ADD or ADHD Medications

  • Medical Author:
    Roxanne Dryden-Edwards, MD

    Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

  • Medical Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

ADHD Symptoms in Children

ADD or ADHD medications facts

  • Attention deficit hyperactivity disorder (often referred to as ADD or ADHD) is a disorder that is characterized by hyperactivity or restlessness, trouble concentrating, and/or trouble controlling one's impulses.
  • People with ADHD have many chemicals in their brain that are not present in the proper amounts in the proper places at the proper times.
  • ADHD medications are designed to increase the ability of the ADHD sufferer to pay attention and manage their impulses and activity level.
  • Most ADHD medications tend to increase the amount of the neurotransmitters dopamine (DA) and/or norepinephrine.
  • Marijuana's addiction potential, side effects, and the lack of research of its benefits for ADHD keep the use of this drug from being a viable treatment.
  • The types of ADHD medicines include stimulants and nonstimulants, the latter including medications that usually treat depression.
  • ADHD medications now come in pill, patch, or liquid forms.
  • Precautions that are often taken when ADHD drugs are prescribed usually involve the prescribing doctor using a variety of ways to make sure the person is healthy.
  • As with many medications, ADHD medications can be associated with certain interactions with other medications, some of which may be dangerous.

What are ADD or ADHD medications?

Attention deficit hyperactivity disorder (often referred to as ADD or ADHD) is a disorder that is characterized by hyperactivity or restlessness, trouble concentrating, and/or trouble controlling one's impulses. It is one of the most common conditions of childhood and adolescence. Most experts agree that this condition affects 8%-10% of school-age children and that more than 40% of children with ADHD grow up into adults with this disorder.

Rather than having any single cause, attention deficit hyperactivity disorder (ADHD) develops from both genetic and life experience risk factors. Individuals with ADHD tend to have problems developing efficient self-regulation skills and decision-making abilities. Biologically, ADHD is a neurochemical and neuroanatomical disorder. People with ADHD have several chemicals in the brain that are not present in the right quantities in the right places at the right times. These chemicals may work sometimes but not consistently, and they are not under the individual's control. This is why people with ADHD have variable performance. Also, some nerve groups seem to be a bit out of position in the brain, causing delays or accelerations of nerve signals.

ADHD medications are designed to increase the ability of the ADHD sufferer to pay attention and manage their impulses and activity level. They also sometimes are used to treat people who suffer from sleep attacks (narcolepsy), chronic fatigue, or to boost the effect of antidepressant medication.

Most ADHD medications increase the amount of two brain chemicals that are used by nerve cells to communicate with one another (neurotransmitters), namely dopamine (DA) and/or norepinephrine. These chemicals have been associated with attention, pleasure, and movement. Although the chemical properties of other ADHD medications like guanfacine (Tenex, Intuniv) and clonidine (Catapres, Kapvay) are known, it is not fully understood how they affect the symptoms of ADHD.

Some medical marijuana advocates have begun to propose marijuana for the treatment of ADHD due to marijuana's effects of decreasing activity and anxiety levels. However, marijuana's addiction potential and side effect -- like impaired memory, judgment, and coordination, mood changes, low motivation, and possible psychosis -- in addition to the lack of research of its benefits for ADHD, keep the use of this drug from being a viable treatment for this disorder. While some over-the-counter medications for adult weight loss, like ephedrine, may improve focus and alertness, their appetite suppression and abuse potential preclude their being a viable option for treatment of a chronic condition like ADHD.

Quick GuideADHD Symptoms in Children

ADHD Symptoms in Children

What are the different types of ADD or ADHD drugs?

The types of ADHD medicines include stimulants and nonstimulants. Some medications that usually treat depression have been found to be helpful in treating some people with ADHD as well. Stimulant medications include methylphenidate and its derivatives, like Ritalin, Methylin and Metadate (methylphenidate) and Ritalin-LA, Focalin, Metadate-CD, Daytrana and Concerta (extended-release methylphenidate). It also includes amphetamine derivatives like dextroamphetamine (Dexedrine), combination amphetamine and dextroamphetamine salts (Adderall), and lisdexamfetamine (Vyvanse).

Nonstimulant medications used in the treatment of ADHD symptoms include atomoxetine (Strattera), guanfacine (Tenex or Intuniv), and clonidine (Catapres or Kapvay), as well as medications that are used primarily in the treatment of depression or anxiety, including bupropion (Wellbutrin) and venlafaxine (Effexor).

What are the differences among the ADHD drugs?

