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ADHD Treatment Options: Stimulants vs. Non-stimulants

Vyvanse. Ritalin. Strattera. Concerta. With so many choices, it can be difficult to choose the right medication for ADHD. A specialist in ADHD explains the difference between stimulants and nonstimulants.

What are the best ADHD medication treatments?

ADHD can be treated with a variety of medications. It is important to consider your own personal preferences when choosing the best medication for you or your child.

ADHD medication is prescribed to adults as well as children as young six-years-old.

ADHD stimulants are the first line treatment. This group includes amphetamines (the most common ADHD treatment) and derivatives.

Patients who are not able to tolerate stimulant medication or do not see its benefits can be prescribed nonstimulants (upto 30% of patients may not respond 2). For ADHD, four non-stimulants have been approved: atomoxetine, viloxazine (clonidine), guanfacine. Non-stimulants may be prescribed in conjunction with stimulants to treat symptoms that are not alleviated by the latter.

Many people ask, “How should I treat ADHD in my child?”

It is often possible to select the “best” ADHD medication through extensive trial and error. The patient’s medical background, genetics and side effects are usually taken into consideration. ADHD medications may be used in conjunction with other treatments such as behavioral therapy.

The most popular ADHD drugs for ADDitude’s readers are listed alphabetically:

Adderall (amphetamine) XR

Concerta (methylphenidate)

Dexedrine (amphetamine)

Evekeo (amphetamine)

Focalin XR (dexmethylphenidate)

Quillivant is a methylphenidate.

Ritalin (methylphenidate)

Strattera (atomoxetine Hydrochloride)

Vyvanse (lisdexamfetamine dimesylate)

Azstarys (serdexmethylphenidate and dexmethylphenidate)

The differences and similarities between these treatments can confuse parents and adults with ADHD. This ADHD medication chart compares stimulants and non-stimulants to treat ADHD.

What are the newest ADHD medications?

Qelbree is a non-stimulant that will be approved in 2021 to treat ADHD in children and adults.

Azstarys is a central nervous stimulant that can be taken by patients six years and older once daily. It will be approved for ADHD treatment in 2021.

As soon as the patient wakes up, the medication begins to work. The medication continues to work through the rest of the evening.

Xelstrym has been approved by the FDA since March 2022. The patch is an amphetamine transdermal that can be applied once daily for ADHD.

What is the effect of stimulant medication on ADHD?

ADHD is a condition that occurs when there are not enough neurotransmitters or neurotransmitters of certain types in the brain. Chemicals called neurotransmitters bridge the gap between nerve cell to transmit signals.

ADHD patients often lack norepinephrine, and its two components, dopa, and dopamine. It is believed that the primary stimulant medications used to treat ADHD stimulate brain cells to produce this neurotransmitter. Although these medications are called stimulants, it is unclear how they alleviate ADHD symptoms.

Since the 1930s two stimulant classes are in common use: dextroamphetamine and methylphenidate. All stimulants that are sold under different brand names are variations on these medications. Adderall is dextroamphetamine. Methylphenidate is available in a variety of forms including a liquid or skin patch.

What are non-stimulants used to treat ADHD?

In theory, the SNRIs Atomoxetine, Viloxazine and Qelbree work by increasing norepinephrine and dopamine in the prefrontal cortex, which is believed to reduce ADHD symptoms.

Clonidine (Kapvay), and guanfacine are both alpha2-agonists. According to the dominant theory, these drugs mimic norepinephrine’s effects on receptors located in the prefrontal cortex. 1

Bupropion, also known as Wellbutrin, is an antidepressant that’s commonly prescribed by doctors.

What is the mechanism of action of ADHD medication?

In addition to other requirements, the FDA requires that all medications are labeled with their 5.

Dosage form/route: tablet, liquid or patch. You can find out how much liquid medication is in each unit on the patient information sheet that comes with your medication. Example: 5mg for 5ml. Daytrana, another methylphenidate skin patch that releases medicine into the bloodstream via the skin. Daytrana 30mg patch releases 3.3mg of methylphenidate per hour. It contains 30mg.

Dose Quantity/Strength : The amount released into the bloodstream by medication over time. In other words, the number value for each product represents the total amount of the drug in the tablet/liquid/capsule/patch, not the amount in the blood at any one time. If methylphenidate was taken in a four-hour tablet and released 5mg over that time, then the product would be called methylphenidate. Adderall is a capsule which releases 10mg immediately and another 10mg four hours later.

Release Mechanism/Duration: (released immediately or over a long period of time). Duration of time a drug remains active and available. Stimulants may release their drugs over a period of time, including an hour, four or eight hours, and even over 12 hours. Ritalin’s manufacturer claims that the tablet immediately releases the drug into the bloodstream. The tablet can last up to four-hours. Ritalin LA comes in capsules that are released gradually. It lasts for eight hours. Both products contain the same medication methylphenidate.

Even FDA guidelines can cause confusion when it comes to ADHD medications. Take the ADHD medication Concerta. Concerta has a 12-hour duration. The sponge is on the bottom of the capsule, with the medication on the top. A small hole is above. As the capsule passes through the gastrointestinal tract, the sponge expands and absorbs water. This forces the drug out of the area.

