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Table 2 Current pharmacological treatments approved for attention deficit hyperactivity disorder (ADHD)

From: Advances in understanding and treating ADHD

Class Generic name, formulation and brand name Daily dosage Duration Mechanism of action Common Side-effects
   STIMULANTS    
Methylphenidate Immediate-release/short-acting (Ritalin, Methylin, Desoxyn) Initial 5-18 mg; increase as needed until beneficial effects peak or unacceptable side effects develop
Two to three times daily; can titrate as needed as long as beneficial effects are greater than side effects
3 to 6 hours Blocks reuptake of D, N
Release of D from storage vesicles
Appetite suppression, delay of sleep onset, abdominal pain, headache, rebound irritability, tics (motor, vocal), jitteriness
  Intermediate-acting (Metadate ER, Metadate CD, Methyllin ER, Ritalin LA, Ritalin SR) One to two times daily 3 to 8 hours Same Same
  Extended release/long-acting (Concerta, Daytrana Patch) Once daily (Patch left on for 9 hrs) 8 to 12 hours Same Same
Dexmethylphenidate Short-acting (Focalin) Two to three times daily; initial half that of IR MPH 4 to 5 hours Same Same
  Extended-release/long-acting (Focalin XR) Once daily 8 to 12 hours Same Same
Amphetamines Immediate-release/short-acting (Dexedrine, DextroStat, Adderall) Initial dose half IR MPH; two to three times daily 4 to 6 hours Release of D newly synthesized D; blocks reuptake of D, N Same
  Intermediate-acting (Dexedrine spansule) One to two times daily 6 to 10 hours Same Same
  Extended-release/long-acting (Adderall-XR) Once daily 8 to 12 hours Same Same
Prodrug Amphetamines Lisdexamfetamine (Vyvanse) Initial 4 × IR MPH once daily 8 to 12 hours Same Same
   NON - STIMULANTS    
NRI Atomoxetine (Strattera) Initial 0.5 mg/Kg; Increase to 1.2-1.8 mg/Kg one to 2 times a day 18 to 24 hours Blocks N reuptake at synapse Sedation, GI irritability, palpitations, sweating, increased suicidal thoughts
   ALPHA2 AGONISTS    
Clonidine IR Clonidine (Catapres) Initial dose 0.05-0.1 mg at night; titrate to max 0.4 mg/per day 3 to 6 hours Arousal at locus ceruleus by N inhibition Sedation, Low blood pressure, rebound hypertension
  ER Clonidine (Kapvay) Initial 0.1 mg qhs; titrate to max 0.4 mg qhs; once daily 12 to 24 hours Same Same
  Clonidine patch (catapres TDS) Initial TTS-1 up to TTS-3 1 to 5 days Same Same
Guanfacine IR Guanfacine (Tenex) Initial 1 mg daily; titrate as needed up to 4 mg MDD; twice daily 12 to 24 hours Same Same
  ER guanfacine (Intuniv) Initial 1 mg; up to 4 mg; once daily ~24 hours Same Same
   ANTIDEPRESSANTS    
NDRI Buproprion Initial: lesser of 3 mg/Kg/d or 150 mg; Maximum: Lesser of 6 mg/Kg/d or 450 mg; No singled does greater than 150 mg; 2 to 3 times a day 8 to 12 hours N and D reuptake inhibition Insomnia, decreased appetite, irritability, anticholinergic (dry mouth, GI etc.), decreased seizure threshold
  IR (Wellbutrin)    Same Same
  ER (Wellbutrin SR) Twice daily 12 to 24 hours Same Same
  (Wellbutrin XL) Once daily 24 hours Same Same
SNRI's (Tricyclics) Imipramine (Tofranil) Initial: 1 mg/Kg/d; Maximum: Lesser of 4 mg/Kg/d or 200 mg; 1 to 2 times per day; obtain baseline EKG; Monitor serum levels 12 to 24 hours N and Serotonin reuptake blockade Sedation, Cardiac increase heart rate, arrhythmias, anticholinergic (dry mouth, GI, etc.), blurry vision
  1. D = Dopamine, N = Norepinephrine, S = Serotonin, IR = Immediate Release, MPH = Methylphenidate, mg/kg = milligrams/kilogram, qhs = before bed