ADHD Medications

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
Updated 09/10

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

methylphenidate
Ritalin
Methylin

Focalin (dexmethylphenidate)

Focalin XR
tablets
5 mg
10 mg
20 mg
chewable
2.5, 5,
10 mg
liquid
5 mg/5ml
10 mg/5ml

tablets
2.5, 5, 10mg

capsules
5, 10, 15, 20mg

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

Focalin: 5 hrs.

Foclin XR: 8 hrs.
Decreased appetite, decreased sleep, less common: headaches, stomach aches, irritability, weight loss, tics, "rebound". Methylphenidate is the generic name of all these. Works quickly, effective often. The most studied. Little 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. Controlled substance. Must hand write all scripts, no refills, no call ins.

methylphenidate-SR

RITALIN-SR

Methylin ER

Metadate ER

Metadate CD

Concerta

Ritalin LA

tablet

20mg SR

10mg ER
20mg ER

10mg CD
20mg CD
30mg CD
40mg CD
50mg CD
60mg CD
capsule

18, 27, 36, 54mg

10, 20, 30, 40mg
capsules 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 Child:
10-40 mg
Adoles:
20-40 mg
Adults:
20-80 mg onset: 30-60 min
duration: 5-8hrs
Concerta onset:
15-30 min
duration: 8-12 hrs Same as Ritalin These are longer lasting versions of methylphenidate. Avoids noon dose, usually. Concerta is new but may truly last all day; it 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. Both Metadate CD and Ritalin LA capsules can be pulled apart and sprinkled on food. Same as Ritalin. The SR form is less reliable.

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: 10-20 mg patch
Adoles: 15-30 mg patch
Adult: onset: 2 hours
duration: 1-2 hours after patch removed Same as Ritalin plus patch may irritate skin. Avoids oral dosing.
Should cover school day and longer.
Duration can be adjusted by time patch is put on and removed.
May be smoother. Same as Ritalin.
Slow onset.
Patch can be removed early or may come off accidentally.

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 amphetamines.

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. Dexedrine, Dexedrine SR and Adderall are amphetamines. Avoids noon dose, usually. Same as Ritalin
A few persons get "meaner" with amphetamines.

ADDERALL
dextroamphetamine
amphetamine
ADDERALL-XR tablet (scored)
5, 7.5, 10, 12.5, 15, 20, 30mg
capsules 5, 10, 15 20, 25, 30mg

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 onset: 30 min
duration: 4-8 hrs
XR onset: 30-60 min
duration: 6-10 hrs
Same as Ritalin. 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 boost. The XR capsule can be opened and sprinkled on food. A general regular Adderall (not XR) is available. Is combination of two types of dextroamphetamine and two types of amphetamine. Precautions same as Ritalin. A few persons get "meaner" with amphetamines. The most abusable of the group.
VYVANSE
(lisdexamfetamine) capsule
20, 30, 40, 50, 60, 70 mg Once a day in AM Child: 20-50 mg
Adoles: 30-70 mg
Adult: 30-70 mg onset: 30-45 min
duration: 8-12 hrs Same as Ritalin. Longer duration. Capsule can be opened and sprinkled on food. Pro - drug avoids IV and snorting routes of abuse. A few persons get "meaner" with amphetamines.

CYLERT
(Pemoline)

18.75, 37.5, 75mg
(chewable)
37.5mg Begin 18.75mg-37.5mg one dose a day. Child:18.75-37.5mg
Adoles:
37.5-112.5mg
Adults:
37.5-150mg onset: 60-90 min
duration: 8-16 hrs

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.

CYLERT (pemoline) is effective, once a day, not abusable, and convenient but has a rare but possibly severe chance of harming the liver. 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)

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
Updated 09/10

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

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:37.5-150mg
Adoles: 50-150mg
Adults:100-300mg
onset: 45 min
duration: 6-24 hrs;
builds up to steady state in blood 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 take 1-2 weeks to help ADHD. Usually advise EKG and blood tests. Desipramine and possibly Imipramine associated with rare sudden cardiac death. May increase overheating especially in hot humid settings. Dangerous in overdose.

