Kevin Leehey, M.D.
1980 E. Ft. Lowell Road, Suite 150 Tucson, Arizona 85719 (520) 296-4280 Fax: (520) 296-3835

MEDICATIONS FOR ATTENTION DEFICIT HYPERACTIVITY DISORDERS

Download PDF Version

methylphenidate based 
Medication Form Dose/Schedule Dose Range Onset/Duration Most Common
Side Effects
Pro Precautions
Methylphenidate (MPH)
Ritalin
Methylin
tablets IR
5, 10, 20 mg
chewable IR
2.5, 5, 10 mg
liquid IR
5 mg/5ml
10 mg/5ml
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: 15-20 min
duration:4 hrs max
Decreased appetite, decreased sleep, less common: headaches, stomach aches, irritability, weight loss, tics, "rebound".  Can overstimulate or make too calm if dose is too strong. These are true for all stimulants listed on the first two charts











Same as above.
EVERY MEDICINE ON THIS TABLE IS (MPH) METHYLPHENIDATE BASED

Methylphenidate is the generic name of all these. Works quickly, effective often. The most studied. Little to no lab testing needed. Good safety history. Methylin has no dye, is very small, and comes in grape chewable and liquid.
Focalin is a refined isomer form which may be better tolerated and smoother.

Caution if history of tics or Tourette's or high blood pressure or heart problems. Controlled substance. Must hand write all scripts, no refills, no call ins.  True for all stimulants listed on the first two charts

Some kids get "meaner" with stimulants, especially amphetamines listed on second chart.
Focalin (dexmethylphenidate)

Focalin XR
tablets IR
2.5, 5, 10mg

Focalin XR comes in 5, 10, 15, 20, 25, 30, 35, 40mg
    Focalin: 4-5 hrs.


Foclin XR: 8 hrs.
methylphenidate-SR

Ritalin-SR

Methylin ER

Metadate ER
tablets
10mg  SR
20mg  SR


10mg ER
20mg ER
Begin 10 or 20mg SR in AM, may need increase or noon dose. May need regular Ritalin to start in AM or extend duration to PM.  All 4 of these are time release capsules. Child:
10-40 mg
Adoles:
20-40 mg
Adults:
20-80 mg
onset: 30-60 min
duration: 5-8hrs
These are longer lasting versions of methylphenidate. Avoids noon dose, usually. Concerta is a methylphenidate in a clever osmotic pressure release mechanism pill. Metadate CD uses a third mechanism to extend the duration and smooth the effect of methylphenidate. Metadate CD,  Ritalin LA, Aptensio XR, and Focalin XR  capsules can be pulled apart and sprinkled on food. Quillivant is a time release liquid while Quillichew is  a chewable time release pill.  Daytrana is a skin patch.

Metadate CD is 30% IR + 70% ER
Ritalin LA is 50% IR + 50% ER
Concerta ER 18, 27, 36, 54mg Once a day in AM. Child: 18-27mg
Adoles: 27-54mg
Adult: 36-72mg
onset: 15-30 min
duration: 8-10 hrs.
Metadate CD



Ritalin LA
10, 20, 30, 40, 50, 60mg CD capsule

10, 20, 30, 40mg capsules
These 2 are time release capsules.

Start 10-20mg AM
Give once a day in AM
Max is 60mg/d
Child: 10-40mg
Adoles: 20-40mg
Adult: 20-60mg

onset: 30 min.
duration: 6-8 hrs.
Quillivant XR





Quillichew ER

Liquid suspension
25mg/5ml
(5mg/1ml)

Chewable tablets
10, 20mg scored
40mg is not scored





Once a day in AM
10-20 mg start
10mg/d = 2 ml
20mg/d = 4 ml
30mg/d = 6 ml
40mg/d = 8 ml
50mg/d = 10 ml


Child: 10-40mg
Adoles: 10-60mg
Adult: 10-60mg

onset: 30 min
duration: 8-12 hrs.




onset: 30-60 min
duration: 8-12 hours




Same as above.
The only time release liquid stimulant.






