomatic cardiovascular disease, moderate-to-severe hypertension, or hyperthyroidism. * Glaucoma, history of drug abuse, or agitation/tics (some agents). ## Adverse Effects * **Common:** Decreased appetite, insomnia, headache, dry mouth, irritability. * **Serious:** Cardiovascular events (tachycardia, elevated BP), sudden cardiac death (rare), priapism, motor tics, and potential for psychosis or mania. ## Key Drug Interactions * **MAOIs:** May cause hypertensive crisis. * **Antihypertensives:** Stimulants may antagonize effects. * **CYP2D6 Inhibitors (e.g., fluoxetine, paroxetine):** May increase levels of atomoxetine and amphetamines. * **Serotonergic Agents:** Increased risk of serotonin syndrome. ## Monitoring * **Baseline/Routine:** Heart rate, blood pressure, weight, and height (pediatrics). * **Psychiatric:** Monitor for new or worsening agitation, aggression, suicidal ideation, or manic symptoms. * **Growth:** Height/weight velocity in children. ## Clinical Pearls * **Stimulant Choice:** If one class (methylphenidate vs. amphetamine) fails or causes intolerable side effects, switching to the other class is often effective. * **Safety:** Stimulants are Schedule II controlled substances; monitor for misuse or diversion. * **Atomoxetine:** Onset of effect is delayed (2–4 weeks for full efficacy). * **Take-home:** Always encourage a "start low, go slow" titration strategy to manage initial side effects. *** **Disclaimer:** This information is for educational purposes only. Always consult current, evidence-based drug monographs (e.g., Lexicomp, Clinical Pharmacology, or official FDA prescribing information) and institutional guidelines before prescribing or administering medication.