Management Options for Attention Deficit/Hyperactivity

Abstract and Introduction

Introduction

A wide array of products are currently on the market in the United States for the management of ADHD. Over the past decade, a number of new treatment options have been introduced, including once-daily products, oral liquid and transdermal dosage formulations, and several generic products (Table).^[1–14] This issue of Pediatric Pharmacotherapy will provide a brief review of some of these products and highlight their unique properties.

Table. Medication Options for the Management of ADHD^1–14
Product (Manufacturer)	Formulation	Approximate Duration of Action	Available Strengths	Dosing Considerations
Methylphenidate
Ritalin® or generic(Novartis and others)	Immediate-release tablets, chewable tablets, or oral solution*	3–4 hours	5, 10, 20 mg tablets 5 mg/5 mL, 10 mg/5 mL solutions	Provides flexibility for initial dose titration
Concerta® (McNeil Pediatrics)	Tablet with OROS® osmotic pump technology; biphasic release with initial peak at 1 hr (20% of dose) and gradual release over 9 hrs	12 hours	18, 27, 36, 54 mg	Must be swallowed whole; non-absorbable shell may be passed in stool
Daytrana® (Noven Therapeutics)	Transdermal patch with drug dispersed in adhesive layer; applied daily	12 hours with 9 hour wear time	10, 15, 20, 30 mg/9 hr	Can vary wear time to control duration of action; monitor for skin sensitization; discard patches appropriately
Metadate CD® (UCB, Inc.)	Diffucaps® capsule with 30% immediate-release beads and 70% delayed-release beads*	8–10 hours	10, 20, 30, 40, 50, 60 mg	Capsule may be opened and beads swallowed whole with applesauce.
Metadate ER® (UCB, Inc.)	Extended-release tablet*	6–8 hours	10, 20 mg	Swallow whole; do not break, crush, or chew
Methylin™ Chewable (Mallinckrodt Inc.)	Chewable tablet*	3–4 hours	2.5, 5, 10 mg	Contains phenylalanine
Methylin ER™ (Mallinckrodt Inc.)	Extended-release tablet*	6–8 hours	10, 20 mg	Swallow whole; do not break, crush, or chew
Ritalin SR® (Novartis)	Extended-release tablet*	6–8 hours	20 mg	Swallow whole; do not break, crush, or chew
Ritalin LA® (Novartis)	Capsule with Spheroidal Oral Drug Absorption System (SODAS®) technology; 50% immediate- release beads and 50% delayed-release (2ndpeak 4 hrs later)*	8–10 hours	10, 20, 30, 40 mg	Capsule may be opened and beads swallowed whole with applesauce. Do not give with antacids or acid suppressants.
Dexmethylphenidate
Focalin® or generic(Novartisand others)	Immediate-release tablets*	4–6 hours	2.5, 5, 10 mg	Active isomer; give approx. ½ methylphenidate dose
Focalin XR® (Novartis)	Capsule with SODAS®technology*	12 hours	5, 10, 15, 20, 30, 40 mg	Capsule may be opened and beads swallowed whole with applesauce. Do not give with antacids or acid suppressants.
Amphetamines
Dextroamphetamine (various manufacturers)	Immediate-release tablets, capsules, or liquid	3–6 hours	5, 10 mg	Provides flexibility during initial titration
Adderall® or generic (Teva and others)	Immediate-release tablet	4–6 hours	5, 7.5, 10, 12.5, 15, 20, 30 mg	Mixture of amphetamine salts provides slightly longer half-life
Adderall XR® (Teva)	Capsule with Micotrol® delivery system: 50% immediate-release and 50% delayed-release beads*	10–12 hours	5, 10, 15, 20, 25, 30 mg	Capsule may be opened and beads swallowed whole with applesauce.
Vyvanse® (Shire)	Capsule containing lisdexamfetamine (dextroamphetamine linked to l-lysine); peak dextroamphetamine reached in approx. 3.5 hrs*	10–13 hours	20, 30, 40, 50, 60, 70 mg	Capsule may be opened and contents dissolved in water; use immediately after dissolving.
Atomoxetine
Strattera® (Lilly)	Capsule*	24 hours	10, 18, 25, 40, 60, 80, 100 mg	Selective norepinephrine inhibitor; may take several weeks to achieve full effect; swallow capsule whole; powder is irritating to eyes
Clonidine
Catapres® or generic (Boehringer Ingelheim and others)	Immediate-release tablets	3–6 hours (wide interpatient variability)	0.1, 0.2, 0.3 mg	Sedating, typically initiated at bedtime; increase weekly by adding morning and then mid-day doses
Catapres-TTS® (Boehringer Ingelheim and others)	Transdermal patch, applied weekly	5–7 days	0.1, 0.2, 0.3 mg/24 hours	Potential for skin irritation; if patch loosens, cover with adhesive overlay; discard patches appropriately
Guanfacine
Tenex® or generic (Promius and others)	Immediate-release tablets	6–12 hours	1, 2 mg
Intuniv™ (Shire)	Extended-release tablet	12–24 hours	1, 2, 3, 4 mg	Swallow tablet whole; a high-fat meal may increase absorption and lead to toxicity