The only chewable extended release ADHD med.
Releases biphasic 30% IR + 70% ER
Comes as powder in bottle, add water, shake vigorously before each use. Refrigerate. Use dropper to measure.

Brand only - 2014


New formulation 2016
Brand only
Aptensio XR capsule 10, 15, 20, 30, 40, 50, 60mg Once a day in AM
Start 10 mg
Child: 10-40mg
Adoles: 10-60mg
Adult: 10-60mg
onset: 30-45 min
duration: 8-12 hours
Same as above. Another capsule option. Can be sprinkled on food. 40% immediate (IR) and 60% delayed release. New 2016
Brand only
DAYTRANA
(methylphenidate
transdermal system)
patch
10, 15, 20, or 30 mg/9 hours
One patch per day to hip in early a.m. Remove after 6 to 12 hours - 9 hours is advised. Child: 10-20mg
patch
Adoles: 15-30mg
patch
Adult: 15-30mg

onset: 2 hours
duration: 1-2 hours after patch removed

Same as above plus patch may irritate skin.

Although not designed to be cut, patch can be cut to lessen dosage.
Avoids oral dosing. Should cover school day and longer. Duration can be adjusted by time patch is put and removed. May be smoother.
Patch can be removed early to shorten duration.

Slow onset.
Patch may come off accidentally.
Patch may rarely lastingly discolor skin. Even low dose patch may be too strong for a child.
Brand only.


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.

amphetamine based
Medication Form Dose/Schedule Dose Range Onset/Duration Most Common
Side Effects
Pro Precautions
DEXEDRINE
(dextroamphetamine)
tablet (scored) IR
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 (MPH) - see 1st chart Stronger and longer effect than Ritalin (MPH). Some people do better with amphetamines. Generic available.

Avoids noon dose, usually. Generic available.

IR Usually once or twice a day. Two doses usually cover a whole day. The XR form should cover the whole school day but may require an after-school IR boost. The XR capsule can be opened and sprinkled on food. Generics are available. Adderall is the most abused stimulant.
25% L and 75% D - amphetamines
Stimulants, especially amphetamines, can help narcolepsy.
Precautions same as Ritalin (MPH) but more so regarding growth, heart, blood pressure, tics, speedy, agitation, anger and abuse.

Inappropriately, I believe, all amphetamines are FDA approved down to age 3, while milder MPH is only approved down to age 6.

Adderall is combination of two types of dextroamphetamine and two types of amphetamine.

Adderall is the most abused.  Adzenys and Evekeo have similar potential as they are also combinations of both amphetamine and dextroamphetamine.

Approved use as diet or binge eating treaments is questionable to me.

DEXEDRINE - SR spansules SR
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: 6-8 hrs
Same as MPH - see 1st chart
Less rebound in longer lasting medicines.
ADDERALL
dextroamphetamine and
amphetamine


ADDERALL-XR
tablet (scored)
5, 7.5, 10, 12.5, 15, 20, 30mg IR

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

1 or 2 times a day.
XR may be once a day.
Child: 5-30 mg
XR 10-20mg
Adoles:
10-40 mg
XR 10-30mg
Adults:
10-50 mg
XR 10-30mg
IR onset: 30 min
duration: 4-6 hrs