Wellbutrin
(bupropion) tablet, scored
75 mg
100 mg
slow release
100 mg
150 mg
200 mg
150mg XL
300mg XL
Begin 37.5-75mg AM.
Usually 2 or 3 times/day
Must take 7 d/wk.
SR is 1 or 2 times/day.
XL is once daily in AM child: 18.75-200mg
Adoles: 100-300 mg
Adults: 150-450 mg
onset: 45-60 min
duration: 4-8 hrs
SR lasts 6-12 hrs,
steady state Decreased appetite, increased energy, sometimes slower sleep onset. Also effective antidepressant. May need 1-3 weeks to build up. Approved to help stop smoking (lessens nicotine withdrawal). Generic available. Less chance of increasing tics than stimulants. 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) except XL.

Tenex
(guanfacine)

Intuniv 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.

Usually AM 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.
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.

Intuniv is once a day in AM, longest duration, least sedating, often smoother and is a new brand. May not help attention as much as stimulants. Do not stop suddenly, same as Clonidine. May rarely have unexpected heart effects.

(clonidine) 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. 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. 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.

Strattera
(atomoxetine) capsules
18mg
25mg
40mg
60mg
80mg
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. Newest option and only available as brand.

Symmetrel
(amantadine) tablet (brand)
100mg
capsule
100mg
liquid
50mg/5ml
Twice daily. 100 to 300mg a day; varies with size onset: 30-60 min
duration:
up to 8 hrs
steady state Side effects are generally minor and uncommon. Nausea, dizziness, insomnia. Affects dopamine, not norepinephrine. Another alternative (like Strattera and Provigil) when stimulant effect is needed but stimulant not tolerated. Also helps Parkinson's disease and influenza. Not a controlled substance. Older, generic available. Benefit may wear off but stopping it for 2 to 4 days usually restores benefit. Usually taken 7 days a week.

Provigil
(modafinil)

Nuvigil
(armodafinil) tablets
100, 200 mg

50, 150, 250 mg Once daily in a.m. 100 to 400mg
(100 to 200 mg usual)

50 to 250 mg onset:
1 hour
duration:
12 hrs
steady state Can have stimulant like side effects though milder. Similar to stimulants but better tolerated. Benefits less than stimulants for ADHD. Good for narolepsy and alertness in sleep disorders. Not a controlled substance.

Nuvigil is longer lasting isomer. Only available as brand.
Rare hypersensitivity rash.

Serzone and Buspar may also partially help 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 uses.

(adhd_1.html)

Medication	Form	Dose/Schedule	Dose Range	Onset/Duration	Most Common Side Effects	Pro	Precautions
methylphenidate Ritalin Methylin Focalin (dexmethylphenidate) Focalin XR	tablets 5 mg 10 mg 20 mg chewable 2.5, 5, 10 mg liquid 5 mg/5ml 10 mg/5ml tablets 2.5, 5, 10mg capsules 5, 10, 15, 20mg	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 Focalin: 5 hrs. Foclin XR: 8 hrs.	Decreased appetite, decreased sleep, less common: headaches, stomach aches, irritability, weight loss, tics, "rebound".	Methylphenidate is the generic name of all these. Works quickly, effective often. The most studied. Little 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. Controlled substance. Must hand write all scripts, no refills, no call ins.
methylphenidate-SR RITALIN-SR Methylin ER Metadate ER Metadate CD Concerta Ritalin LA	tablet 20mg SR 10mg ER 20mg ER 10mg CD 20mg CD 30mg CD 40mg CD 50mg CD 60mg CD capsule 18, 27, 36, 54mg 10, 20, 30, 40mg capsules	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	Child: 10-40 mg Adoles: 20-40 mg Adults: 20-80 mg	onset: 30-60 min duration: 5-8hrs Concerta onset: 15-30 min duration: 8-12 hrs	Same as Ritalin	These are longer lasting versions of methylphenidate. Avoids noon dose, usually. Concerta is new but may truly last all day; it 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. Both Metadate CD and Ritalin LA capsules can be pulled apart and sprinkled on food.	Same as Ritalin. The SR form is less reliable.
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: 10-20 mg patch Adoles: 15-30 mg patch Adult:	onset: 2 hours duration: 1-2 hours after patch removed	Same as Ritalin plus patch may irritate skin.	Avoids oral dosing. Should cover school day and longer. Duration can be adjusted by time patch is put on and removed. May be smoother.	Same as Ritalin. Slow onset. Patch can be removed early or may come off accidentally.
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 amphetamines.
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.	Dexedrine, Dexedrine SR and Adderall are amphetamines. Avoids noon dose, usually.	Same as Ritalin A few persons get "meaner" with amphetamines.
ADDERALL dextroamphetamine amphetamine ADDERALL-XR	tablet (scored) 5, 7.5, 10, 12.5, 15, 20, 30mg capsules 5, 10, 15 20, 25, 30mg	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	onset: 30 min duration: 4-8 hrs XR onset: 30-60 min duration: 6-10 hrs	Same as Ritalin.	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 boost. The XR capsule can be opened and sprinkled on food. A general regular Adderall (not XR) is available.	Is combination of two types of dextroamphetamine and two types of amphetamine. Precautions same as Ritalin. A few persons get "meaner" with amphetamines. The most abusable of the group.
VYVANSE (lisdexamfetamine)	capsule 20, 30, 40, 50, 60, 70 mg	Once a day in AM	Child: 20-50 mg Adoles: 30-70 mg Adult: 30-70 mg	onset: 30-45 min duration: 8-12 hrs	Same as Ritalin.	Longer duration. Capsule can be opened and sprinkled on food. Pro - drug avoids IV and snorting routes of abuse.	A few persons get "meaner" with amphetamines.
CYLERT (Pemoline)	18.75, 37.5, 75mg (chewable) 37.5mg	Begin 18.75mg-37.5mg one dose a day.	Child:18.75-37.5mg Adoles: 37.5-112.5mg Adults: 37.5-150mg	onset: 60-90 min duration: 8-16 hrs	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.

