This document discusses ADHD medication. It begins by explaining that the ADHD brain has slower development in the frontal cortex and neurotransmitter pathways are not as effective as they should be. ADHD medication works by making these brain areas more functional and helping neurotransmitters pass messages. Medications are part of a treatment plan and are prescribed by hospitals then monitored by GPs. Younger children are not usually prescribed medication while older children and adults may be for severe ADHD. The document outlines UK guidelines for ADHD medication including stimulants like methylphenidate and lisdexamfetamine, and non-stimulants like atomoxetine. Side effects of different medications are also discussed.

1. ADHD Medication
what’s the point?

2. The ADHD Brain
• Development of the cortex in the frontal lobe
of the brain is slower
• It doesn’t work as well as it should
• Nerves pathways which drive the brain are
linked by neurotransmitters
• Noradrenaline
• Dopamine
• Scans show areas of reduced metabolism i.e.
areas not working
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3. ADHD medication……….
• Makes these areas work
• Makes nerve pathways in the frontal lobe cortex more effective
• Helps the nerve cells pass messages between themselves using
neurotransmitters
• Usually by increasing the amount of neurotransmitter available

4. Where do these medicines fit in?
• Part of plan inc. psychological, behavioural, educational or
occupational needs
• Not to be started by G.P.
• Prescribed by Hospital & then issued by G.P.
• (Already on it from G.P. should be referred to hospital)
• Health checks done by hospital CAMHS (transfer to GP when
move to adult service)

5. Medications Age Appropriate?
• Pre-school < 5 years
• not recommended
• School age
• moderate ADHD
• Non-drug interventions
• Parent education programme
• School age/Adults
• severe ADHD
• Medication with other interventions

6. NICE Guidance
First Line- Methylphenidate
Stimulant
• Medikinet
• Ritalin
• Tranquilyn
• Equasym XL
• Afternoon release
• Medikinet MR
• Morning release
• Concerta XL
• Longer lasting
• Delmosart
• Matoride XL
• Xaggitin XL
• Xenidate XL
8 hours
8-12 hours
3 hours

7. Equasym

8. Second Line- Lisdexamphetamine
(Elvanse) Stimulant
• Prevents reuptake noradrenaline
• After 6 week trial methylphenidate
• Switch to dexamphetamine (Amfexa) if responding to
lisdexamphetamine but need shorter effect
Adults either methylphenidate or
lisdexamphetamine/dexamphetamine
first line

9. Third Line-Atomoxetine
(Strattera) Non-stimulant
• Prevents reuptake noradrenaline
• (? Doesn’t work if lisdexamphetamine doesn’t)
• Cannot tolerate methylphenidate or
lisdexamphetamine/dexamphetamine
• 6 week trial of either
• Useful if tics/tourette’s, anxiety, stimulant misuse/risk of selling
stimulants
• Mood elevating
• Gastro side-effects
• Use with slower cognitive processing (not stupid!)

10. Guanfacine (Intuniv)
Non-Stimulant
• Needs tertiary referral for adults
• Regulates noradrenaline
• May reduce tics
• Causes sleepiness particularly in first month
• Good in combination with a stimulant

11. Clonidine
• Tertiary referral for children with ADHD/
sleep disturbance/rages or tics
• Better for restlessness than inattention
• Good for tics
• Dry mouth and hypotension

12. Others
• Risperidone (Risperdal)
• Aripiprazole (Abilify)
• SSRIs for anxiety e.g. fluoxetine, sertraline, citalopram
(ok with methyphenidate)

13. Monitoring/Side Effects
• Height every 6 months (?growth can be affected by
methylphenidate,lis/dexamphetamine & atomoxetine)
• - dose related, e.g. methylphenidate 60mg daily for 10 years-somewhat disproved
• Weight – after 3-6months, then every 6 months – methylphenidate can be
appetite suppressant, improved mood on atomoxetine can cause weight gain
• Heart rate & blood pressure before and after each dose change and every 3
months
• ?Potential for suicidal thinking/self harm – atomoxetine (due to antidepressant
action c.f sertraline etc in adolescents)- not in clinical practice
• ?Liver problems (rare)- atomoxetine – should monitor liver function periodically-
not in clinical practice
• ?Reduction seizure threshold- guanfacine > atomoxetine

14. Melatonin
2mg m/r licensed (Circadin)/3mg unlicensed Bio-
melatonin
• Used to help sleep problems associated with stimulants
• We produce melatonin as we go to sleep
• Need to be in the dark for it to work properly
• Take 30mins before bedtime
• Licensed dose circadin 2mg at night
• (designed for over 55year old stops waking in
the night)
• Maximum 10mg at night
• Unlicensed Specially imported
- better release
• Adults –from Hospital