|
Monthly NewsNote
October 2005
 Email this article to a friend
Stimulant Medication Review
There is often confusion or lack of knowledge when I talk to parents about my choice of a medication for ADD. This NewsNote is a brief outline of the stimulant medications we now use and I hope it will be useful for parents as well as non-medical therapists who are often asked questions.
There are two chemically different stimulant medication groups. The goals of both are the same as are the potential side effects. The choice of medication by the physician depends on the needs of the child or adult, and there is no right or wrong, except perhaps to the drug salesperson.
Let me start with Methylphenidate. This is the basic active medication in all the varieties discussed in this paragraph. However, they all have a different dispensing system which has an impact on how they are taken and how long they may last. These are both important because not all children can swallow pills and the time needed for a medication to be effective can be from 4 hours to 12 hours. Let me go over the medications that are in the methylphenidate group. The flagship is Ritalin. This form has been available for over 50 years. It lasts 3 or 4 hours and would need to be used 3 or 4 times a day. The generic form is relatively inexpensive. Longer lasting are RitalinLA and MetadateCD. These forms release the medication differently but should last the school day. A longer form, lasting 10 to 12 hours is Concerta. A slightly altered form of methylphenidate is Focalin. The short acting form lasts 4 or 5 hours. The most recent entry into the field is Focalin XR. Exactly how long it lasts is not clear yet, but for most it seems to last 10 hours. There is a recent entry called Methylin which comes in a liquid or chewable form. This is a 3 hour drug and requires a dose every 3 hours if it is used.
The RitalinLA, FocalinXR and MetadateCD can be sprinkled. That means the capsule can be opened and put in a teaspoon of applesauce, yogurt, etc so that a child can swallow it with ease.
There are many questions that go through my mind as I choose a medication. Some of these include the length of time I need it to work, what time homework is being done (the athletes often don't get home until 6 PM), whether the problem is academically oriented ADD or ADHD with hyperactivity that causes more of a 24 hour problem, etc. It often takes time to find the right medication, as success is rarely instant.
And then there is the possibility of choosing the dextroamphetamine group of drugs. Of importance are Dexedrine, Adderall, and AdderallXR. Dexedrine is a short-acting medication, lasting about three hours. I find it more useful for adults than children. Adderall regular lasts about 5 hours. It is very effective and allows a good deal of flexibility because you can take it as needed. This is useful for college students, though we now have a problem of students sharing their medication. The AdderallXR is a long acting form and is usually good for 10 to 12 hours. It is effective and can be sprinkled. However, it often has more impact on sleep which at times can be a problem. It is an excellent drug for high school students and adults working a 9 to 5 job.
As mentioned, the specific choice of drug needs to be tailored to the needs of the child or adult. But this is a list of what we now have and a few words about each. There are other medications for ADD that are not stimulants. Please consult my NewsNote on Non Stimulants (Feb. 2004) filed under medication in the Newsletter Library.
For more information consult your physician.
|
