[Attention deficit hyperactivity disorder: pharmacological options that are not "Ritalin"].
4
Citation
0
Reference
20
Related Paper
Citation Trend
Abstract:
Methylphenidate (Ritalin) is the drug of choice for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). Methylphenidate has been rigorously studied and found to be a safe and effective drug. However, there is a need for pharmacological alternatives since there are patients and therapists who are reluctant to use the drug. In some cases it is ineffective, others suffer from intolerable side effects and still others need treatment extended for the entire day. Recently, new pharmacological agents have been introduced for use in Israel. This article discusses the use of these new psychostimulants as well as other non-psychostimulant options. One of the new psychostimulants is Concerta, a very long acting methylphenidate preparation, that has been shown to be very effective. Adderall, a mixture of amphetamine salts, and Dexedrine (dexamphetamine) are also widely used. This article also presents data on an older psychostimulant, Cylert, Nitan (pemoline), prescribed until recently as a major alternative for Ritalin but, at present, it is rarely used because of its hepatotoxicity. Strattera (atomoxetine), a new non-stimulant drug, is a selective noradrenaline reuptake inhibitor that is a promising therapeutic option for children with ADHD. In summary, it is encouraging that there are multiple pharmacological options for treating children with ADHD. There is no one drug for all children and this is particularly important for children with do not respond to methylphenidate. Last, but not least, the mere fact that the new drugs are not called Ritalin, may play an important role in reducing the irrational opposition to the pharmacological treatment of ADHD.Keywords:
Stimulant
Dextroamphetamine
Attention deficits
Cite
The most frequently used pharmacological treatment for attention deficit/hyperactivity disorder (ADHD) over the last few decades has been methylphenidate. Although methylphenidate is still one of the first choices in the treatment of ADHD, new alternatives have appeared with the intention of improving on some of its drawbacks.The work being carried out on the development of drugs that may be an alternative to methylphenidate is centred on two main lines. On the one hand, preparations have been developed that allow the sustained release of methylphenidate by means of the SODAS and OROS techniques and these have allowed us to obtain methylphenidate preparations that only require a single daily dose. As an alternative to stimulants, other drugs have been studied that act by means of different mechanisms and which have proved to be quite effective in ADHD. Another recent arrival has been atomoxetine, a new drug with a noradrenergic action that was designed specifically for the treatment of ADHD. In this paper, we describe the neuropharmacological bases of these drugs, and the mechanisms of action and possible indications of each of them are also discussed.
Attention deficits
Stimulant
Cite
Citations (2)
There is a substantial body of literature documenting the efficacy of multiple unrelated pharmacological agents in attention-deficit hyperactivity disorder (ADHD) individuals throughout the life-cycle. The available literature indicates the important role of psychopharmacological agents in the reduction of the core symptoms of ADHD and associated impairments. The literature documents that stimulants not only improve abnormal behaviours of ADHD, but also improves self-esteem, cognition, and social and family function. However, response varied in different age groups and with certain comorbidities. In addition there is a large body of literature documenting the efficacy of atomoxetine which shows improvement in these same domains. More research is needed on alternative pharmacological treatments and to further evaluate established therapeutics beyond school-aged Caucasian boys. Further, more research is needed on the efficacy of treatment for comorbid ADHD, use of combined medications, and the combination of medication and psychosocial treatment.
Pharmacotherapy
Guanfacine
Cite
Citations (247)
Stimulants have been the mainstay of the psychopharmacological treatment of attention deficit hyperactivity disorder (ADHD) for over 60 years. In the last 5 years, there have been a number of important developments in terms of potential new treatments for ADHD. Since stimulants have such a short half-life, considerable research has focused on the development of new delivery systems that will allow once-a-day dosing. New formulations of both amphetamine (AMP) and methylphenidate (MPH) have appeared which differ in terms of their optical isomers from the commonly used compounds. A wide variety of compounds are currently in development as therapeutic agents for ADHD. Some, like the stimulants, primarily impact the noradrenergic and dopaminergic neurotransmitter systems, while others have novel effects on the cholinergic, histaminergic and peptidergic systems. Advances in the pharmacogenetics of ADHD may lead to the development of yet more compounds in the near future.
