Can amantadine treat Attention Deficit Hyperactivity Disorder (ADHD)?

Amantadine for ADHD Treatment

Amantadine is not recommended as a first-line treatment for ADHD, as stimulants and established non-stimulants have stronger evidence and are recognized in clinical guidelines as the standard of care. 1

Established ADHD Medications

First-Line Treatments

• Stimulants (methylphenidate and amphetamines) are the first-line pharmacological treatment for ADHD due to their large effect sizes, rapid onset of action, and extensive evidence base 1
• Stimulants have demonstrated superior efficacy compared to non-stimulant medications for reducing core ADHD symptoms 1

Established Non-Stimulant Options

• Atomoxetine (norepinephrine reuptake inhibitor) is the primary second-line treatment when stimulants are ineffective or poorly tolerated 1, 2
• Alpha-2 adrenergic agonists (clonidine, guanfacine) are also established non-stimulant options with evidence supporting their efficacy 1
• These medications provide "around-the-clock" effects compared to the time-limited effects of stimulants 1

Evidence for Amantadine in ADHD

• Amantadine is considered an emerging or experimental treatment for ADHD, not included in major clinical guidelines as a standard treatment option 1
• One small randomized clinical trial (n=40) compared amantadine to methylphenidate in children and adolescents with ADHD over 6 weeks 3
• This study showed no significant differences between amantadine (100-150 mg/day) and methylphenidate (20-30 mg/day) on Parent and Teacher Rating Scale scores 3
• The authors concluded that amantadine "may be beneficial" but noted their results "do not constitute proof of efficacy" 3
• Amantadine has been investigated primarily as a potential add-on treatment to enhance cognitive functions rather than as a standalone ADHD therapy 4

Treatment Algorithm Based on Guidelines

1. For children (6-11 years) and adolescents (12-18 years):

   • Begin with FDA-approved stimulant medications (methylphenidate or amphetamine formulations) 1
   • If stimulants are ineffective or poorly tolerated, switch to atomoxetine 1
   • Consider alpha-2 agonists (guanfacine, clonidine) as alternative non-stimulants 1

2. For preschool children (4-5 years):

   • Begin with evidence-based behavioral therapy as first-line treatment 1
   • Consider methylphenidate only if behavioral interventions are insufficient and symptoms remain moderate-to-severe 1

Important Considerations

• Amantadine is not listed in any major ADHD treatment guidelines from the US, Europe, or Asian countries 1
• The evidence base for amantadine in ADHD is extremely limited compared to established medications 4, 3
• When selecting ADHD medications, clinicians should consider:
  • Severity of symptoms
  • Presence of comorbidities
  • Duration of symptom control needed
  • Patient/family preferences 1
  • Side effect profiles 1

Conclusion

While one small study suggests amantadine might have some efficacy in ADHD, the evidence is insufficient to recommend it over established treatments. Clinicians should adhere to guideline-recommended medications (stimulants first, followed by atomoxetine or alpha-2 agonists) that have robust evidence supporting their efficacy and safety profiles.