The numbering of each dose is confusing. Take Concerta (18mg). The capsule must have 15mg if you want 5mg released every 4 hours for 12hrs. The sponges take a long time to become sufficiently moist to expand. It is important to release the medication slowly at first, until the sponge starts working. Researchers found that 3mg was the perfect amount. You need 3mg to start, plus 5mg every four hours. The total dosage is 18mg. Concerta 18 is another name for the medication.

What are the side-effects of ADHD medication

The side effects of stimulant medications are similar in general.

Reduced appetite

stomach pain

sleep disturbances

Headaches

Non-stimulants have a number of side effects.

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stomach pain

Reduced appetite

nausea

After adjusting stimulant medications, patients often experience side-effects. Doctors may increase the dosage if a patient does not see any benefits, or if side effects can be tolerated. Once the patient adjusts, most side effects will disappear. The American Academy of Pediatrics states that clinicians should titrate ADHD medications to achieve maximum benefit with acceptable side effects.

If the adverse reactions persist, the clinician can switch to a non-stimulant or another stimulant.

List of ADHD stimulants

Methylphenidate

Generic: immediate release tablet lasting for approximately four hours. Available in 10mg or 15mg.

Aptensio® XR: Brand name, capsules with immediate and prolonged release. Lasts 12 hours. Available in 10mg, 15mg, 30mg, 40mg or 50mg.

Concerta is an branded tablet that will last 12 hours. The 18mg and the 27mg doses are available. There are generic equivalents available*

Cotempla(r), XR-ODT : Brand name of extended-release oral disintegrating tablets; available in dosages of 8.6mg, 17.3mg, 25.9mg, and 34.6mg

Daytrana, a skin patch with a brand name, lasts eight hours. It is available in both 10mg or 15mg. There are generic equivalents.

Jornay is the brand name of delayed-release extended release capsules. Available in 20, 40, 60, 80 and 100mg.

Dextro-Methylphenidate

Focalin, a brand name tablet, lasts four hours. The dosages are 2.5mg or 5mg. Generic alternatives are available.

Focalin: Brand name, capsules, lasting 8 hours. Immediate release followed by delayed release. Available in 5mg. 10mg. 15mg. 20mg. 25mg. 30mg. 35mg. Generic equivalents available.

Serdexmethylphenidate and Dexmethylphenidate

Azstarys, a capsule brand name that lasts 13 hours. It is co-formulated with an immediate release. Available in three different strengths: 26mg/5.2mg*, 39.2mg/7.8mg*, and 52.3mg/10.4mg*

Dextro-Amphetamine/Modified Amphetamine Mixture

Generic tablet that releases immediately. Four-hour duration. Available in both 10mg or 5mg.

Adderall is a brand name, tablet with immediate release that lasts for 4 hours. Generic equivalents in 5mg, 7.5mg, 10mg, 12.5mg, 15mg, 20mg, and 30mg are available*

Adderall XR : brand name capsules, immediate release or delayed release; lasts for 8 hours; comes in 5mg and 10mg. Generic equivalents are also available*

Adzenys is the brand name for extended-release oral solution. 3.1mg/2.5mL; 6.3mg/5mL; 9.4mg/7.5mL; 12.5mg/10mL; 15.7mg/12.5mL; 18.8mg/15mL

Adzenys XR-ODT: brand name; orally-disintegrating tablet; immediate and delayed release; lasts up to 12 hours; comes in 3.1mg, 6.3mg, 9.4mg, 12.5mg, 15.7mg, and 18.8mg*

Dexedrine Spansule: 15mg capsules, immediate release with gradual release. Lasts for 8 hours. Generic equivalent also available.

Dyanavel XR : extended release liquid tablet, lasts 13 hours. Available in 2.5mg/1mL, 5mg/2mL, 10m/4mL, 12.5m/5mL 15mg/mL 17.5m/7mL 20mg/8mL*

Evekeo, a brand name tablet with an immediate release. The tablet lasts four hours, and is available in either 10mg or 5-mg.

Evekeo ODT, a brand of immediate-release tablets that disintegrate orally, is the name. There are five strengths available: 5mg. 10mg. 15mg. and 20mg.

Brand name Mydayis. Available in 25mg, 12.5mg, and 50mg.

Brand-name liquid with immediate release. Four-hour duration. Available in 5mg/5mL.

Vyvanse : Brand name, chewable tablet or capsule that lasts 10-12 hours. Available in 20mg/30mg/50mg/60mg/70mg/80mg/capsules*

Xelstrym, a brand of transdermal patches, comes in five strengths: 5, 9, 13.5, and 18 mg.

Brand name Zenzedi. Available in 25mg and 5mg. Also available in 10mg. 15mg. 20mg. 30mg. The generic equivalents in 10mg, 5mg, and 30mg are also available.

ADHD Medication: Non Stimulants

Atomoxetine

Strattera, a brand-name capsule with a 24-hour duration and a 10mg to a 100mg dosage, is available in a range of strengths.

Clonidine

Generic equivalents come in 0.1mg and 0.2mg.

Guanfacine

Intuniv : extended-release tablets in 1mg and 2mg dosages; duration of 24 hours; generic equivalents available*

Viloxazine Hydrochloride

Qelbree – Brand Name: 100mg or 200mg per day.

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