Medication	Form	Dose/ Schedule	Dose Range	Onset/ Duration	Most Common Side Effects	Pro	Precautions
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:37.5-150mg Adoles: 50-150mg Adults:100-300mg	onset: 45 min duration: 6-24 hrs; builds up to steady state in blood	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 take 1-2 weeks to help ADHD. Usually advise EKG and blood tests. Desipramine and possibly Imipramine associated with rare sudden cardiac death. May increase overheating especially in hot humid settings. Dangerous in overdose.
Wellbutrin (bupropion)	tablet, scored 75 mg 100 mg slow release 100 mg 150 mg 200 mg 150mg XL 300mg XL	Begin 37.5-75mg AM. Usually 2 or 3 times/day Must take 7 d/wk. SR is 1 or 2 times/day. XL is once daily in AM	child: 18.75-200mg Adoles: 100-300 mg Adults: 150-450 mg	onset: 45-60 min duration: 4-8 hrs SR lasts 6-12 hrs, steady state	Decreased appetite, increased energy, sometimes slower sleep onset.	Also effective antidepressant. May need 1-3 weeks to build up. Approved to help stop smoking (lessens nicotine withdrawal). Generic available. Less chance of increasing tics than stimulants.	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) except XL.
Tenex (guanfacine) Intuniv	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. Usually AM	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.	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. Intuniv is once a day in AM, longest duration, least sedating, often smoother and is a new brand.	May not help attention as much as stimulants. Do not stop suddenly, same as Clonidine. May rarely have unexpected heart effects.
(clonidine)	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.	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.	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.
Strattera (atomoxetine)	capsules 18mg 25mg 40mg 60mg 80mg 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. Newest option and only available as brand.
Symmetrel (amantadine)	tablet (brand) 100mg capsule 100mg liquid 50mg/5ml	Twice daily.	100 to 300mg a day; varies with size	onset: 30-60 min duration: up to 8 hrs steady state	Side effects are generally minor and uncommon. Nausea, dizziness, insomnia.	Affects dopamine, not norepinephrine. Another alternative (like Strattera and Provigil) when stimulant effect is needed but stimulant not tolerated. Also helps Parkinson's disease and influenza. Not a controlled substance. Older, generic available.	Benefit may wear off but stopping it for 2 to 4 days usually restores benefit. Usually taken 7 days a week.
Provigil (modafinil) Nuvigil (armodafinil)	tablets 100, 200 mg 50, 150, 250 mg	Once daily in a.m.	100 to 400mg (100 to 200 mg usual) 50 to 250 mg	onset: 1 hour duration: 12 hrs steady state	Can have stimulant like side effects though milder.	Similar to stimulants but better tolerated. Benefits less than stimulants for ADHD. Good for narolepsy and alertness in sleep disorders. Not a controlled substance. Nuvigil is longer lasting isomer.	Only available as brand. Rare hypersensitivity rash.