Efficacy and tolerability of ADHD medications in a clinical practice

Randomized controlled trials have shown that stimulants reduce symptoms of impulsivity and hyperactivity in children with attention deficit/hyperactivity disorder (ADHD); however, these rigid protocols show no advantage of one medication over another. Our study examined the question of differential efficacy and tolerability of five medications used for ADHD, in the open-label setting of our outpatient child neurology clinic. This retrospective study identified 137 children and adolescents (109 boys and 28 girls), with a mean age of 10 years (range 4 to 19 years) treated for ADHD. Treatment options were amphetamine/dextroamphetamine extended release (adderall XR) in 19.0%, amphetamine/dextroamphetamine (adderall), osmotic controlled-released (OROS) formulation of methylphenidate (OROS-MPH, concerta) in 29.2%, atomoxetine (strattera) in 21.9% and methylphenidate standard release (MPH) in 16.8%. Global effectiveness was assessed for each medication. Overall, 78% of patients improved with medication, with no significant statistical difference in efficacy among the five medications. Side effects included decreased appetite (14.6%), insomnia (10.2%), headaches (7.3%), and tics (3.7%). The only difference in side effects was with atomoxetine showing a significantly lower incidence of headaches than amphetamine/dextroamphetamine XR, amphetamine/dextroamphetamine or OROS-MPH. In conclusion, our results in the open-label setting were comparable to those found in randomized controlled trials; the medications we examined were equally effective with minimal differences in side effect profiles.