ADHD Medications

Kevin Leehey, M.D.
1200 North El Dorado Place
Building H, Suite 800
Tucson, AZ 85715
(520) 296-4280

MEDICATIONS FOR ATTENTION DEFICIT
HYPERACTIVITY DISORDERS

Medication Form Dose/Schedule Dose Range Onset/Duration Most Common
Side Effects Pro Precautions

METHYLPHENIDATE
Ritalin
Methylin
tablets
5 mg
10 mg
20 mg Usually given two or three times a day. Begin 5 mg early AM & noon. Child:
5-45 mg
Adoles:
10-60mg
Adults:
20-80mg onset: 30 min
duration:4 hrs max Decreased appetite, decreased sleep, less common: headaches, stomach aches, irritability, weight loss, tics, "rebound". Works quickly, effective often. The most studied. Little lab testing needed. Good safety history. Caution if history of tics or Tourette's or high blood pressure. Controlled substance. Must hand write all scripts, no refills, no call ins.

METHYLPHENIDATE-SR

RITALIN-SR

Metadate ER

Methylin ER

Concerta tablet
20mg SR

10mg ER
20mg ER

10mg ER
20mg ER

18mg
36mg Begin 20mg SR in AM, may need increase or noon dose. May need regular Ritalin to start in AM or extend duration to PM Child:
20-40 mg
Adoles:
20-40 mg
Adults:
20-80 mg onset: 30-60 min
duration: 5-8hrs Same as Ritalin Avoids noon dose, usually. Often works less well than alternatives. Same as Ritalin.

DEXEDRINE
Dextroamphetamine tablet (scored)
5mg
10mg Same as Ritalin Child:2.5-30 mg
Adoles:10-45 mg
Adults:10-60 mg onset: 30 min
duration: 4-5 hrs Same as Ritalin Stronger and longer effect than Ritalin. Some people do better with Dexedrine. Same as Ritalin
A few persons get "meaner" with Dexedrine.

DEXEDRINE - SR spansules
5mg
10mg
15mg Begin 5mg in early AM. May only need once a day. May need regular Dexedrine in AM to start effect early, or afternoon dose to extend effect in afternoon. Child:5-15 mg
Adoles:
10-30 mg
Adult:
10-40 mg onset: 30-60 min
duration: 6-10 hrs Same as Ritalin,
Less rebound in longer lasting medicines. Avoids noon dose, usually. Same as Ritalin
A few persons get "meaner" with Dexedrine.

ADDERALL
Dextroamphetamine
Amphetlamine tablet (scored)
5mg
10mg
20mg
30mg 1 or 2 times a day. Child:5-15 mg
Adoles:
10-30 mg
Adults:
10-40 mg onset: 30-60 min
duration: 4-8 hrs Expected to be same as Ritalin. Often once or twice a day. Another new option. Few good studies, but indirect knowledge of its components, Dexedrine and Amphetamine. This is proving to be a good option. Although approved since 1970 there are few studies. Is combination of two types of dextroamphetamine and two types of amphetamine. Precautions same as Ritalin. A few persons get "meaner" with Dexedrine.

CYLERT
Pemoline tablet
18.75 mg
37.5mg
75mg
(chewable)
37.5mg Begin 18.75 mg-37.5 mg one dose a day. Child:
18.75-37.5 mg
Adoles:
37.5-112.5 mg
Adults:
37.5-150 mg onset: 60-90 min
duration 8-16hrs Same as Ritalin One dose a day. Not abusable. Can call in and write for refills. Same as Ritalin. One in 10,000 risk of acute liver failure limits usefulness and requires blood testing. Slower effect. May take 2-4 weeks to work.

