Complete Guide to ADHD Medications

Complete Guide to ADHD Medications

For children with attention deficit hyperactivity disorder, or ADHD (ADHD), it is tough to focus on tasks, pay attention, sit still, and control impulsive behavior. Stimulant medications are the most effective treatment for reducing these symptoms. In this guide, you’ll learn how ADHD medications work, how different types of medication might affect your child, and what side effects your child might experience.

ADHD medication

Stimulants are the best type of medication used to treat ADHD and the most common. There are only two stimulant medications: methylphenidate (the active ingredient in Ritalin, Concerta, and other formulations) and amphetamine (the active ingredient in Adderall, Vyvanse, and different formulations). Both medications are available in rapid-release and extended-release formulations.

Both drugs (methylphenidate and amphetamine) are equally effective and have the same benefits and risks. While most people will respond equally well to either medication, some people respond better to one than the other. Typically, if you start treatment with one of these drugs and it doesn’t work well or can’t tolerate it, you should probably try the other drug.

Medications with methylphenidate

Ritalin is a rapid-release formulation of methylphenidate that lasts 3-4 hours. Focalin is another form of methylphenidate that also lasts about 4 hours. Both medications start to work (or “work”) about 30 to 45 minutes after taking them. This medication can be crushed and mixed with food for children who have trouble swallowing pills. There is also a liquid and a quick-release chewable tablet form of methylphenidate.

Other methylphenidate preparations have been created to release the drug over a more extended period, extending the duration of the drug’s effect. This is incredibly beneficial when providing an outcome that lasts as long as a school day (typically 6-8 hours). Some of these compounds start to work as quickly as quick-release medications. These compounds include:

  • Concerta is one of the longest-release methylphenidate medications, lasting between 8-12 hours. Concerta cannot be chewed or opened. It has to be swallowed whole to work the way it was designed. This can be a problem for some children.
  • Ritalin-LA and Metadate CD are capsules that are filled with medication. These drugs are very similar in duration: about 6-8 hours. The great thing about this is that the tablet can be opened for children who cannot swallow pills and the medicine sprinkled on food (for example, yogurt, Nutella, applesauce, etc.).
  • Aptensio XR and Focalin XR are medicine-filled capsules that can be opened and mixed with food. They usually last longer than Ritalin LA or Metadate CD.
  • Quillivant XR is an extended-release formulation of methylphenidate in liquid form, making it a good alternative for children who have trouble swallowing capsules and cannot tolerate the microspheres in the pills. The liquid formula may also allow more precise dose adjustment or “titration.”
  • Quillichew ER is an extended-release chewable formula of methylphenidate that can last up to 8 hours.
  • Daytrana is a methylphenidate patch. This is another option for children who cannot swallow pills. The patch can be worn for up to 9 hours and get another hour of response after the patch has been removed. However, the patch can often take 1 to 2 hours to start working.

Medications with amphetamines

Adderall, Evekeo, Zenzedi, and Dexedrine are fast-release forms of amphetamines, taking effect around 30-45 minutes after ingestion and adequate for 3-4 hours. Amphetamines tend to be slightly more potent than methylphenidate and last longer, but overall the effects are similar to methylphenidate.

As with methylphenidate, some amphetamine preparations have been created to release the drug over a more extended period, extending the duration of the drug’s effect. This is of great benefit when trying to provide a response lasting a school day (typically 6-8 hours). Some of these compounds work as quickly as the fast-release forms of these drugs. These compounds include:

  • Adderall XR is the longer release form of Adderall and was designed to be effective for 10-12 hours. Like Metadate CD and Ritalin LA, Adderall XR is a microbead capsule that can be opened and mixed with food.
  • Vyvanse is an amphetamine plus an additional compound called lysine, which attaches to the amphetamine creating an extra step the body has to go through to activate it. Vyvanse can last for a long time, up to 14 hours, but it may take a little longer in the morning to start working.
  • Dexedrine Spansule is the extended-release form of Dexedrine and typically lasts 6-8 hours.
  • Dynavel XR is an extended-release liquid form of amphetamine. It can have an effect that lasts up to 10-12 hours.
  • Adzenys XR-ODT is a tablet that dissolves in the mouth and does not need to be swallowed. It has a similar duration of response as Adderall XR.

Potential Benefits

These medications can reduce the troublesome symptoms of ADHD. Therefore, children tend to be less hyperactive, impulsive, more focused, and less distractible when drugs work. However, these medications do not treat any learned behavior or other learning problems.

Side Effects of ADHD Medications

loss of appetite

This is the most common side effect of these medications. Loss of appetite occurs when the drugs are working and gradually recovers as the benefits of the medication wear off. Children can be starving when the medicine wears off, and if they haven’t eaten, they can also be irritable and moody. This is usually a manageable problem, but we suggest discussing it with the prescribing doctor.

sleeping problems

Children taking this medicine may have trouble falling asleep. This is usually a mild change and tends to occur more in younger children who may have had trouble sleeping before taking medication.

Many things can interfere with sleep. So it’s also essential to find out if any of those things are present (worry about school or friends, too much screen time before bed, etc.) when the effects of the medication are being evaluated.

Trouble falling asleep can sometimes get better over time and can be improved by changing the time or type of medicine given. For example, if a child is taking a quick-release formula, it may mean that she is taking a second or third dose too late in the day so that she has not worn off before bedtime.

Increase

Despite the concerns that have been expressed regarding growth and stimulants, a well-conducted recent clinical study showed that neither ADHD nor stimulant treatment is associated with a change in growth velocity in children during the growth period. Maximum growth or final height when they become adults. Combined with other studies, it seems clear that stimulant treatment has little or no impact on development.

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By Michael Caine

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