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Clinician’s Corner: Non Stimulant Treatment of ADHD

About 20% of patients do NOT respond to, or cannot tolerate stimulants so we can explore some other options for treatment of ADHD:

    • Some antidepressants
      • Bupropion (Wellbutrin®) has the most efficacy for adult ADHD
    • Modafinil  (Provigil®)  functions as a stimulant for excess daytime sleepiness without the apparent severe side effects and withdrawal issues associated with the CII (amphetamines, methylphenidate) medications.
      • Warnings: watch for dermatologic and psychiatric reactions.
      • Do NOT use: not for use in children of any age

Best options for “tics” induced by amphetamine use

Background

About 20% of ADHD patients have a tic disorder. Stimulants may worsen tics, at least in some patients. Labeling of some stimulant medications contraindicates their use in patients with tics or Tourette’s syndrome. However, recent studies suggest that stimulants can be used safely in patients with tics, and do not always significantly worsen tic

Atomoxetine (Strattera®): ideal for patients with substance abuse history, tics, or failure on stimulants.

Warnings:

  • Atomoxetine increased the risk of suicidal ideation in short-term studies in children or adolescents with ADHD
  • Adjust doses down in patients receiving paroxetine (Paxil®) and fluoxetine (Prozac®)
  • May increase heart rate and blood pressure.
  • Frequently causes headache, insomnia and increased anxiety

Central Alpha Agonists:  May be a good choice for patients with tics or insomnia. Clonidine and Guanfacine may be useful in over aroused, easily frustrated, highly active, or aggressive individuals

  • Guanfacine extended release (Intuniv®): Causes sedation, fatigue and low blood pressure. Longer half-life and fewer side effects than clonidine.
  • Clonidine extended Release (Kapvay®) 0.1mg

Is an old blood pressure drug that works well, but causes a lot of drowsiness.

Theories for causing ADHD

Psychiatry Today Advisor (dated April 14, 2020) listed the following as potential causes for ADHD:

  • Journal of the American Academy of Child & Adolescent Psychiatry suggests low maternal levels of Vitamin-D can cause ADHD
  • Journal of Pediatrics- maternal obesity could contribute to ADHD.
  • JAMA Network Open: nonionizing radiation, a common exposure given its source in electric appliances, power lines, and wireless network infrastructure, could be another key risk factor in ADHD development

August Birthdays?

New England Journal of Medicine : https://www.nejm.org/doi/10.1056/NEJMoa1806828

Children with August birthdays who are sent to school with a September 1st cut off are more likely to be diagnosed and medicated for ADHD, due to immature behavior. There might be an age difference of one year in the same classroom between kids born in August versus September. The researchers analyzed data from a large insurance company to make this determination. Prescription data was also utilized.

Your Thompson Pharmacist is a great resource for helping you or your child with ADHD.  With electronic prescriptions most prescribers send the prescription directly to our pharmacy.  We’ll be glad to help you with all your prescription needs.  Go Ahead and ASK, at Thompson Pharmacy it’ ALL for YOU!