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February 2003 - MEDICATION - PART TWO
THE AMPHETAMINES
This month's Newsnote is the second and final of an overview of stimulant medications
used for ADD.
As I mentioned last month, there are two primary stimulant groups, amphetamines and
methylphnidates. 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. In the January Newsnote I discussed
methylphenidate so the current focus will be on the amphetamines.
The medications that are in this group are divided into two sub-groups,
Dexedrine and Dexedrine Spansules and Adderall and AdderallXR.
The Dexedrine group is generally used less often, perhaps because no company is
actively marketing the drug to consumers. However, it is effective, available as a branded
generic known as Dextrostat, and reasonably priced.
I often use Dexedrine in a 5 mg. dose when I start to work with medication in an adult
with ADD. I like this approach because Dexedrine lasts about 4 hours and gives a good idea
of how the individual will respond and at what dose. In many adults, Ritalin lasts only an
hour or two, which I feel makes it less useful at least initially. I do like the longer
acting forms of both medications, but only after I have established the correct dose with
the short acting form.
Dexedrine comes in a spansule form, which lasts about six hours. Frequently a short
acting tablet and a spansule work well in combination.
Several changes to the dextroamphetamine molecule lead to the formation of Adderall.
Adderall is a good medication and lasts about 5 hours. But because this is not a full
school day, the longer acting AdderallXR was developed.
The XR form is supposed to last 12 hours, and sometimes it does. However, in my
experience it often lasts closer to 9 hours. That is not bad, but may it may require a
shorter acting form of Adderall or Dexedrine for homework time.
Keep in mind that no individual medication or class of medications is necessarily
better than another. What is important is to take the time to find the medication that is
effective for the particular patient and fills the particular needs, whether that be for a
school day, a work day, or a college student who studies from 10 PM to 2 AM.
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