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.
List of ADHD medications
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.
Many people have both ADHD and depression or anxiety. For this reason, doctors may prescribe an antidepressant or anti-anxiety medication with a stimulant for ADHD treatment.
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.