January 2003 - MEDICATION - PART ONE
This month’s newsnote as well as the next will give an overview of stimulant
medication used for ADD. This month I will review a group called the methylphenidates and
next month I will go into the amphetamines.
These groups have the same type of effectiveness and similar side effects. However,
they are chemically quite different and one may work better or have fewer side effects in
a specific individual. Which is better for the patient is often a matter of "trial
and error."
The flagship of the methylphenidate group is Ritalin, which has been in use for about
50 years and so is the best known.
Ritalin is a short acting drug, lasting about 3 to 4 hours in children and less in most
adults. This is also available in a generic form that is satisfactory for most people.
Recently an adaptation of the Ritalin molecule has been developed and is marketed as
Focalin. Focalin is supposed to have fewer side effects, though this is not yet clear.
Recently, long-acting forms of the methylphenidates have come to market. One practical
benefit is that school-children do not have to go to the nurse for a mid-day dose. In
addition, they may help the patient function better because there are no ups and downs in
blood levels and therefore the ability to focus is better sustained. Problems may include
more problems with appetite and perhaps sleep.
There are several long-term brands. Each is the same drug with a different delivery
system. This makes each one slightly different from the other. One is Concerta. This is a
brilliant high tech delivery system creating a medication that lasts 12 hours. Somewhat
shorter in duration is Metadate CD. This lasts 8 or 9 hours and it is my impression that
it may have fewer side effects than the others. In addition, it can be
"sprinkled" if a child cannot swallow a pill.
The most recent entry is RitalinLA. This is the same as Ritalin, but with a second dose
included in the long acting tablet. The duration of action is about 9 hours. It can also
be sprinkled if necessary.
Adults use the same medications, though doses may vary. Of course, the medication has
to be worked out for each individual, and this often takes some time. As always, consult
your physician with any questions.
