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Dennis B. Kottler, MD
Westlake Village, CA
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There are many medications which have been used to treat ADHD and they all have varying degrees of success with different patients. Following is an overview of these medications:
Ritalin (methylphenidate) variety:
There are many variants of methylphenidate such as Focalin or Concerta -- the latter is long acting. Focalin is an isomeric form of methylphenidate or Ritalin. It is "dexmethylphenidate" or the right-handed isomer, analagous to Lexapro vs Celexa (Lexapro, an antidepressant, is the right-handed stereoisomer - or enantiomer - of Celexa). Whereas Focalin is a short acting medication - 2.5 to 4 hr half life, Focalin XR is a long-acting form.
This group includes dextroamphetamine in the form of Dexedrine (short-acting), Dextroamphetamine Spansules (long-acting), Adderall (a mixture of amphetamine salts), and Vyvanse. Vyvanse, a newer medication, is a "prodrug" and is helpful where abuse is an issue because it has a delayed effect requiring metabolic degradation to work.Other
Guanfacine (Intuniv), is a newer ADHD medication approved in children 6 to 17 years of age at a dosage of 1 to 4mg/day.
Strattera, a noradrenergic drug with antidepressant effects, has been shown effective in both childhood and adult ADHD.
Wellbutrin, an excellent antidepressant medication, is used off-label for ADHD.
Provigil and Nuvigil have also been used in the treatment of ADHD with some success and are used off label for this application.In general, with ADHD medications, exercise caution when there is a history of abuse. Blood pressure elevation and arrhythmia are possible problems with the stimulants
Use of medication is at best empirical and each medication must be given a therapeutic trial before trying another one.
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