The following is a brief overview of the most common medications used in the UK for the treatment of ADHD. We do not endorse any of the following but do recognise the need for a description of these medications to enable those who have been diagnosed to make informed choices in the treatment they or their child receives.
For more information and also for details on other medications available outside the UK we recommend the Medication List on Taming The Triad by Margie Sweeney M.D.
Please note that the following is not intended to be a substitute for professional medical advice. It is only intended as a guide, purely for information only. Any medication or alteration of current medications should be discussed fully with your physician or other medical professional.
This is the generic name for one of the most common medications for ADHD - there are a number of brand names which are detailed below.
Cautions: mild hypertension (contra-indicated if moderate or severe)-monitor blood pressure; history of epilepsy (discontinue if convulsions occur); tics and Tourette syndrome (use with caution)-discontinue if tics occur; monitor growth in children (see also below); avoid abrupt withdrawal; data on safety and efficacy of long-term use not complete.
SPECIAL CAUTIONS IN CHILDREN: Monitor height and weight as growth retardation may occur during prolonged therapy (drug free periods may allow catch-up in growth but withdraw slowly to avoid inducing depression or renewed hyperactivity). In psychotic children may exacerbate behavioural disturbances and thought disorder.
Contra-indications: cardiovascular disease including moderate to severe hypertension, hyperexcitability or agitated states, hyperthyroidism, history of drug or alcohol abuse, glaucoma, pregnancy and breast-feeding - DRIVING. May affect performance of skilled tasks (e.g. driving); effects of alcohol unpredictable.
EVENING DOSE. If effect wears off in evening (with rebound hyperactivity) a dose at bedtime may be appropriate (establish need with trial bedtime dose)
This is licensed in the UK for the treatment of children - however Ritalin can be prescribed for adults, as it does not have a licence for adults it can only be prescribed through the individual doctors clinical judgement.
Ritalin is one of the stimulant drugs and is a derivative of amphetamine - when used correctly it is safe and effective.
Ritalin reduces hyperactivity and impulsiveness and increases the attention span.It is a fast absorbing medication and is usually absorbed within ½ hour reaching maximum effectiveness within 1 - 2 hours after 4 - 5 hours it has passed through the system.
There is no evidence that Ritalin can become addictive or the patient become dependant.Both of which usually return to normal within a short time but proper monitoring by a qualified ADHD aware doctor is essential
Less common side effects can include: -Tics, irritability, depression, tummy aches, headaches, nausea, dizziness, dry mouth and constipation.
These are mainly seen at higher doses and are not always attributed to the Ritalin. They should therefore be discussed with the doctor.
There is no evidence to suggest that Ritalin free holidays are necessary and certainly the idea of only using in school time is unnecessary.
Ritalin releases dopamine from the storage vessels.This is a new generic form of Methylphenidate which has just been brought out in the UK by UCB Pharma.
This medication is available in not only the 10mg tablet form but also in 5mg and 20mg tablets. This will eliminate the need for halving tablets.
The Effects and Side Effects are the same as Methylphenidate above.
The Slow Release form of Equasym, Equasym XL known as Metadate CD in the USA is available off licence in the UK. The Pharmacist would have to get in touch with Celltech who fax them a form which they can then fax back with the details and the medication is sent down the following day.
Equasym XL - MethylphenidateThis is a new generic form of Methylphenidate which has just been brought out in the UK by UCB Pharma.
This medication is available in 10mg, 20mg or 30mg capsules.
The Effects and Side Effects are the same as Methylphenidate above.
The Slow Release form of Equasym XL is known as Metadate CD in the USA.
ConcertaConcerta™ is an extended-release formulation of methylphenidate tablets for ADHD treatment which is designed to last throughout the day with just one dose. Methylphenidate is the most commonly prescribed medication for treating and managing ADHD. It has been used safely and successfully among children and adults for more than 25 years.
Concerta™ is now licensed and available in the UK (see our news item) via Janssen-Cilag, patient/carer orientated web-site..
Concerta™ is an integral part of a total treatment program that typically includes behavior modification and medication.
How does Concerta™ work? Concerta™ is designed to be taken just once a day in the morning, before a child leaves for school. The drug over-coat dissolves within one hour providing an initial dose of methylphenidate. The medication is then released gradually in a smooth pattern, improving attention and behavior throughout the day. The advanced system was designed to help a child maintain focus without in-school and after-school dosing. Due to its controlled release, Concerta™ minimizes the peaks and valleys-the fluctuating levels of medicine in the blood-associated with other medications when they are taken more than once per day.
Concerta™ is available in 18 mg and 36 mg tablets. It should be taken in the morning, with or without breakfast. Concerta™ tablets must be swallowed whole with the aid of liquid, such as water, milk, or juice. Concerta™ must not be chewed, divided, or crushed.
Concerta™ was developed by ALZA for Crescendo Pharmaceuticals. On August 1, 2000, the U.S. Food and Drug Administration approved the new drug application for Concerta™ for the treatment of ADHD. The product will be manufactured and marketed by ALZA. McNeil Consumer Healthcare will co-promote Concerta™ in the U.S. For more information see concerta.net
Side Effects In a controlled clinical study with patients using Concerta™, the most common side effects reported were headache(14%), upper respiratory tract infection (8%), stomachache (7%), vomiting (4%), loss of appetite (4%), sleeplessness (4%), increased cough (4%), sore throat (4%), sinusitis (3%), and dizziness (2%).
