ADHD is a developmental condition that affects concentration and attention. Many different medications can reduce ADHD symptoms, each of which has a range of benefits and side effects.
Attention deficit hyperactivity disorder (ADHD) medications are usually stimulants, such as Adderall XR, Vyvanse, and Concerta. However, people can also use nonstimulant drugs, such as Strattera or Intuniv XR, to relieve the symptoms of ADHD. Medications can have short-, medium-, or long-acting effects.
The best medication for a person depends on many factors, including the medication's side effects, how long it lasts, and an individual's personal preferences.
A doctor can advise on which type is best, but it is useful to know the benefits and side effects of each type.
In this article, we will compare the different medications that people can take to control ADHD symptoms.
The mental processes that ADHD affects include self-control, attention, working memory, and creative thinking.
Medications that act on certain brain chemicals involved in ADHD, namely dopamine and norepinephrine, may help people control the symptoms of the condition.
Doctors prescribe two main types of drug to treat the symptoms of ADHD:
Stimulants are more effective than nonstimulants in adults, adolescents, and children. However, there is a risk of drug misuse with stimulants, and they can cause rebound symptoms. For this reason, many people use nonstimulants instead. Using long-acting versions of stimulants can also reduce the potential for misuse.
The following table lists the stimulant and nonstimulant drugs that people can take to treat ADHD symptoms.
|Long-acting stimulants||amphetamine (Adderall XR)|
|dexmethylphenidate (Focalin XR)|
|methylphenidate (Ritalin LA)|
|Short- and intermediary-acting stimulants||dextro-amphetamine (Dexedrine and Dexedrine Spansules)|
|methylphenidate (Ritalin, Ritalin SR, and generics)|
|guanfacine (Intuniv XR)|
Doctors prescribe stimulants as the first line of treatment for children, adolescents, and adults with ADHD. Stimulants act on norepinephrine and dopamine, two brain chemicals that may play a role in ADHD.
Stimulants called amphetamines are more effective and produce fewer side effects in adults. The first choice for children and adolescents with ADHD is methylphenidate.
What are the side effects?
The most common side effects of stimulant medications for ADHD are:
- increased heart rate
- increased blood pressure
- reduced appetite
- difficulty sleeping
Serious heart-related complications are rare. Doctors should closely monitor people with heart problems who are taking stimulants.
Stimulants of the central nervous system have a high potential for misuse and dependence. Longer-acting formulations have a lower potential for misuse, and doctors more commonly prescribe these.
What are the drug interactions?
Stimulants can interact with several medications.
Monoamine oxidase inhibitors are antidepressants that people should not take with stimulants. In fact, a person must stop taking any monoamine oxidase inhibitor at least 14 days before starting to take any stimulant medication.
Other antidepressants that interact with stimulants include:
- selective serotonin reuptake inhibitors
- serotonin norepinephrine reuptake inhibitors
- tricyclic antidepressants
The following sections look at types of stimulant ADHD medication in more detail.
Methylphenidate works by increasing the levels of dopamine in the brain. Long-term studies lasting for more than 20 years have demonstrated that methylphenidate is safe and effective.
Methylphenidate is present in five different medications. Long-acting and short- and intermediary-acting forms are available.
Long-acting methylphenidate medications are available in the following strengths in milligrams (mg):
|Biphentin||10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 80 mg|
|Concerta||18 mg, 27 mg, 36 mg, 54 mg|
|Novo-methylphenidate ER-C||18 mg, 27 mg, 36 mg, 54 mg|
|Ritalin LA||10 mg, 20 mg, 30 mg, 40 mg|
|Daytrana||10 mg, 15 mg, 20 mg, 30 mg, 40 mg|
Short-acting methylphenidate medications are available in the following strengths:
|Ritalin||5 mg, 10 mg, 20 mg|
|Ritalin SR||20 mg|
|methylphenidate||5 mg, 10 mg, 20 mg|
The following sections discuss methylphenidate drugs for ADHD in more detail.
Biphentin capsules (available in Canada) release 40% of the methylphenidate at once and the remaining 60% gradually. This means that the effect lasts for 10–12 hours, which covers the major part of the day.
Some people need a longer effect of methylphenidate after the effect of the long-acting drug wears off. In these cases, they can take a short-acting stimulant later in the day.
People can open the capsule of Biphentin and sprinkle it into food if they have difficulty swallowing pills.
Concerta capsules use osmotic-controlled release oral delivery system (OROS) technology to release methylphenidate. The effect of methylphenidate is also long-acting, as it releases 22% immediately and the remaining 78% gradually.
The OROS technology is only present in Concerta and not in the generic formulations. When a person swallows Concerta, fluid from the stomach and intestines enter the tablet and push the medication out of the pill slowly throughout the day.
Similar to Biphentin, the medication will last for 10–12 hours. At the end of the effect of the medication, people can use a short-acting methylphenidate form if needed.
People should not cut or crush Concerta capsules. People who cannot swallow pills may have difficulty taking Concerta.
Novo-methylphenidate ER-C (available in Canada) is the generic equivalent to Concerta. This product does not use the OROS technology for releasing the medication.
The major reason that people choose the generic form instead of Concerta is its lower cost. However, no clinical studies have confirmed that this generic provides the same effect as Concerta.
Some doctors have reported behavioral changes when people switch from Concerta to its generic equivalent. Caregivers, individuals, pharmacists, and doctors should report any behavioral changes they observe.
Ritalin LA is an extended-release tablet that releases half of the medication at once and the other half slowly throughout the day.
Doctors can prescribe Ritalin LA to children, adolescents, and adults with ADHD. People should not crush, chew, or split this tablet.