Table. Medication Options for the Management of ADHD^1–14

Product (Manufacturer)

Formulation

Approximate Duration of Action

Available Strengths

Dosing Considerations

Methylphenidate

Ritalin® or generic(Novartis and others)

Immediate-release tablets, chewable tablets, or oral solution*

3–4 hours

5, 10, 20 mg tablets 5 mg/5 mL, 10 mg/5 mL solutions

Provides flexibility for initial dose titration

Concerta® (McNeil Pediatrics)

Tablet with OROS® osmotic pump technology; biphasic release with initial peak at 1 hr (20% of dose) and gradual release over 9 hrs

12 hours

18, 27, 36, 54 mg

Must be swallowed whole; non-absorbable shell may be passed in stool

Daytrana® (Noven Therapeutics)

Transdermal patch with drug dispersed in adhesive layer; applied daily

12 hours with 9 hour wear time

10, 15, 20, 30 mg/9 hr

Can vary wear time to control duration of action; monitor for skin sensitization; discard patches appropriately

Metadate CD® (UCB, Inc.)

Diffucaps® capsule with 30% immediate-release beads and 70% delayed-release beads*

8–10 hours

10, 20, 30, 40, 50, 60 mg

Capsule may be opened and beads swallowed whole with applesauce.

Metadate ER® (UCB, Inc.)

Extended-release tablet*

6–8 hours

10, 20 mg

Swallow whole; do not break, crush, or chew

Methylin™ Chewable (Mallinckrodt Inc.)

Chewable tablet*

3–4 hours

2.5, 5, 10 mg

Contains phenylalanine

Methylin ER™ (Mallinckrodt Inc.)

Extended-release tablet*

6–8 hours

10, 20 mg

Swallow whole; do not break, crush, or chew

Ritalin SR® (Novartis)

Extended-release tablet*

6–8 hours

20 mg

Swallow whole; do not break, crush, or chew

Ritalin LA® (Novartis)

Capsule with Spheroidal Oral Drug Absorption System (SODAS®) technology; 50% immediate- release beads and 50% delayed-release (2ndpeak 4 hrs later)*

8–10 hours

10, 20, 30, 40 mg

Capsule may be opened and beads swallowed whole with applesauce.
Do not give with antacids or acid suppressants.

Dexmethylphenidate

Focalin® or generic(Novartisand others)

Immediate-release tablets*

4–6 hours

2.5, 5, 10 mg

Active isomer; give approx. ½ methylphenidate dose

Focalin XR® (Novartis)

Capsule with SODAS®technology*

12 hours

5, 10, 15, 20, 30, 40 mg

Capsule may be opened and beads swallowed whole with applesauce.
Do not give with antacids or acid suppressants.

Amphetamines

Dextroamphetamine (various manufacturers)

Immediate-release tablets, capsules, or liquid

3–6 hours

5, 10 mg

Provides flexibility during initial titration

Adderall® or generic (Teva and others)

Immediate-release tablet

4–6 hours

5, 7.5, 10, 12.5, 15, 20, 30 mg

Mixture of amphetamine salts provides slightly longer half-life

Adderall XR® (Teva)

Capsule with Micotrol® delivery system: 50% immediate-release and 50% delayed-release beads*

10–12 hours

5, 10, 15, 20, 25, 30 mg

Capsule may be opened and beads swallowed whole with applesauce.

Vyvanse® (Shire)

Capsule containing lisdexamfetamine (dextroamphetamine linked to l-lysine); peak dextroamphetamine reached in approx. 3.5 hrs*

10–13 hours

20, 30, 40, 50, 60, 70 mg

Capsule may be opened and contents dissolved in water; use immediately after dissolving.

Atomoxetine

Strattera® (Lilly)

Capsule*

24 hours

10, 18, 25, 40, 60, 80, 100 mg

Selective norepinephrine inhibitor; may take several weeks to achieve full effect; swallow capsule whole; powder is irritating to eyes

Clonidine

Catapres® or generic (Boehringer Ingelheim and others)

Immediate-release tablets

3–6 hours (wide interpatient variability)

0.1, 0.2, 0.3 mg

Sedating, typically initiated at bedtime; increase weekly by adding morning and then mid-day doses

Catapres-TTS® (Boehringer Ingelheim and others)

Transdermal patch, applied weekly

5–7 days

0.1, 0.2, 0.3 mg/24 hours

Potential for skin irritation; if patch loosens, cover with adhesive overlay; discard patches appropriately

Guanfacine

Tenex® or generic (Promius and others)

Immediate-release tablets

6–12 hours

1, 2 mg

Intuniv™ (Shire)

Extended-release tablet

12–24 hours

1, 2, 3, 4 mg

Swallow tablet whole; a high-fat meal may increase absorption and lead to toxicity

Options for the Management of Attention Deficit/Hyperactivity (ADHD)

Abstract and Introduction

Introduction

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Options for the Management of Attention Deficit/Hyperactivity (ADHD)

Abstract and Introduction

Introduction

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