imipramine*<> tablets
10 mg
25 mg
50 mg
75 mg
100 mg Begin with evening dose.
Twice a day (AM and eve) may help ADHD more than once a day. Must take 7d/wk. Taper off when stopping.
child:25-100mg
Adoles: 50-150mg
Adults:100-300mg
onset: 1-2 hrs
duration: 6-24 hrs
Sedation, high heart rate, dry mouth, constipation, can worsen abnormal heart rate or glaucoma, or slow urination if enlarged prostate, fatigue, blurry vision An antidepressant. Does not cut appetite. Less chance of increasing tics. May also help depression, anxiety, bedwetting. Lasts better all day. More interactions, less precise (broader range of effects) than other options. Prevents migraines, helps chronic pain. Older, generic available. May not help attention as much as stimulants. May 1-2 weeks to help ADHD. Usually advise EKG and blood tests. Desipramine and possibly Imipramine associated with sudden cardiac death. May increase overheating especially in hot humid settings. Dangerous in overdose.

wellbutrin
Bupropion tablets
75 mg
100 mg
slow release
100 mg
150 mg Begin 37.5-75mg AM.
Usually 2 or 3 times /day
Must crush pill to split dose.
Must take 7 d/wk.
SR is 1 or 2 times/day. child:37.5-150mg
Adoles: 100-300 mg
Adults: 150-450 mg
onset: 45 min
duration: 4-8 hrs
SR lasts 6-12 hrs
Decreased appetite, increased energy, sometimes slower sleep onset. Also effective antidepressant. May need 1-3 weeks to build up. Recently approved to help stop smoking (lessens nicotine withdrawal). Avoid if seizure or eating disorder history. Should be given 2 or 3 times/day, SR is 1-2 times a day. May not help attention as much as stimulants. Must spread doses (5 to 6 hrs) and limit dose at any one time (150-200mg).

effexor
Venlafaxine tablet, scored
25 mg
37.5 mg
50 mg
75 mg
100 mg
XR 37.5, 75, 150 mg 2 or 3 times a day.
XR once daily (extended release) child: 18.75-200mg
Adoles:75-300 mg
Adults:150-375mg
onset: 45-60 min
duration: 4-8 hrs

XR lasts 12 hrs May increase or decrease energy, nausea, constipation, dry mouth. More vivid dreams may occur. Decreased sex drive or response occurs less than with other serotonin reuptake inhibitors (SRI).
Effexor increases both serotonin and norepinephrine thus affecting two important neurotransmitter systems, unlike other SRI's. May help attention deficit hyperactivity disorder (ADHD). An antidepressant that often helps anxiety also.
Slight risk increased blood pressure at doses over 200mg total a day (less than 5% chance).

tenex
Guanfacine tablets
1.0
2.0 Begin in evening. May need 3 times/day. No patch form.
Must take 7 d/wk. child: 0.5-4 mg
Adoles: 1.0-6mg
Adult:2.0-8mg
onset: 45-60 min
duration: 4-8 hrs
Less sedating than Clondine, but can cause sedation, sometimes (25%) nightmares. May lower blood pressure.
Less sedating than Clondine. Same other benefits. Can be given 2 or 3 times/day. May need 1-2 weeks to build up. Helps tics, hyperactivity. Does not cut appetite. Invented to treat high blood pressure.
May not help attention as much as stimulants. Do not stop suddenly, same as Clondine. May rarely have unexpected heart effects.

clondine<> tablets
0.1 mg
0.2 mg
Patch
(TTS-1/2/3) Begin in evening due to sedation. May need to build up to 4 times/day. Patch on skin lasts 5-7 days. Must take 7 d/wk. child: 0.1-0.5mg
Adoles: 0.1-0.6mg
Patch up to TTS-3 onset 30-45 min
duration: 3-5 hrs
patch 4-7 days duration Very sedating. May lower blood pressure, dizziness. Skin irritation common with patch. Helps tics. Helps severe hyperactivity and impulsivity. May need 1-2 weeks to build up. Does not cut appetite. Invented to treat hypertension. Has been used to treat opiate and/or nicotine withdrawal. Older, generic available. Avoid if serious depression. Partial effect on attention. Taper off slowly to avoid rebound hypertension or agitation. May rarely have unexpected heart effects.