Who shouldn't use Concerta™ ? Concerta™ should not be taken by patients who: have significant anxiety, tension, or agitation, since Concerta™ may make these conditions worse; are allergic to methylphenidate or any of the other ingredients in Concerta™; have glaucoma, an eye disease; have tics or Tourette's syndrome, or a family history of Tourette's syndrome; are taking a prescription monoamine oxidase inhibitor (MAOI). Ordinarily, Concerta™ should not be administered to patients with preexisting severe gastrointestinal narrowing. Concerta™ should not be used in children under six years, since safety and efficacy in this age group have not been established.
Concerta™ should be given cautiously to patients with a history of drug dependence or alcoholism. Chronic abusive use can lead to marked tolerance and psychological dependence. (See Boxed Warning).
Strattera
Strattera, developed by Eli Lilly and Company (NYSE:LLY & UK), is the first licensed treatment for ADHD that is not a stimulant medication.
Strattera, a selective norepinephrine reuptake inhibitor, has a different pharmacologic mechanism than other currently approved ADHD treatments. It's not known precisely how atomoxetine reduces ADHD symptoms. Scientists believe it works by blocking or slowing reabsorption of norepinephrine, a brain chemical considered important in regulating attention, impulsivity and activity levels. This keeps more norepinephrine at work in the tiny spaces between neurons in the brain.
Side effects can include: Most people in clinical studies who experienced side effects were not bothered enough to stop using atomoxetine. The most common side effects in children and adolescents were decreased appetite, nausea, vomiting, tiredness and upset stomach. In adults, the most common side effects were problems sleeping, dry mouth, decreased appetite, upset stomach, nausea or vomiting, dizziness, problems urinating, and sexual side effects. For more information on the clinical studies click here
Check out our News Section for details of Strattera now having a UK license
December 22nd 2004 News Item: Lilly Announces Important Liver Safety Update to Strattera® Label
Ritalin S.R.Slow Release Ritalin is now available in the UK but it is not easy to get hold. The advantage of SR is it could remove the need for a mid-day dose at school, by allowing a slow released stream of medication into the system for about 6 hours, it does however take longer to get into the system to start with.
Be aware that Ritalin SR may not work for all.
Dexedrine (Dextroamphetamine Sulfate)Dexedrine affects the neurotransmitter Norepinephrine primarily, and secondarily Dopamine, which is significantly different than Ritalin, and can produce very different results for patients. Dexedrine is only similar to Ritalin in that the same type of side effects can occasionally be seen. Dexedrine also appears to stay in the blood longer than Ritalin reducing the frequency of the dose.
Dexedrine inhibits re-uptake of dopamine.A single entity amphetamine product combining the neutral sulfate salts of dextroamphetamine and amphetamine, with the dextro isomer of amphetamine saccharate and d, l-amphetamine aspartate.
A recent study in the U.S. which was published in the Journal of the American Academy of Child and Adolescent Psychiatry in May 2000, said: "Adderall(R) (mixed salts of a single-entity amphetamine product) is significantly more effective at reducing inattention, oppositional behaviour, and other symptoms of attention deficit/hyperactivity disorder (ADHD) than methylphenidate, an older ADHD treatment.
The study of 58 children with ADHD also found that the benefits of Adderall last longer than those of methylphenidate (which is sold under the brand name Ritalin(R)). In fact, 70 percent of patients taking a single morning dose of Adderall found significant improvement in ADHD symptoms, while just 15 percent of patients taking methylphenidate improved significantly with only one dose."
Side effects can include:
Cardiovascular: Palpitations, tachycardia, elevation of blood pressure. There have been isolated reports of cardiomyopathy associated with chronic amphetamine use.
Central Nervous System: Psychotic episodes at recommended doses (rare), overstimulation, restlessness, dizziness, insomnia, euphoria, dyskinesia, dysphoria, tremor, headache, exacerbation of motor and phonic tics and Tourette's syndrome.
Gastrointestinal: Dryness of the mouth, unpleasant taste, diarrhea, constipation, other gastrointestinal disturbances. Anorexia and weight loss may occur as undesirable effects when amphetamines are used for other than the anorectic effect.
Allergic: Urticaria.
Endocrine: Impotence, changes in libido.
See Shire Pharmaceuticals for more information.
Adderall XR is available on private prescription in the UK from Pharmarama. They stock Adderall XR 10mg, 20mg, 25mg & 30mg Capsules. They require a private prescription written by a UK registered doctor. They need this posted to them and they then dispense it and send them out for next day delivery. The price for Adderall XR is £9.50/Capsule.
FocalinImipramine helps with anxiety and depression and is used when stimulant medication fails to get a response or it not appropriate to be given. It is not as effective with the core ADHD symptoms.
Side effects can include:
dry mouth, constipation, rash, raised blood pressure, confusion, seizures, abnormal heart rhythms.
Only the first two are usually seen however this medication should be carefully monitored by the doctor and regular blood pressure and pulse checks should be made. Also if there is a concern EEG recordings can be taken.
Imipramine inhibits re-uptake of norepinephrine.Clonidine is an antihypertensive medication and is often used later in the day to help combat insomnia which can be caused by stimulant medication. Clonidine can help symptoms by: -
Decreasing impulsivity and hyperactivity, decreasing aggression, improving sleep.Clonidine should only be discontinued under proper guidence for gradual withdrawal to avoid any withdrawal symptoms.
Drug CombinationsIf certain medications help only some of the symptoms a combination of medications may be tried, but only in consultation with your physician or medical practitioner.
For example Tricylic Antidepressiants can help with depression but ADHD symptoms remain, Ritalin or Dexedrine can be used in conjunction to enable relief of all symptoms. Likewise Clonidine can be used to combat aggressive behaviour along with Ritalin or Dexedrine for the other ADHD symptoms.