ADHD MEDICATION FACTS
Attention deficit/hyperactivity disorder (ADHD) is a mental health disorder that is usually diagnosed during childhood.
According to The American Psychiatric Association, 5% of children in the U.S. have ADHD, although studies have reported rates as high as 11%.
Childhood ADHD persists into adulthood ADHD for about 50% of individuals.
Adults with ADHD may have symptoms of restlessness, inattention, and impulsive behavior. Impairment in executive function, as well as social, emotional and vocational wellbeing is also common.
Adults with ADHD often have difficulty with time management and prioritizing, completing, and focusing on tasks.
According to the National Comorbidity Survey Replication, a nationwide household survey of 18 to 44 year-olds, 4.4% of adults in the U.S. have ADHD.
Surveys conducted by the National Institutes of Health report a prevalence of 3 to 5%, with comparable rates between men and women.
It’s been noted that all adults with ADHD had ADHD as children, but not diagnosed. ADHD tends to be underdiagnosed in adults; fewer than 20% of adults with ADHD have been diagnosed or treated.
This is due to a lack of awareness as well as the presence of certain disorders such as mood and anxiety in adults with ADHD.
When ADHD symptoms are mistaken for these disorders, adults are more likely to be treated for the disorders rather than for ADHD.
Absorption and excretion of amphetamines — and therefore blood levels — are affected by pH.
Fruit juices, vitamin C, and some drugs (guanethidine, reserpine) acidify the stomach, decreasing absorption. Alkalinizing agents, such as antacids, increase amphetamine absorption.
- Amphetamines should not be used along with tricyclic antidepressants or decongestants.
A 14-day clearing period is required between the use of a Monoamine Oxidase Inhibitor (MAOI) and amphetamine. Otherwise, severe hypertension may occur.
Methylphenidate should not be used within 14 days of using an MAOI. Otherwise, a hypertensive crisis might occur.
Because it raises blood pressure and heart rate, methylphenidate should be used with caution with other drugs that can affect blood pressure and heart rate. Dosage adjustment may be necessary for:
- Warfarin (Coumadin)
- Phenytoin (Dilantin)
- Antidepressants (tricyclics and selective serotonin reuptake inhibitors)
Atomoxetine should not be used within 14 days of an MAOI, otherwise severe, possibly fatal reactions could occur.
Increases in heart rate and blood pressure may occur if atomoxetine is administered with other medications that can increase heart rate or blood pressure.
The sedative effect of alcohol, barbiturates, or other drugs may be increased by guanfacine.
Bupropion should not be used within 14 days of an MAOI. Medications that can interact with bupropion include:
- Tricyclic and SSRI antidepressants (nortriptyline, desipramine, imipramine, norfluoxetine, sertraline, paroxetine, fluvoxamine)
- Atomoxetine (Strattera)
- Anticonvulsants (carbamazepine, phenytoin, phenobarbital)
- Antipsychotics (haloperidol, risperidone, thioridazine)
- Beta-blockers (metoprolol, propranolol)
- Antiarrhythmics (propafenone, flecainide)
- Diabetes medications
Bupropion may increase adverse effects seen with levodopa and amantadine.
Some medications increase the likelihood of seizures (antidepressants, theophylline, steroids) and should be used with caution in patients taking bupropion.
Adverse events or reduced tolerance are possible when bupropion is combined with alcohol.
Using bupropion with nicotine patches may increase the risk for high blood pressure.
Tricyclic antidepressants (TCAs) should not be used within 14 days of an MAOI. Severe, even fatal, reactions may occur. Many drugs may interact with TCAs. These include:
- Quinidine (Quinidex)
- Cimetidine (Tagamet)
- Other antidepressants (such as fluoxetine, sertraline, paroxetine)
- Anticonvulsants (barbiturates, phenytoin)
The stimulants share common side effects. Most common among them is their potential for abuse.
When doses of methylphenidate or amphetamines start low and are slowly increased, the result is a slow rise in brain dopamine levels.
That pattern of therapeutic use is unlikely to trigger enticing side effects, such as euphoria. However, taken inappropriately, brain dopamine levels soar — as does the risk for addiction.
To help prevent abuse, the government has put limits on how much of the medication can be dispensed at one time, and how often it can be dispensed.
The main side effects of stimulant medications are
- problems sleeping,
- decreased appetite, and
Other side effects of methylphenidates and amphetamines include:
- Cardiac problems, including palpitations, increased heart rate, changes in blood pressure, chest pain, sudden death
- Neurologic problems including hallucinations, psychosis, tics, Tourette’s syndrome, seizure
- Other effects such as skin rash, vision problems, and nausea
The side effects associated with atomoxetine (Strattera) include:
Gastrointestinal effects such as dry mouth, nausea, abdominal pain, vomiting, and serious liver problems
Suicidal thinking, headache, sleepiness, dizziness, irritability, change in libido, erectile and ejaculatory dysfunction, menstrual changes, decrease in appetite and, urinary dysfunction