Are there any non-oral Attention Deficit Hyperactivity Disorder (ADHD) medications available, such as transdermal patches or injectables?

Non-Oral ADHD Medications Available

Yes, there are non-oral ADHD medications available, with transdermal patches being the primary option, including methylphenidate transdermal system (MTS) and the recently FDA-approved dextroamphetamine transdermal system (d-ATS). 1, 2, 3, 4, 5

Available Non-Oral ADHD Medication Options

Transdermal Patches

1. Methylphenidate Transdermal System (MTS)

   • Delivers methylphenidate through the skin over approximately 9 hours 4
   • Available in multiple patch sizes (12.5-37.5 cm²) corresponding to doses of 10-30 mg 4
   • FDA-approved for children aged 6-12 years with ADHD 4
   • Peak plasma concentrations reached in approximately 8 hours 4
   • Allows for individualized control over effect duration based on when the patch is applied and removed 3

2. Dextroamphetamine Transdermal System (d-ATS)

   • Recently approved by the FDA for ADHD treatment 5
   • Provides flexibility in treatment duration through variable wear times 5
   • Fills an unmet need for patients who cannot or prefer not to take oral medications 5

Clinical Advantages of Transdermal Systems

• Improved adherence: May improve treatment adherence in patients who cannot tolerate or have difficulties with pill formulations 2
• Flexible duration: Unlike oral extended-release formulations, patches allow control over duration of effect by adjusting wear time 3
• Retrievable dosing: Clinicians can think in terms of retrievable drug delivery (mg/hour) rather than fixed non-retrievable doses 3
• Steady absorption: Provides steady drug absorption without the peaks and troughs often seen with oral formulations 4

Clinical Considerations When Prescribing Transdermal Systems

Dosing Paradigm

• Clinicians must shift their thinking from fixed oral doses to controlling two variables:
  1. Patch size (controlling mg/hour delivery rate)
  2. Duration of patch wear (controlling total daily exposure) 3

Application Techniques

• Proper patient and caregiver education is essential regarding:
  • Patch site selection and rotation
  • Application techniques
  • Timing of application and removal
  • Skin hygiene and care 3

Potential Drawbacks

• Skin irritation and dermal discomfort must be considered alongside typical stimulant side effects 5
• May not be suitable for all patients, particularly those with sensitive skin
• Limited availability compared to the wide range of oral formulations 6

Other Non-Stimulant Options

While not technically non-oral delivery systems, it's worth noting that several ADHD medications are available in alternative oral formulations for patients who struggle with swallowing pills:

• Methylphenidate extended-release oral suspension (MEROS) - a liquid preparation 2
• Chewable tablets and liquid formulations of various stimulants 1

Clinical Bottom Line

When considering non-oral ADHD medications, transdermal patches offer a viable alternative to traditional oral formulations, particularly for patients who:

• Have difficulty swallowing pills
• Need flexible duration of effect
• Require retrievable dosing options
• Have adherence issues with oral medications

The choice between methylphenidate transdermal system and dextroamphetamine transdermal system should follow the same principles used when selecting between oral methylphenidate and amphetamine formulations, with consideration of the patient's specific needs and response profile.