Amantadine, Serzone, and Buspar are being evaluated for ADHD.
Simultaneous use of alcohol or cigarettes and especially street drugs should be avoided. All medications should be avoided if possible in pregnancy. This chart is intended to be a summary guide, not a full and complete list.
*- Desipramine (Norpramin) and Nortriptyline (Pamelor) are similar medications with similar use.

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Medication	Form	Dose/Schedule	Dose Range	Onset/Duration	Most Common Side Effects	Pro	Precautions
METHYLPHENIDATE Ritalin Methylin	tablets 5 mg 10 mg 20 mg	Usually given two or three times a day. Begin 5 mg early AM & noon.	Child: 5-45 mg Adoles: 10-60mg Adults: 20-80mg	onset: 30 min duration:4 hrs max	Decreased appetite, decreased sleep, less common: headaches, stomach aches, irritability, weight loss, tics, "rebound".	Works quickly, effective often. The most studied. Little lab testing needed. Good safety history.	Caution if history of tics or Tourette's or high blood pressure. Controlled substance. Must hand write all scripts, no refills, no call ins.
METHYLPHENIDATE-SR RITALIN-SR Metadate ER Methylin ER Concerta	tablet 20mg SR 10mg ER 20mg ER 10mg ER 20mg ER 18mg 36mg	Begin 20mg SR in AM, may need increase or noon dose. May need regular Ritalin to start in AM or extend duration to PM	Child: 20-40 mg Adoles: 20-40 mg Adults: 20-80 mg	onset: 30-60 min duration: 5-8hrs	Same as Ritalin	Avoids noon dose, usually.	Often works less well than alternatives. Same as Ritalin.
DEXEDRINE Dextroamphetamine	tablet (scored) 5mg 10mg	Same as Ritalin	Child:2.5-30 mg Adoles:10-45 mg Adults:10-60 mg	onset: 30 min duration: 4-5 hrs	Same as Ritalin	Stronger and longer effect than Ritalin. Some people do better with Dexedrine.	Same as Ritalin A few persons get "meaner" with Dexedrine.
DEXEDRINE - SR	spansules 5mg 10mg 15mg	Begin 5mg in early AM. May only need once a day. May need regular Dexedrine in AM to start effect early, or afternoon dose to extend effect in afternoon.	Child:5-15 mg Adoles: 10-30 mg Adult: 10-40 mg	onset: 30-60 min duration: 6-10 hrs	Same as Ritalin, Less rebound in longer lasting medicines.	Avoids noon dose, usually.	Same as Ritalin A few persons get "meaner" with Dexedrine.
ADDERALL Dextroamphetamine Amphetlamine	tablet (scored) 5mg 10mg 20mg 30mg	1 or 2 times a day.	Child:5-15 mg Adoles: 10-30 mg Adults: 10-40 mg	onset: 30-60 min duration: 4-8 hrs	Expected to be same as Ritalin.	Often once or twice a day. Another new option. Few good studies, but indirect knowledge of its components, Dexedrine and Amphetamine. This is proving to be a good option.	Although approved since 1970 there are few studies. Is combination of two types of dextroamphetamine and two types of amphetamine. Precautions same as Ritalin. A few persons get "meaner" with Dexedrine.
CYLERT Pemoline	tablet 18.75 mg 37.5mg 75mg (chewable) 37.5mg	Begin 18.75 mg-37.5 mg one dose a day.	Child: 18.75-37.5 mg Adoles: 37.5-112.5 mg Adults: 37.5-150 mg	onset: 60-90 min duration 8-16hrs	Same as Ritalin	One dose a day. Not abusable. Can call in and write for refills.	Same as Ritalin. One in 10,000 risk of acute liver failure limits usefulness and requires blood testing. Slower effect. May take 2-4 weeks to work.