In addition to the chemical differences among ADHD medications just described, there are differences in how long the effects of a dose of medication lasts and how they are taken. The length of time a dose of medication can last ranges from about two to four hours as with Ritalin, four to six hours as with Adderall or Dexedrine, 10-12 hours with Focalin-XR and Concerta, and up to 12-13 hours with Vyvanse.

Ways of giving ADHD drugs have increased. While medications to treat this disorder used to come only in pill form, there is now the option of the methylphenidate patch (Daytrana) and Catapres topical patches for children, teenagers, or adults who have trouble swallowing. Methylphenidate (Quillivant-XR) and Methylin liquid are two liquid forms of stimulant medications and have received FDA approval to treat ADHD.

Are any side effects associated with ADHD medications?

Side effects associated with ADHD medications are primarily related to the group of medications to which the medication is related. However, like any other psychiatric medication, they may uncommonly cause negative changes in mood or behavior, including suicidal thoughts or actions. For example, stimulants are known to be a group that can decrease appetite and weight, cause stomach upset, headaches, and insomnia as well as raise blood pressure, uncommonly unmask tics, and rarely cause psychosis. While there has been concern expressed that stimulant medication may decrease physical growth of children who take it, that tends to be uncommon and only amounts to a decrease of ½ to 1 inch in children who do experience that side effect.

When taken in excess or snorted, stimulants that treat ADHD can produce euphoria and result in addiction. Stimulant abuse has increased over the past four years, in apparent parallel to the decrease in teens of perceived risk of abusing these substances.

Serious but uncommon side effects that can be associated with stimulant medications include sudden death, stroke, and heart attack. While those usually occur when stimulants are abused, people who have a preexisting heart problem are particularly at risk.

Nonstimulant medications like Strattera, Intuniv, and Kapvay may cause drowsiness and tiredness, with Intuniv tending to cause those side effects 12 hours after it is taken as opposed to Strattera and Kapvay, which may cause drowsiness within an hour after being taken. Tenex and guanfacine(Intuniv) and clonidine (Catapres and Kapvay), both effective at treating high blood pressure, may drop blood pressure to the point of causing dizziness and palpitations or decrease the heart rate. They have also been known to cause decreased appetite, headache, stomach upset, nausea, dry mouth, constipation, and irritability. While other mood changes, including suicidal thoughts, have been documented with the use of Strattera, people taking any psychiatric mesdication should be monitored for the possibility of suicide, given that any psychiatric medication by definition is designed to alter brain chemistry. In contrast, Strattera may slightly increase blood pressure. Strattera also has been known to cause dry mouth, insomnia, decreased appetite, constipation, decreased libido, dizziness, and sweating as side effects.

What are the precautions for ADHD drugs?

Precautions that are often taken when ADHD drugs are prescribed usually involve either reviewing recent lab work or requesting new lab work to make sure the person is healthy. The prescribing doctor might also ask that an electrocardiogram (EKG, ECG) or full evaluation by a cardiologist be done if the person has a personal history of heart problems or a family history of early heart disease near or under 50 years of age. The person taking the medication should be monitored for side effects. When stimulant medications are prescribed, the weight and blood pressure of the person should be monitored to ensure that excessive weight loss or significant increase in blood pressure has not occurred. For nonstimulant medications, precautions involve monitoring blood pressure to ensure that a significant decrease does not occur. If Wellbutrin is being considered to treat ADHD, the prescribing doctor will inquire about any history of eating disorder or seizures, since the risk of having seizures is significantly higher for those individuals if given Wellbutrin.

Quick GuideADHD Symptoms in Children

ADHD Symptoms in Children

Are ADHD medications associated with drug interactions?

As with nearly every other kind of medication, ADHD medications can be associated with certain interactions with other medications. The amount of stimulant ADHD medication in the system can be particularly sensitive to how acidic substances are. Acidic substances like orange juice, tomato juice, and acidic medications decrease the amount of some stimulant medications in the system, and more basic substances like some diuretic antihypertensive medications can increase the levels of some stimulants.

Stimulants may cause blood thinners and antiseizure medications to remain at a higher level for longer and have an additive effect on medications used to treat psychosis. Fortunately, stimulant medications do not tend to change or be changed in terms of how they work or what they do when given with other, nonstimulant ADHD medications, like guanfacine, clonidine, or atomoxetine. However, other substances and medications that stimulate the nervous system can add to the effects of the stimulants. Examples of this are caffeine, ephedrine, and antidepressants like monoamine oxidase inhibitors (MAOIs). Stimulants should not be taken within 14 days of an MAOI.

