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The Types of ADHD Medications

NOTE: This article consists of three parts. Part 1 serves as an introduction and outlines medications like Ritalin; Part 2 lists the remaining stimulants, and Part 3 reviews non-stimulant ADHD medicines. Reading all three articles is highly recommended.


The article was medically reviewed by Dr. Pavlo Papach, a psychiatrist at Maale Hacarmel Mental Health Center in Israel. All the information is offered for educational purposes only.



Introduction

The variety of medications used to manage ADHD is massive, and it’s expanding too. In recent years, several non-stimulants have made it onto the market, and familiar medications have appeared in updated formulations. This is all great news, but for someone new to ADHD, it may also be overwhelming. That’s what this overview is for. Though admittedly a touch technical in some places, this article reviews the general landscape of ADHD meds available and provides a brief rundown of specific medications.


The Two Classes of ADHD Medications

In general, ADHD medications are divided into two big classes: stimulants and non-stimulants. Most ADHDers will begin with a stimulant like Ritalin, Adderall, Focalin, or Vyvanse. That being said, several non-stimulant medications have recently been approved for ADHD as well. Certain medications are also used off-label, especially for those who have mental or physical health concerns beyond ADHD.


Part 1 Stimulants

Stimulants are divided into two distinct types: those based on methylphenidate and amphetamine. These medications target the core symptoms of ADHD, namely inattention, impulsivity, and hyperactivity.

All stimulants work rapidly, but their effect wears off in 12 or fewer hours.


These medications are the first-line treatment for ADHD, meaning they are usually prescribed before trying any other medication. There’s no known rule that can predict which type of stimulant - methylphenidate or amphetamine - will work better for which person. Hence, tolerance and effectiveness are determined subjectively on a case-by-case basis.


Stimulants are also typically available in a large range of doses. This allows medical professionals to slowly achieve the optimal dose for every person and minimize the risks of side effects.


Both methylphenidate and amphetamine are classified as Schedule II Controlled Substances due to their potential for abuse when taken in high doses by non-ADHDers. For this reason, it is imperative to take these medications exactly at the prescribed dose.


Methylphenidate

Methylphenidate hydrochloride and its derivatives are the active ingredients in a whole array of ADHD medications. The first medication containing methylphenidate hydrochloride - Ritalin - has been on the market since 1961. Initially, it was only FDA-approved for children aged 6-12 years, but it is now also available for adolescents and adults up to 65 years old.


From capsules to chewable tablets, liquids, and skin patches, methylphenidate is offered in many forms. This is not merely a matter of convenience. These solutions aim to provide a more even release of methylphenidate into the bloodstream and extend the time between doses.


Some medications come in special tablets or capsules with several membranes that gradually release methylphenidate. “As side effects may be related to when the medications peak in your bloodstream, these medications may have fewer side effects for some patients,” write Dr. Benjamin Cheyette and Dr. Sarah Cheyette in an article in Psychology Today. If you are prescribed a long-acting stimulant (e.g., Ritalin LA, Focalin XR), avoid crushing, cutting, or chewing them because this will ruin the extended-release technology.


The four most common medications containing methylphenidate are:


1. Ritalin

Depending on the duration of action, Ritalin is currently sold in three forms:

  • Ritalin - immediate-release tablets available in 5, 10, and 15 mg doses. Works for 3-5 hours.

  • Ritalin SR - sustained-release tablets only available in a 20 mg dose. Works for 7-8 hours.

  • Ritalin LA - extended-release capsule available in 10, 20, 30, and 40 mg doses. Works for 8 hours.


2. Concerta - extended-release tablets available in 18, 27, 36, and 54 mg doses. Works for 10-12 hours.


3. Quillivant XR - extended-release liquid available in a 5 mg/ml dose. Works for 8-12 hours.


4. Focalin contains dextro-methylphenidate, a newer form of methylphenidate considered to be more potent and have fewer side effects than other medications in this group. “Dexmethylphenidate is the active part of methylphenidate, which is why Focalin is considered twice as strong — on a mg-for-mg basis — as drugs such as Ritalin and Concerta,” states Janice Rodden in an Additude article.


For this reason, Focalin is sometimes prescribed for individuals with ADHD who cannot tolerate or don’t feel the benefits of other meds with methylphenidate.


Depending on the duration of action, Focalin is currently sold in two forms:

  • Focalin - immediate-release tablets available in 2.5, 5, and 10 mg doses. Works for 3-5 hours.

  • Focalin XR - extended-release capsules available in 5, 10, 15, 20, 30, 35, and 40 mg doses. Works for 12 hours.


Part 2 of this article reviews another group of stimulants that includes common medications like Adderall and Vyvance.

_________

In this article, we listed just some of the most commonly-prescribed stimulants. For more detailed info, here’s a link to a credible source with a table that lists all ADHD medications:


ADHD Medications Approved by the FDA


Part 2 Amphetamine Derivatives

The effectiveness of an early form of amphetamine called Benzedrine was first described in 1937 by one Dr. Charles Bradley, who noticed that some kids he treated using amphetamine for headaches suddenly exhibited an interest in school and became more well-behaved.


By the 1970s, amphetamine-containing stimulants like Benzedrine and Dexedrine were widely used to treat so-called "hyperactive" kids, an outdated 20th-century term for ADHD.


Nowadays, both children and adults with ADHD can receive stimulants like Adderall and Vyvanse. Just like methylphenidate, medications containing amphetamine are approved for ages 6 to 65. These meds are only available in tablets and extended-release capsules.


Compared to Ritalin, a dose of Adderall lasts a little longer and is reported anecdotally to have less of a rebound effect (irritability, tiredness, and moodiness caused by a stimulant wearing off rapidly).


