From the Guidelines
Methylphenidate is the initial medication of choice for Attention Deficit Hyperactivity Disorder (ADHD) inattentive type.
Key Points
- Psychostimulants, including methylphenidate and amphetamine, are first-line pharmacotherapies for patients with ADHD 1.
- Methylphenidate actions include dopamine and norepinephrine transporter inhibition, agonist activity at the serotonin type 1A receptor, and redistribution of the vesicular monoamine transporter 2 1.
- Long-acting formulations of psychostimulants, such as osmotic-release oral system methylphenidate, are associated with better medication adherence and probably a lower risk of rebound effects 1.
- Common adverse effects of methylphenidate include decreased appetite, sleep disturbances, increased blood pressure and pulse, headaches, irritability, and stomach pain 1.
- Clinical guidelines recommend monitoring of pulse and blood pressure when prescribing psychostimulant medication, such as methylphenidate 1.
Medication Considerations
- The choice of methylphenidate formulation should take into account the patient's symptom profile and individual needs 1.
- Methylphenidate is available in short-acting and long-acting formulations, with the latter encompassing different controlled-release stimulant formulations 1.
- Physicians should be aware of the potential effects of methylphenidate on height and weight gain, and monitor patients carefully 1.
From the Research
Initial Medication for ADHD Inattentive Type
The initial medication of choice for Attention Deficit Hyperactivity Disorder (ADHD) inattentive type is typically stimulants, which include:
- Methylphenidate
- Amphetamines 2, 3, 4, 5 These medications are considered first-line treatments for ADHD due to their high efficacy in managing symptoms of inattention and hyperactivity.
Mechanism of Action
Stimulants, such as methylphenidate and amphetamines, work by:
- Increasing presynaptic release of dopamine and other biogenic amines in the brain
- Inhibiting the reuptake of dopamine and norepinephrine 4
Alternative Options
Non-stimulant medications, such as atomoxetine, may be considered as alternative options for patients who do not respond to stimulants or experience adverse effects 3, 4, 6 However, these medications are generally considered to be less efficacious than stimulants.
Emerging Treatments
Research is ongoing to develop new treatments for ADHD, including:
- Viloxazine
- Dasotraline
- Amantadine
- Tipepidine 6 These emerging treatments may offer promising alternatives or add-on therapies for patients with ADHD.