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Clinician’s Corner: TREATMENT of ADHD

Amphetamines and Methylphenidate: According to the AAP (American Academy of Pediatrics) at least 80% of ADHD patients will respond positively to stimulants if used in a systematic fashion. 69.3% of kids with diagnosed ADHD take medication.

Psychostimulants are considered first line agents for ADHD, unless the patient has a history of:

  • substance abuse
  • bipolar disorder
  • active psychotic disorder.

The use of ADHD drugs is on the rise as more adults are being diagnosed with ADHD.

ADULTS: 4.4% of adult population is diagnosed with ADHD, although believed to be higher.  There is an 85% risk of adult ADHD if diagnosed as a child.

Considerations before prescribing amphetamines/ methylphenidate:

  • Stimulants increase blood pressure by 3 to 4 mmHg and heart rate by 1 to 2 beats per minute, on average, in children and adolescents.
  • In adults, they can increase systolic blood pressure by about 5 mmHg. These effects raise concern that stimulants may increase the risk of cardiovascular events
  • A weekend drug holiday might be effective for managing insomnia or appetite suppression; may also be tried to reduce effect on growth, especially in patients with a family history of short stature.
  • Stimulants and atomoxetine are unlikely to increase stroke, heart attacks, or sudden death. Still avoid them in patients with serious heart problems, or if blood pressure or heart rate increase would be a problem. Adderall was temporarily removed from the Canadian market due to these adverse effects
  • Regardless of chosen medication, monitor heart rate, blood pressure, height, and weight.
  • Cases of painful and prolonged penile erections and priapism have been reported with methylphenidate products
  • Tolerance to stimulants unlikely. Plateau effect after first week is not tolerance.
  • Stimulant dose based on weight, disease severity, and target symptoms (hyperactivity may require higher doses than inattentiveness).
  • Long-acting medications just as effective as shorter-acting agents. Long-acting agents usually preferred for convenience and to minimize breakthrough symptoms, irritability, and headache.
  • Common side effects include anorexia, abdominal pain, insomnia, and headache.
  • Rarely, stimulants may cause psychotic symptoms such as hallucinations. Final adult height might be decreased by less than an inch

BENEFITS of TREATMENT

Treatment of ADHD with stimulants and psychotherapy has been shown to decrease disruptive behaviors and improve academic performance, self-esteem, cognition, and personal relationships. In addition, it has been reported that ADHD children treated with stimulant therapy during childhood are at lower risk for drug and alcohol abuse when they are older than those who are not treated.

REASONS TO STOP TREATMENT

  • Hallucinations
  • Delusions
  • Paranoia
  • Aggression
  • Cardiovascular adverse event

There are at least 15 different forms of methylphenidate (Ritalin) or mixed amphetamine (Adderall) that are available by prescription at Thompson Pharmacy.  Unfortunately, the insurance companies dictate which formulation is covered for our patients.  Your Thompson Pharmacist will work with your physician in getting you the most effective treatment for your patient’s ADHD.  These drugs are in Schedule-2 and must be e-prescribed, or in rare case written on a paper prescription blank.  There can be no refills, and your physician must send (or write) a new order each month.

Make sure to check the security of your home if you have these drugs prescribed for a family member.  These pills should be well hidden, and best kept in a lock box. We’re here to help your family members get the most out of therapy, Go Ahead and AS… at Thompson Pharmacy it’s ALL for YOU!!