Listed below are three of the most widely-used stimulants of this type:


1. Adderall is a medication that contains four amphetamine salts: amphetamine sulfate, dextroamphetamine sulfate, dextroamphetamine saccharate, and amphetamine aspartate. Adderall was FDA-approved in 1996, and it is one of the most common ADHD medications today.


Depending on the duration of action, Adderall is currently sold in two forms:

  • Adderall - immediate-release tablets available in 5, 7.5, 10, 12.5, 15, 20, and 30 mg doses. Works for 4-8 hours.

  • Adderall XR - extended-release capsules available in 5, 10, 15, 20, 25, and 30 mg doses. Works for 8-12 hours.


2. Dexedrine (dextroamphetamine sulfate) is one of the first stimulants ever discovered. It’s available in extended-release capsules of 5, 10, and 15 mg doses. The medication works for 6-9 hours.


3. Vyvanse is a newer formulation of amphetamine. It is a so-called prodrug, which refers to a medication that becomes active when it is metabolized in the human body. Vyvanse contains an inert substance called lisdexamfetamine dimesylate that is transformed into amphetamine in the liver. The added step is believed to result in a more even and gradual release, which makes it more tolerable for some ADHDers who cannot take Adderall. It’s also considered to have a lower risk of abuse.


Depending on the duration of action, Vyvanse is currently sold in two forms:

  • Vyvanse capsules are available in 10, 20, 30, 40, 50, 60, and 70 mg doses. Works for 10-14 hours.

  • Vyvanse chewable tablets are available in 10, 20, 30, 40, 50, and 60 mg doses. Works for 8-12 hours.


The Centers for Disease Control and Prevention (CDC) report that stimulant medications are considered effective for 70-80% of children with ADHD. When used within the prescribed dosage, the risks of side effects, rebound symptoms, and abuse are low. Still, these medications are not universal; some people can’t take stimulants, whereas others don’t find them effective. Part 3 of this article explores the alternatives, namely non-stimulant medications.


_________

In this article, we listed just some of the most commonly-prescribed stimulants. For more detailed info, here’s a link to a credible source with a table that lists all ADHD medications:


ADHD Medications Approved by the FDA



Part 3 Non-stimulant ADHD medications

Researchers and treating psychiatrists are putting a lot of faith in this new class of ADHD medications. Prior to 2002, when atomoxetine, the first non-stimulant, was approved by the FDA, methylphenidate and amphetamine were the only medications available for ADHD.


“Non-stimulant medications provide hope for those who are not interested in or unable to take a stimulant. Non-stimulant medications can also be taken in addition to stimulants for those who still have symptoms despite stimulant treatment,” writes Samantha Roseberry in a Psychology Today article.


A crucial advantage of non-stimulant medications is that they can be used alone or supplemented with stimulants or other medications. This feature renders non-stimulants especially helpful for a large group of adults who have ADHD and anxiety or depression. As Prof. Stephen M. Stahl, author and professor of psychiatry at the University of California, San Diego, wrote in Stahl’s Essential Psychopharmacology, “treatment of ADHD in adults generally means concomitant treatment of ADHD with one or more additional disorders, and generally with a combination of drugs for the different conditions.” Non-stimulants like atomoxetine can be combined with antidepressants and anxiety medications to treat cognitive symptoms of ADHD, anxiety, and depression simultaneously.


It takes up to several months for non-stimulants to achieve their full effect. Upon crossing the threshold, the medication takes effect for 24 hours. Non-stimulants are also not controlled substances, as they work differently from stimulants.


There are two main types of non-stimulants - norepinephrine reuptake inhibitors and alpha agonists - that are approved by the FDA for ADHD:


Norepinephrine reuptake inhibitors

Atomoxetine (Strattera) was the first ADHD non-stimulant. It’s available in 10, 18, 25, 40, 60, 80, and 100 mg doses. Straterra is FDA-approved for use from ages 6 to adults.


Viloxazine hydrochloride (Qelbree) - available in 100, 150, and 200 mg doses. Qelbree is the latest non-stimulant approved for ADHD. It was granted FDA approval in 2021 for children and adolescents with ADHD 6-17 years of age. It works similarly to atomoxetine.


Alpha agonists

This group of non-stimulants includes two medications - guanfacine and clonidine - that were initially used to treat hypertension. In 2009, the FDA extended its use to adults and children ages six and older.

  • Clonidine (Kapvay) - available in 0.1 and 0.2 mg doses.

  • Guanfacine (Intuniv) – available in 1, 2, 3, and 4 mg doses.

Off-label use

Certain medications are prescribed by doctors, even though they are not yet approved for ADHD. This kind of off-label use is legal and widespread when studies show that a certain medication is effective beyond the permissions granted by the FDA.


Tricyclic and Atypical Antidepressants

While not FDA-approved for treating ADHD, antidepressants are frequently prescribed off-label. The most common antidepressant used for ADHD is Bupropion (Wellbutrin), available only in a 150 mg dose.


Wake-promoting agents

Modafinil (Provigil) and armodafinil (Nuvigil) are medications used for treating sleep disorders. They work similarly to stimulants but are less potent and have a lower risk of side effects and abuse. Clinical trials show that both of these medications are effective for ADHD.


  • Modafinil (Provigil) - available in tablets of 100 or 200 mg.

  • Armodafinil (Nuvigil) - available in tablets of 50, 200, and 250 mg.


As this brief overview of ADHD medications hopefully shows, ADHDers have a wide variety of medical treatments available. Remember that most research shows that medications are best used in conjunction with other treatments, such as coaching and psychotherapy.


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