From the Guidelines
Stimulants, such as methylphenidate and lisdexamfetamine, are the most effective and commonly used medications for treating ADHD, with non-stimulants like atomoxetine and guanfacine being considered as second-line options. According to the most recent study 1, stimulants have large effect sizes for reducing ADHD core symptoms and are available in short-acting and various long-acting formulations. Methylphenidate typically starts at 5-10mg once or twice daily, while lisdexamfetamine often begins at 30-50mg once daily, with doses gradually increased as needed. Non-stimulant options, such as atomoxetine, may be used when stimulants cause side effects or aren't effective, and have the advantage of providing "around-the-clock" effects.
Some key points to consider when selecting a medication for ADHD include:
- Severity of symptoms
- Presence of comorbidities
- Need for symptom relief during specific periods of the day
- Patient preferences
- Potential side effects, such as decreased appetite, sleep disturbances, and increased blood pressure and pulse
Behavioral therapy, including cognitive behavioral therapy (CBT) 1, is an essential complementary treatment, which can help individuals with ADHD develop executive functioning skills, emotional self-regulation, and impulse control. CBT has been found to be the most effective psychotherapy option for ADHD, particularly when used in combination with medication. Regular follow-up appointments are crucial to monitor the effectiveness of treatment and adjust the medication regimen as needed.
In terms of medication adherence, factors such as patient attitudes, physician-patient relationship, family support, and knowledge about the disorder and medication should be evaluated and improved before initiating treatment. Once-daily dosing is generally preferred over twice-daily dosing to increase medication adherence. Overall, treatment should be individualized based on symptom severity, age, potential side effects, and comorbid conditions to optimize outcomes and improve quality of life.
From the FDA Drug Label
Atomoxetine capsules are indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) The efficacy of atomoxetine capsules was established in seven clinical trials in outpatients with ADHD: four 6 to 9-week trials in pediatric patients (ages 6 to 18), two 10-week trial in adults, and one maintenance trial in pediatrics (ages 6 to 15) Atomoxetine capsules are indicated as an integral part of a total treatment program for ADHD that may include other measures (psychological, educational, social) for patients with this syndrome.
Common medications for ADHD include:
- Atomoxetine Treatment for ADHD may include:
- Drug treatment with medications such as atomoxetine
- Psychological measures
- Educational measures
- Social measures 2 2
From the Research
Common Medications for ADHD
- Stimulants, such as methylphenidate or amphetamines, are the recommended first-line option for the pharmacological treatment of individuals with attention deficit hyperactivity disorder (ADHD) 3
- Methylphenidate is an effective ADHD treatment with a good safety profile, and dose optimization may enhance the safety and efficacy of treatment 4
- Other medications, such as atomoxetine, bupropion, and modafinil, may also be effective in treating ADHD symptoms 5
Treatment Strategies for ADHD
- Flexible titration of stimulant medications, considering the presence of ADHD symptoms and tolerated dose-limiting adverse events, is associated with both improved efficacy and acceptability 6
- Optimizing stimulant dosage to individual patient needs is recommended, and dose optimization may enhance the safety and efficacy of treatment 4
- Non-stimulants and combined pharmacological approaches may be considered for patients who do not respond optimally to stimulants 3
Medications for ADHD in Specific Populations
- In children and adolescents, methylphenidate is a preferred first-choice medication for the short-term treatment of ADHD 5
- In adults, amphetamines are a preferred first-choice medication for the short-term treatment of ADHD 5
- In children and youth with autism spectrum disorder (ASD), methylphenidate and atomoxetine may be effective in reducing ADHD symptoms 7