imipramine*<>	tablets 10 mg 25 mg 50 mg 75 mg 100 mg	Begin with evening dose. Twice a day (AM and eve) may help ADHD more than once a day. Must take 7d/wk. Taper off when stopping.	child:25-100mg Adoles: 50-150mg Adults:100-300mg	onset: 1-2 hrs duration: 6-24 hrs	Sedation, high heart rate, dry mouth, constipation, can worsen abnormal heart rate or glaucoma, or slow urination if enlarged prostate, fatigue, blurry vision	An antidepressant. Does not cut appetite. Less chance of increasing tics. May also help depression, anxiety, bedwetting. Lasts better all day. More interactions, less precise (broader range of effects) than other options. Prevents migraines, helps chronic pain. Older, generic available.	May not help attention as much as stimulants. May 1-2 weeks to help ADHD. Usually advise EKG and blood tests. Desipramine and possibly Imipramine associated with sudden cardiac death. May increase overheating especially in hot humid settings. Dangerous in overdose.
wellbutrin Bupropion	tablets 75 mg 100 mg slow release 100 mg 150 mg	Begin 37.5-75mg AM. Usually 2 or 3 times /day Must crush pill to split dose. Must take 7 d/wk. SR is 1 or 2 times/day.	child:37.5-150mg Adoles: 100-300 mg Adults: 150-450 mg	onset: 45 min duration: 4-8 hrs SR lasts 6-12 hrs	Decreased appetite, increased energy, sometimes slower sleep onset.	Also effective antidepressant. May need 1-3 weeks to build up. Recently approved to help stop smoking (lessens nicotine withdrawal).	Avoid if seizure or eating disorder history. Should be given 2 or 3 times/day, SR is 1-2 times a day. May not help attention as much as stimulants. Must spread doses (5 to 6 hrs) and limit dose at any one time (150-200mg).
effexor Venlafaxine	tablet, scored 25 mg 37.5 mg 50 mg 75 mg 100 mg XR 37.5, 75, 150 mg	2 or 3 times a day. XR once daily (extended release)	child: 18.75-200mg Adoles:75-300 mg Adults:150-375mg	onset: 45-60 min duration: 4-8 hrs XR lasts 12 hrs	May increase or decrease energy, nausea, constipation, dry mouth. More vivid dreams may occur. Decreased sex drive or response occurs less than with other serotonin reuptake inhibitors (SRI).	Effexor increases both serotonin and norepinephrine thus affecting two important neurotransmitter systems, unlike other SRI's. May help attention deficit hyperactivity disorder (ADHD). An antidepressant that often helps anxiety also.	Slight risk increased blood pressure at doses over 200mg total a day (less than 5% chance).
tenex Guanfacine	tablets 1.0 2.0	Begin in evening. May need 3 times/day. No patch form. Must take 7 d/wk.	child: 0.5-4 mg Adoles: 1.0-6mg Adult:2.0-8mg	onset: 45-60 min duration: 4-8 hrs	Less sedating than Clondine, but can cause sedation, sometimes (25%) nightmares. May lower blood pressure.	Less sedating than Clondine. Same other benefits. Can be given 2 or 3 times/day. May need 1-2 weeks to build up. Helps tics, hyperactivity. Does not cut appetite. Invented to treat high blood pressure.	May not help attention as much as stimulants. Do not stop suddenly, same as Clondine. May rarely have unexpected heart effects.
clondine<>	tablets 0.1 mg 0.2 mg Patch (TTS-1/2/3)	Begin in evening due to sedation. May need to build up to 4 times/day. Patch on skin lasts 5-7 days. Must take 7 d/wk.	child: 0.1-0.5mg Adoles: 0.1-0.6mg Patch up to TTS-3	onset 30-45 min duration: 3-5 hrs patch 4-7 days duration	Very sedating. May lower blood pressure, dizziness. Skin irritation common with patch.	Helps tics. Helps severe hyperactivity and impulsivity. May need 1-2 weeks to build up. Does not cut appetite. Invented to treat hypertension. Has been used to treat opiate and/or nicotine withdrawal. Older, generic available.	Avoid if serious depression. Partial effect on attention. Taper off slowly to avoid rebound hypertension or agitation. May rarely have unexpected heart effects.