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

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