From the Guidelines
The most recent and effective stimulants on the market for ADHD include long-acting formulations such as osmotic-release oral system methylphenidate and the prodrug lisdexamfetamine dimesylate, which have been shown to improve medication adherence and reduce rebound effects 1. When considering new stimulants, it's essential to weigh the benefits and risks, including potential adverse effects such as decreased appetite, sleep disturbances, and increased blood pressure and pulse.
- Key factors to consider when selecting a stimulant formulation include the patient's symptom profile, individual needs, and potential risks, such as preexisting cardiovascular diseases or suicidality.
- Recent evidence suggests that psychostimulant medication may decrease the risk of suicidal events in patients with ADHD, but careful monitoring is still necessary 1.
- Long-acting stimulant formulations differ in their pharmacokinetic profiles, and physicians should choose a formulation that is appropriate for the patient's needs, taking into account factors such as the rate at which peak levels are attained and decline 1.
- Common adverse effects of stimulant medications include decreased appetite, sleep disturbances, increased blood pressure and pulse, headaches, irritability, and stomach pain, which are generally mild and/or temporary 1.
- Statistically significant increases in blood pressure and heart rate have been observed with stimulant medications, and clinical guidelines recommend monitoring of pulse and blood pressure when prescribing these medications 1.
- Treatment with psychostimulants is associated with a statistically significant reduction in height and weight gain, which can be clinically relevant in subgroups and requires careful monitoring 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
New Stimulants on the Market
- The new stimulants on the market include modafinil, lisdexamfetamine, mixed amphetamine salts, and methylphenidate 2, 3, 4, 5.
- Modafinil is a novel wakefulness-promoting agent that has been shown to have greater efficacy than placebo in the treatment of attention-deficit hyperactivity disorder (ADHD) in children and adults 2, 6.
- Lisdexamfetamine, mixed amphetamine salts, and methylphenidate are psychostimulants that have been found to be effective in reducing ADHD symptoms in adults 5.
Efficacy and Safety
- Modafinil has been found to improve ADHD symptoms in children and adolescents, with a significant reduction in symptom ratings compared to placebo 2, 6.
- The most common adverse events associated with modafinil are insomnia, headache, and decreased appetite 2, 6.
- Lisdexamfetamine, mixed amphetamine salts, and methylphenidate have been found to be effective in reducing ADHD symptoms in adults, with varying effect sizes 5.
- The safety of stimulant medications, including modafinil, has been reviewed, and while there are potential risks, the majority of treatment complications are reversible or manageable with appropriate clinical care 3.
Comparison of Stimulants
- A meta-analysis found that lisdexamfetamine had the largest effect size in reducing ADHD symptoms in adults, followed by mixed amphetamine salts and methylphenidate 5.
- Modafinil did not show significant efficacy in reducing ADHD symptoms in adults in one meta-analysis 5, but has been found to be effective in children and adolescents 2, 6.
- The choice of stimulant medication may depend on individual patient needs and responses to treatment, as well as the presence of comorbid conditions 4.