What alternative Attention Deficit Hyperactivity Disorder (ADHD) medications can be used for an adult patient experiencing jaw clenching due to Adderall (amphetamine and dextroamphetamine)?

Managing Jaw Clenching from Adderall: Alternative ADHD Medications

For an adult patient experiencing jaw clenching from Adderall, switching to a non-stimulant medication such as atomoxetine (Strattera) is the recommended approach. 1

First-Line Alternative Options

Non-Stimulant Medications

1. Atomoxetine (Strattera)

   • Starting dose: 0.5 mg/kg/day
   • Target dose: 1.2 mg/kg/day
   • Benefits: Does not worsen tics and has lower abuse potential 1
   • No risk of jaw clenching as it works through a different mechanism (selective norepinephrine reuptake inhibitor)

2. Guanfacine (Intuniv)

   • Dosing: 0.1 mg/kg once daily
   • Alpha-2 adrenergic receptor agonist that enhances noradrenergic neurotransmission in the prefrontal cortex 1
   • Side effects include nausea, fatigue, and somnolence, but no jaw clenching

Alternative Stimulant Options

If non-stimulants are not effective and you need to stay with stimulants:

1. Consider a different stimulant formulation
   • Lisdexamfetamine (Vyvanse) may have different side effect profile than Adderall
   • Methylphenidate-based medications (Concerta, Ritalin) work through a slightly different mechanism than amphetamine-based medications like Adderall 2

Decision Algorithm

1. First try: Atomoxetine (Strattera)

   • Most evidence-supported non-stimulant for ADHD
   • Approximately 50% of non-responders to methylphenidate will respond to atomoxetine therapy 3

2. If atomoxetine is ineffective or poorly tolerated: Try Guanfacine (Intuniv)

   • Particularly useful if the patient also has anxiety symptoms 1

3. If non-stimulants fail: Consider a methylphenidate-based stimulant

   • Different mechanism than amphetamine-based medications (like Adderall)
   • May not cause the same jaw clenching side effect

Switching Process

When switching from Adderall to atomoxetine:

• Initiate atomoxetine with a schedule of dose increases while cross-tapering with Adderall
• Use a slow titration schedule with divided doses to minimize adverse events
• Atomoxetine and Adderall can be co-administered during the switching period with monitoring of blood pressure and heart rate 3
• Allow for a trial period of at least 6-8 weeks to evaluate the overall tolerability and efficacy of atomoxetine

Important Considerations

• Bupropion is another potential option but should be used with caution due to its activating properties which may worsen anxiety symptoms 1
• For patients with comorbid substance use disorders, non-stimulants are preferred due to lower abuse potential 1
• Regular monitoring of blood pressure, heart rate, and other side effects is recommended at each follow-up visit 1
• Schedule follow-up within 2-4 weeks after medication initiation to assess response and side effects

Caveat

Jaw clenching (bruxism) is a recognized side effect of amphetamine-based medications like Adderall 2. This side effect is less common with non-stimulant medications, making them a suitable alternative for patients experiencing this specific adverse effect.