Psychopharmacology
Histaminergic
Neurotransmitter Systems
Cite
Citations (18)
D-amphetamine, the mixed preparation of d, l-amphetamine, and methylphenidate are first line agents for the treatment of attention deficit disorder (ADHD). Despite the impressive track record for the stimulants in the treatment of ADHD, they fail in 25% of patients due to lack of efficacy or the emergence of unwanted side effects. With respect to Atomoxetine and other nonstimulants in treatment of ADHD, the Alpha2-receptor agonist clonidine has been used for more than 20 years. The findings from controlled studies, however, have been somewhat inconsistent, showing benefit and negative results. The noradrenaline reuptake inhibitor Desipramine has also shown some benefit. The novel antidepressant bupropion was found to be superior to placebo. Niederhofer could demonstrate, that also drugs, affecting the serotonine system (Tianeptine), may improve some symptoms associated with ADHD. Data about additional biological treatment options for ADHD are very scarse. This talk gives an overview of actual results. - bright light therapy has been proven to be effective - also rTMS seems to improve especially the hyperactivity-related symptoms - there are some herbals with proven norepinephrinergic, noradrenergic and serotonergic effects. We present a comparison of these data. The observed improvement is lower than the 50%-60% improvement reported in stimulant trials, but is similar than the level of improvement observed in other nonstimulant studies. These finding also raises questions about the utility of combining those therapeutic options with stimulants. In patients with ADHD, this combination might permit lower doses of the stimulant.
Bupropion
Desipramine
Stimulant
Guanfacine
Cite
Citations (0)
Bupropion
Desipramine
Reboxetine
Clomipramine
Tricyclic
Cite
Citations (89)
Introduction: Methylphenidate (MPH) plays a principal role in the multimodal treatment of attention-deficit/hyperactivity disorder (ADHD). Controlled studies have demonstrated an effective reduction in the core symptoms of the disorder following MPH therapy, although long-term studies also demonstrate that the therapeutic benefits dissipate in the absence of combined psychosocial interventions.Areas covered: This review article focuses on the pharmacological characteristics of MPH, examining its effects on brain metabolism and the neurotransmitter system. Neuropsychological and clinical effects of different immediate and extended release MPH formulations are discussed to aid clinicians in choosing the appropriate formulation. The drug’s addictive potency and abuse potential is also discussed. Data came from a literature search of relevant studies performed using the PubMed database up to June 2013.Expert opinion: MPH is effective in the treatment of the core symptoms of ADHD. Considerable clinical expertise is required to identify an individually well-adapted dosage which will produce the optimal clinical effects with potential side effects minimized. Due to low adherence to medication, especially in adolescents, motivation to treatment and attentive clinical monitoring is mandatory, as is the consideration of risks of abuse or the presence of a comorbid addictive disorder.
Neurotransmitter Systems
Attention deficits
Cite
Citations (37)
Stimulants are a highly efficacious and safe treatment for attention-deficit/hyperactivity disorder (ADHD), with 75% to 90% of patients responding well if two different stimulants (amphetamine and methylphenidate) are used. Nonetheless, a subset of ADHD patients will either fail to respond to stimulants or have side effects that preclude their use (tics, severe loss of appetite, marked insomnia). For such patients, there are a number of non-stimulant agents that serve as second-line treatments. Tricyclic antidepressants (TCAs) are the most studied of these drugs. They are superior to placebo in the treatment of ADHD and may reduce abnormal movements in patients with ADHD/tic disorder. TCAs often produce side effects of sedation, dry mouth, and constipation. Bupropion is superior to placebo in the treatment of ADHD and has a more favorable side-effect profile than the TCAs. A new selective norepinephrine reuptake inhibitor, atomoxetine, has been shown to be efficacious in the treatment of ADHD and has recently received an approvable letter from the Food and Drug Administration. The a-agonists clonidine and guanfacine have also been used as alternative agents in ADHD, though the controlled data are more limited. A recent controlled clinical trial suggests a combination of methylphenidate and clonidine has advantages in the treatment of comorbid ADHD and tics over either medication alone. Clinical guidelines for each of these agents, as well as their use in combination with stimulants in comorbid conditions, will be discussed.
