ADHD , drugs used

A summary of major categories of drugs used in the pharmaco-therapy of ADHD is provided in Table 35.1, and the corresponding treatment algorithm is provided in Table 35.2... 

Methylphenidate, Transdermal (Daytrana) [Cll] [CNS Stimulant] WARNING w/ Hx of drug or alcohol dependence chronic use can lead to dependence or psychotic behavior observe closely during withdrawal of drug Uses ADHD in children 6-12 y Action CNS stimulant Dose Peds. 

One of the most controversial CNS-acting drugs in contemporary society is methylphenidate (Ritalin ). This drug is structurally related to amphetamine and is a mild stimulant that has abuse potential similar to amphetamine. Methylphenidate is classified as a Schedule II controlled substance. It is effective in the treatment of narcolepsy and attention-deficit hyperactivity disorder (ADHD). Its use in ADHD has caused the greatest controversy. 

It is true that Strattera has not been demonstrated to cause dependence and abuse like Ritalin, Adderall, and the other stimulant drugs used to treat ADHD and therefore has not been placed in Schedule II by the DEA. But Strattera is a highly stimulating drug. According to the label for Strattera, as found in the Physicians Desk Reference (2007, p. 1817, Table 1), in the clinical trials used for FDA approval, irritability was reported in 8% of subjects, crying in 2%, and mood swings in 2%. 

The FDA s cowardly retreat on the issue of stimulant adverse effects took place under fire from the psychiatric establishment. Earlier, in February 2006, the FDA s panel of advisors had shocked the agency and medical authorities by recommending a black-box warning for all stimulant drugs used in the treatment of ADHD concerning cardiovascular risks, including heart attack, stroke, and sudden death. 

Him, M. (2005, September 16). ADHD drugs Adult use doubles in 4 years. WebMD Medical News. Retrieved from http //www.mediocmenet.com... 

Examples of drugs used to treat ADHD are dexamfetamine, methylphenidate and atomoxetine. These drugs inhibit the re-uptake of noradrenaline and dopamine. Increase in levels of these two transmitters in the prefrontal cortex is thought to increase inhibitory control in the limbic system. 

Drugs Used for Depression, Bipolar Disorders, and Attention Deficit Hyperactivity Disorder (ADHD)... 

A critical part of the assessment must be to determine the patient s impairment at various times throughout the day to ensure that medication coverage overlaps with the time when the patient is most likely to benefit. As with all medication trials, it is important to start with a low dose of medication and keep increasing it slowly until the optimal risk-to-benefit ratio has been determined. Stimulant medication (methylphenidate, mixed amphetamine salts, and pemoline) and atomoxetine (a non-stimulant selective norepinephrine reuptake inhibitor, approved by the FDA for adult ADHD) are the first-line treatments of adult ADHD. Pemoline is not recommended as first-line treatment due to the risk of hepatoxicity. Stimulant drugs used to treat adults with ADHD are considered safe and effective, and have been well studied. There are several new long-acting formulations of... 

In recent years, extensive use has been made of new formulations for old drugs, a good example being Alza s Concerta (methylphenidate, extended release Figure 1.22). This drug, used to treat Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents, uses sophisticated osmotic pressure delivery to maintain drug concentrations, with once a day (qd) dosing, at levels comparable with those observed with thrice daily... 

McCarthy S, Cranswick N, Potts L, Taylor E, Wong IC. Mortality associated with attention-deficit hyperactivity disorder (ADHD) drug treatment a retrospective cohort study of children, adolescents and young adults using the general practice research database. Drug Saf 2009 32 1097-100. 

In 1970, the U.S. government passed the original Controlled Substances Act, and under this law methamphetamine was classified as a Schedule II drug in its injectable form and a Schedule III in its noninjectable (pill) form. However, a year later, both forms of methamphetamine were reclassified as Schedule II drugs. Today, it is still sold under the name Des-oxyn for a few medical uses, such as for the treatment of atten-tion-deficit/hyperactivity disorder (ADHD) and narcolepsy. 

Substance-Induced Anxiety Disorder. Numerous medicines and drugs of abuse can produce panic attacks. Panic attacks can be triggered by central nervous system stimulants such as cocaine, methamphetamine, caffeine, over-the-counter herbal stimulants such as ephedra, or any of the medications commonly used to treat narcolepsy and ADHD, including psychostimulants and modafinil. Thyroid supplementation with thyroxine (Synthroid) or triiodothyronine (Cytomel) can rarely produce panic attacks. Abrupt withdrawal from central nervous system depressants such as alcohol, barbiturates, and benzodiazepines can cause panic attacks as well. This can be especially problematic with short-acting benzodiazepines such as alprazolam (Xanax), which is an effective treatment for panic disorder but which has been associated with between dose withdrawal symptoms. 

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