Because of the way in which guanfacine is eliminated (metabolized) by the body, it can tend to increase the amount of medications like the antiseizure/mood stabilizer medication valproate. As with clonidine, that also is used as a blood pressure (antihypertensive) medication, caution is used when it is being given with other antihypertensives. Since both tend to slow down the nervous system, they also should be used with caution in people taking any sedative.

It is recommended that Wellbutrin never be combined with MAOIs or taken within 14 days of an MAOI because the result can be serious and even fatal reactions such as high body temperature, muscle rigidity, twitching, and agitation, resulting in delirium, and coma. If Wellbutrin or Effexor is taken with other drugs, the effects of either could be increased, decreased, or altered. Therefore, it is important that the prescribing doctor be informed of any other medications being taken.

REFERENCES:

Bussing, R., D.M. Mason, L. Bell, P. Porter, and C. Garvan. "Adolescent outcomes of childhood attention-deficit/hyperactivity disorder in a diverse community sample." Journal of the American Academy of Child and Adolescent Psychiatry 49.6 June 2010: 595-605.

De Sousa, A., and G. Kalra. "Drug therapy of attention deficit hyperactivity disorder: current trends." Mens Sana Monographs 10.1 January-December 2012: 45-69.

Docherty, J.R. "Pharmacology of stimulants prohibited by the world anti-doping agency (WADA)." British Journal of Pharmacology 154.3 June 2008: 606-622.

Jernigan, M.G., G.M. Kipp, A. Rather, et al. "Clinical implications and management of drug-drug interactions between antiretroviral agents and psychotropic medications." Mental Health Clinics 2.9 (2013): 70.

Mao, K. "Can medical cannabis stop the ADHD epidemic?" Waking Times Apr. 11, 2013.

National Institute on Drug Abuse 1. "Drug facts: is marijuana medicine?" National Institute on Drug Abuse 2012 July.

National Institute on Drug Abuse 2. "Regular marijuana use by teens continues to be a concern." National Institute on Drug Abuse 2012 December.

Physicians' Desk Reference Network. Physicians' Desk Reference, 67th ed. Montvale, New Jersey, 2013.

Roesch, B., M. Corcoran, M. Haffey, et al. "Pharmacokinetics of coadministration of guanfacine extended release and methylphenidate extended release." Drugs Research and Development 13.1 Mar. 2013: 53-61.

Wilens, T.E., N.R. Morrison, and J. Prince. "An update on the pharmacotherapy of attention-deficit/hyperactivity disorder in adults." Expert Review in Neurotherapy 11.10 Oct. 2011: 1443-1465.

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Reviewed on 8/21/2015
References
REFERENCES:

Bussing, R., D.M. Mason, L. Bell, P. Porter, and C. Garvan. "Adolescent outcomes of childhood attention-deficit/hyperactivity disorder in a diverse community sample." Journal of the American Academy of Child and Adolescent Psychiatry 49.6 June 2010: 595-605.

De Sousa, A., and G. Kalra. "Drug therapy of attention deficit hyperactivity disorder: current trends." Mens Sana Monographs 10.1 January-December 2012: 45-69.

Docherty, J.R. "Pharmacology of stimulants prohibited by the world anti-doping agency (WADA)." British Journal of Pharmacology 154.3 June 2008: 606-622.

Jernigan, M.G., G.M. Kipp, A. Rather, et al. "Clinical implications and management of drug-drug interactions between antiretroviral agents and psychotropic medications." Mental Health Clinics 2.9 (2013): 70.

Mao, K. "Can medical cannabis stop the ADHD epidemic?" Waking Times Apr. 11, 2013.

National Institute on Drug Abuse 1. "Drug facts: is marijuana medicine?" National Institute on Drug Abuse 2012 July.

National Institute on Drug Abuse 2. "Regular marijuana use by teens continues to be a concern." National Institute on Drug Abuse 2012 December.

Physicians' Desk Reference Network. Physicians' Desk Reference, 67th ed. Montvale, New Jersey, 2013.

Roesch, B., M. Corcoran, M. Haffey, et al. "Pharmacokinetics of coadministration of guanfacine extended release and methylphenidate extended release." Drugs Research and Development 13.1 Mar. 2013: 53-61.

Wilens, T.E., N.R. Morrison, and J. Prince. "An update on the pharmacotherapy of attention-deficit/hyperactivity disorder in adults." Expert Review in Neurotherapy 11.10 Oct. 2011: 1443-1465.

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