Guanfacine
Stimulant
Bupropion
Tricyclic
Akathisia
Cite
Citations (107)
Initiatives to develop better-tolerated, more efficacious pharmacological agents with improved drug delivery systems have driven recent research in attention-deficit hyperactivity disorder (ADHD). While stimulants are the primary pharmacotherapy for ADHD, these drugs have a limited duration of action and a subset of patients will either fail to respond to these medications or have side effects that preclude their use. The development of atomoxetine, the first nonstimulant approved for ADHD, has been followed by additional innovative research, such as the methylphenidate transdermal system, modafinil, NRP-104 and cholinergic agents. This review highlights some of the recent trends in ADHD treatment and the current status of promising treatment options that may help to shape the future of ADHD treatment.
Pharmacotherapy
Cite
Citations (61)
Attention deficit hyperactivity disorder (ADHD) is one of the most frequent neurodevelopmental disorders in the child population. Its treatment is complex and must include psychoeducational, environmental and pharmacological measures. In recent years, the main novelties as regards its pharmacological treatment have been the appearance of lisdexamphetamine and extended-release guanfacine.The increase in the number of drugs available for the treatment of ADHD makes it possible to treat and cover a very wide range of different clinical situations. The purpose of this review is to perform an analysis of the literature on the two drugs.The study determines the strong points of both treatments, with special attention given to their mechanism of action, their tolerability and their efficacy.Extended-release guanfacine enables the professional to treat situations that are poorly covered by stimulants, such as children with irritability and tics, with a significant profile characterised by moderate efficacy and good tolerability and safety. The appearance of lisdexamphetamine has brought about a very important change because, according to the literature, it is a drug that, from the clinical point of view, is both complete and effective in improving the symptoms of ADHD. Moreover, it has a good safety profile.Actualizacion en el tratamiento farmacologico del trastorno por deficit de atencion/hiperactividad: lisdexanfetamina y guanfacina de liberacion retardada.Introduccion. El trastorno por deficit de atencion/hiperactividad (TDAH) es uno de los trastornos del neurodesarrollo mas frecuentes en la poblacion infantil. Su tratamiento es complejo y debe incluir medidas psicoeducativas, ambientales y farmacologicas. En los ultimos años, las principales novedades respecto a su tratamiento farmacologico son la aparicion de la lisdexanfetamina y la guanfacina de liberacion retardada. Objetivo. El aumento del numero de farmacos disponibles para el tratamiento del TDAH permite tratar y cubrir situaciones clinicas muy diversas. El proposito de la presente revision es realizar un analisis de la bibliografia sobre ambos farmacos. Desarrollo. Se establecen los puntos fuertes de ambos tratamientos, atendiendo especialmente a su mecanismo de accion, a su tolerabilidad y a su eficacia. Conclusiones. La guanfacina de liberacion retardada permite tratar situaciones escasamente cubiertas con los estimulantes, tales como los niños con irritabilidad y tics, con un perfil significativo de moderada eficacia y una buena tolerabilidad y seguridad. La aparicion de la lisdexanfetamina ha supuesto un cambio muy importante porque, segun la bibliografia, se trataria de un farmaco completo y efectivo, desde el punto de vista clinico, para mejorar los sintomas del TDAH. Ademas, posee un buen perfil de seguridad.
Guanfacine
Irritability
Tolerability
Attention deficits
Cite
Citations (2)
As sustained methylphenidate becomes available in the United Kingdom, there is likely to be considerable demand related to the difficulties that frequently arise with standard methylphenidate due to the need for midday doses at school, as well as the pronounced ‘on/off’ therapeutic effects sometimes seen with multiple doses. This article briefly discusses longer acting stimulants, reviews the available literature, anticipates possible problems in the use of slow release methylphenidate, and presents clinical guidelines for its use.
Cite
Citations (6)