XR onset: 30-60 min
duration: 8-10 hrs

Similar to MPH. - see 1st chart
EVEKEO
D and L amphetamine sulfate
tablet (scored)
5, 10mg IR
once to twice or rarely 3 times a day Child: 2.5 - 20mg
Adoles: 5-30mg
Adult: 5-40mg
onset: 30 min.
duration: 4-6 hrs
Similar to MPH - see 1st chart
Same as Adderall IR
Very similar to Adderall IR tablets.
Is a 50/50 racemic mix of L and D amphetamine.
New in 2016.  Brand
ADZENYS XR ODT
orally disintegrating tablet
D and L amphetamine
tablet: 3.1, 6.3, 9.4, 12.5, 15.7, 18.8mg XR Once a day in AM
Start 3.1 to 6.3 based on age and weight.
Child: 3.1 - 9.4
Adoles:3.1 - 18.8
Adult: 3.1 - 18.8
onset: 30-60 min
duration: up to 12 hours
Similar to MPH - see 1st chart
Same as Adderall XR
This is equivalent to Adderall XR and is the only orally disintegrating ADHD med. New 2016. Brand
DYANAVEL XR
oral suspension
D and L amphetamine
liquid suspension
2.5 mg/ml
(1 ml = 1 cc)
Once a day in AM
Start 2.5 mg
Max 20 mg
Child: 2.5-10mg
Adoles: up to 20mg
Adult: up to 20mg
onset: 30-60 min
duration: up to 12 hours
Similar to MPH - see 1st chart
Same as Adderall XR
This is simply an Adderall like mixed amphetamine XR option in a liquid form.
Does not need refrigeration.  Comes ready mixed, shake before using.
New 2016. Brand
VYVANSE
(lisdexamfetamine)
capsule
10, 20, 30, 40, 50, 60, 70 mg XR
Once a day in AM Child: 10-50mg
Adoles: 20-70mg
Adult: 20-70mg
onset: 30-45 min
duration: 8-12 hrs
Similar to MPH - see 1st chart Longer duration. Capsule can be opened and sprinkled on food. Pro - drug avoids IV and snorting routes of abuse. Brand only.  May be gentlest amphetamine.


non-stimulants

Medication Form Dose/ Schedule Dose Range Onset/ Duration Most Common Side Effects Pro Precautions
Strattera
(atomoxetine)
capsules
10, 18, 25,40, 60, 80, 100mg
Once or twice daily. Start in AM. Give evening if sedation. Based on weight, 0.5 to 1.5mg/kg, target 1-1.4 mg/kg onset 30-60 min
duration: 5-8 hrs,
steady state
Stimulant side effects but milder (see Ritalin); plus sedation, nausea possible. Increases norepinephrine (NRI) stimulant-like action but lasts all day. Not a controlled substance. No direct dopamine effect so may be better tolerated. Takes 2 to 4 weeks for maximum effects. Must be taken 7 days a week. Only available as brand.
Tenex
(guanfacine)







Intuniv
(guanfacine ER)
tablets
1.0 mg
2.0 mg






tablets
1, 2, 3, 4 mg
Begin in evening. May need 3 times/day. No patch form. Must take 7 d/wk.





Intuniv usually AM, once a day
child: 1.0-5.0mg
Adoles: 1.0-4mg
Adult:2.0-6mg
onset 30-45 min
duration: 4-8 hrs
Less sedating than Clonidine, but can cause sedation, sometimes (25%) nightmares. May lower blood pressure.

Intuniv is once a day in AM, longest duration, least sedating, often smoother and is a new brand.
Less sedating than Clonidine. 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. Generic available. Will not help attention as much as stimulants. Do not stop suddenly, same as Clonidine. May rarely have unexpected heart effects.
Catapres
(clonidine)




Kapvay
(clonidine ER)
0.1 mg
0.2 mg
Patch
(TTS-1/2/3)


tablets
0.1, 0.2mg
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.

Kapvay is usually AM.
May be given BID.
Adoles: 0.1-0.6mg
Patch up to TTS-3
duration: 3-5 hrs
patch 4-7 days duration
Very sedating. May lower blood pressure, dizziness. Skin irritation common with patch.

Kapvay is similar to Intuniv.
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.

Other options include imipramine, bupropion, amantadine, modafinil, pramipexole (Mirapex), donepezil (Aricept) and memantine (Namenda).
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.

(adhd_1.html)
(8/16)