Medications to Treat Attention-Deficit Hyperactivity Disorder
Parent involvement in medication treatment is extremely important to ensure the child takes the required doses on time, to monitor for side effects and effectiveness of the drug, and to enlist the school's help when medication needs to be taken during school hours. Medication often is the first-line treatment for ADHD and includes the following types of drugs:
- Stimulants (including amphetamines)
- Mood stabilizers
- Neuroleptic drugs
Stimulants & ADHD
Stimulants that decrease impulsivity and hyperactivity and increase attention are commonly used to treat ADHD. These medications are used with careful monitoring and compliance and may improve symptoms in approximately 70 to 90 percent of cases. In children with ADHD, an improvement in symptoms often leads to an improvement in self-esteem.
These drugs increase the levels of the neurotransmitters dopamine, norepinephrine, and serotonin. Higher levels of dopamine are thought to reduce hyperactivity, while an increase in norepinephrine improves attention. The effects of low serotonin levels in children with ADHD are not fully understood.
The following stimulants are used to treat ADHD:
- Methylphenidate (Ritalin, Concerta, Methylin, Daytrana Patch)
- Dextroamphetamine (Dexedrine, Dextrostat)
- Amphetamine: combined dextroamphetamine and levoamphetamine (Adderall)
- Lisdexamfetamine (Vyvanse)
Methylphenidate is the most widely studied ADHD drug. Ritalin is available as a once daily preparation.
Dextroamphetamine (Dexedrine, Dextrostat) is available in long-lasting doses. The combination of dextroamphetamine and levoamphetamine (Adderall), two amphetamines, is shown to be effective, though it is not prescribed as often as methylphenidate, and is available as a once daily preparation.
Stimulants are usually well tolerated by children and adults. Though they may slow the growth rate in children, they do not seem to affect their eventual height. Using the summer as a "drug holiday" (no medication) may help normalize growth.
Tics may occur temporarily in about 9 percent of children treated with stimulants and may be chronic in about 1 percent. Careful monitoring is necessary to detect the emergence and/or worsening of tics while using stimulant medication.
Children and adults with high blood pressure (hypertension) should take the smallest dose possible, as amphetamines in general and magnesium pemoline in particular may worsen hypertension. Blood pressure should be carefully monitored throughout treatment.
Although drug abuse does not usually occur with properly monitored prescribed stimulants, there may be a risk for abuse in patients who also suffer from conduct disorder and those who have a preexisting substance dependency. If the risk among the patient's peers or family is high, it may be preferable to choose another class of drug.
Currently, there is no evidence to show that these drugs cause birth defects or problems for nursing babies; however, pregnant women are advised to discuss this with their physician. Women may be advised to avoid stimulants while nursing, since the stimulants may be excreted in breast milk.
In October of 2005, the Food and Drug Administration (FDA) withdrew approval for magnesium pemoline (Cylert), a drug that had been used rarely as a second-line medication to treat ADHD. This medication carries a high risk for liver failure. Generic versions have remained on the market to allow physicians to find alternative treatments for their patients. Magnesium pemoline has been associated with 13 deaths due to liver failure since its introduction in 1975, and liver function levels must be monitored every 2 weeks during treatment.
In February of 2006, an FDA advisory panel recommended the most serious warning label (i.e., "black box" safety warning) for these ADHD medications, due to an increased risk for severe cardiovascular problems in adults and children. Studies have shown an increased risk for heart attack, stroke, high blood pressure (hypertension), and abnormal heart beat (arrhythmia).
Common side effects of stimulants include the following:
- Emotional oversensitivity, crying easily
- Loss of appetite (anorexia)
- Poor appetite and weight loss
In December 2013, the FDA warned that products containing methylphenidate may increase risk for a serious condition called priapism, which is characterized by prolonged, painful erections. Priapism is rare and can occur in males of any age. Before taking these drugs, boys (their caregivers, if young) and men should be instructed about the symptoms of priapism and the importance of getting immediate medical attention if it occurs. Other ADHD medications, including atomoxetine (Strattera), also carry this risk.
In June 2015, the FDA warned that a permanent loss of skin color can occur with repeated exposure to chemical compounds in the methylphenidate transdermal system (Daytrana Patch). This condition, which is thought to be permanent, is called chemical leukoderma. It is not physically harmful, but may be disfiguring and cause emotional distress. Report new areas of lighter skin to your child's health care provider.