Daytrana is a methylphenidate patch that a person puts on their hip. Researchers have studied its effects in children aged 6–12 and those aged 13–17.
A person applies this patch to their skin 2 hours before they need the effects of the medication. The person should remove the patch after a maximum of 9 hours.
Ritalin, Ritalin SR, and generics
Methylphenidate is also available in short-acting formulations. Ritalin, Ritalin SR, and their generic equivalents release methylphenidate immediately, but the effect does not last long.
People must take multiple doses per day of these short-acting medicines to achieve the desired effect.
Doctors prefer to prescribe long-acting stimulants and add a short-acting medicine if the person needs additional help after the effect of the long-acting drug wears off.
Dextro-methylphenidate is a variation of methylphenidate present in Focalin and Focalin XR. This variation of methylphenidate is more active than its typical counterpart.
It is available in a short- and long-acting formulation. Focalin and Focalin XR are available in the following strengths:
|Focalin||2.5 mg, 5 mg, 10 mg|
|Focalin XR||5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg|
A person can open these capsules and sprinkle them into food. Doctors can prescribe Focalin and Focalin XR to all age groups.
Amphetamines are a type of stimulant that increases the release of both dopamine and norepinephrine.
Adderall XR, Vyvanse, Dexedrine, and Dexedrine Spansules contain amphetamines. These products are available in the following strengths:
|Adderall XR||5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg|
|Vyvanse||20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg|
|Dexedrine Spansules||5 mg, 10 mg, 15 mg|
Amphetamines are also available in both long-acting and short-acting formulations. We discuss each amphetamine stimulant in more detail below.
Dextro-amphetamine is the main active ingredient in Adderall XR. Doctors can prescribe this medication to children, adolescents, and adults with ADHD. As a long-acting medication, it provides symptom control for 10–12 hours.
Sometimes, doctors will need to prescribe a short-acting amphetamine drug to provide symptom control later in the afternoon.
Vyvanse contains lisdexamfetamine, which is an inactive form of amphetamine. When a person takes Vyvanse, their body transforms the inactive medicine into dextroamphetamine. Vyvanse has similar effects to Adderall XR.
Children can gain control of their ADHD symptoms for 13 hours when taking Vyvanse. Adults who take Vyvanse can gain 14 hours of symptom control.
Dexedrine and Dexedrine Spanules
Dexedrine and Dexedrine Spansules contain dextro-amphetamine.
Dexedrine Spansules will last about 6–8 hours. The Dexedrine tablet will only last 3–5 hours, so people tend to use it once the long-acting drug wears off later in the day.
Nonstimulant medications act on a set of different pathways that offer another treatment option. Doctors may prescribe nonstimulant medications in combination with stimulants or alone.
Some people cannot tolerate the side effects of stimulant medications and can only take nonstimulants.
When people use nonstimulant medications, they may only notice their symptoms start to improve after about 6–8 weeks. As a result, this treatment is not appropriate for people who require urgent symptom control.
There are two nonstimulant drugs for ADHD available, and their strengths are listed in the following table:
|Strattera||10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg|
|Intuniv XR||1 mg, 2 mg, 3 mg, 4 mg|
Strattera may be beneficial for people with ADHD who also have anxiety, as stimulants can make anxiety worse.
Doctors can prescribe Strattera to children, adolescents, and adults. People can take both stimulant medications and Strattera if necessary.
The most notable side effects of Strattera include nausea and stomach upset. People should not open Strattera capsules because the medication may irritate the eyes. They must swallow Strattera capsules whole, which can be challenging for some people.
Doctors recommend Intuniv XR to treat ADHD symptoms in children aged 6–12.
The major benefit of this medication is that its effect can last into the evening and early morning. Children with other challenges, such as anxiety, aggression, and tics, can use Intuniv XR.
People should not chew, crush, or break the tablets. People should only swallow them whole.
People taking Intuniv XR must let their doctor or pharmacist know if they are taking any medications for their heartbeat. People should exercise caution when taking such drugs to prevent the heart rate from getting too low.
Doctors and pharmacists should remind caregivers not to abruptly stop administering Intuniv XR to their children because blood pressure and pulse may increase. Caregivers should wean children off of Intuniv XR gradually.
Intuniv XR can interfere with many drugs, including ketoconazole and valproic acid.
People taking Intuniv XR should let their doctors and pharmacists know which medications they are taking to be sure that there will be no problematic interactions.
People should also avoid eating grapefruit or drinking grapefruit juice when taking Intuniv XR.
Some research has shown that combining medication and psychosocial interventions is an effective strategy for managing ADHD symptoms.
There are five main types of interventions:
- behavioral interventions
- social interventions
- educational and vocational accommodations
Psychoeducation is effective for children over 8 years old. This intervention educates children and their caregivers on ADHD and its impacts.
Healthcare professionals design behavioral interventions such as coaching and lifestyle changes for people of all age groups with ADHD. They use rewards and consequences with the aim of improving behavior.
Social interventions can help people improve their social skills and manage their anger.
Older children and adults can benefit from self-talk, behavioral therapy, and family therapy. A psychotherapist may use play and expressive arts therapy as well as supportive counseling.
Educational and vocational institutes include special education programs and workplace interventions to provide additional help for people with ADHD.
Long-acting stimulant formulations are the first choice of treatments for people with ADHD. They allow people to benefit from the effect of the medication throughout the school or work day.
Doctors also prefer longer-acting medications due to the lower risk of misuse.
Healthcare professionals should recommend a combination of medication and psychosocial interventions to improve the lives of people with ADHD.