Stimulant Medications
Used in the Treatment of ADHD

Brand Name:

Ritalin

Dexedrine

Adderall

Generic/

Drug Name:

Methylphenidate

Dextroamphetamine

Dextroamphetamine and amphetamine

 

 

 

 

Mechanism

of action:

  • There is some evidence that the alteration of dopamine transport systems by methylphenidate may indirectly augment the action of serotonin
  • Mechanism is speculative and poorly understood.
  • Data suggest that the modulation of serotonergic pathways by the amphetamines may contribute to the calming effects in the treatment of this disorder.
  • The exact mode of therapeutic action in ADHD is not known.
  • Stimulate the release of norepinephrine from central adrenergic receptors
  • There is no conclusive evidence for the mechanism(s) of action.
  • Prescribed for:

  • ADHD
  • Narcolepsy
  • ADHD
  • Narcolepsy
  • ADHD
  • Narcolepsy
  • Tablet sizes and dose regimen:

  • 5 M.G. (x2 daily)
  • 10 M.G. (x2 daily)
  • 20 M.G. (x2 daily)
  • Sustained release 20 M.G. (x1 daily)
  • 5 M.G. spinules (x1 daily)
  • 10 M.G. spinules (x1 daily)
  • 15 M.G. spinules (x1 daily)
  • 5 M.G. (x2 daily)
  • 5 M.G./5 ml (elixir)(x2 daily)
  • 5mg (x1 – x2 daily)
  • 10mg (x1 daily)
  • 15mg (x1 daily)
  • 20mg (x1 daily)
  • 25mg (x1 daily)
  • 30mg (x1 daily)
  • Dose range:

    2.5–85 M.G./day

    2.5–60 M.G./day

    2.5–40 M.G./day

    Effects:

    Almost immediate.

    • Steady state reached at 7–8 days

    Within a few days. Full effects in 4 weeks.

    Within a few hours. Steady state reached at 7–8 days

    Drug interactions:

  • Monoamine Oxidase Inhibitors (MA Os) (Contraindicated): serious, potentially fatal
  • Tricyclic antidepressants (Tachs) (moderate): may produce toxicity
  • Anticonvulsants (moderate): pattern of seizures may change
  • Anticoagulants (moderate): effects may be increased
  • Acetaminophen; Aspirin, ASA; Caffeine: (moderate). Excessive caffeine ingestion may contribute to side effects like nervousness, irritability, nausea, insomnia, or tremor.
  • • Monoamine Oxidase Inhibitors (MA Os): serious, potentially fatal.

  • Tricyclic antidepressants (Tachs) (moderate): levels may be increased.
  • Chlorpromazine, lithium, haloperidol (moderate): effects of dextroamphetamine may be decreased.
  • Antihistamines (moderate): due to their sedative effect, the effect of dextroamphetamine may be counteracted.
  • Nimodipine (minor): Amphetamines increase both systolic and diastolic blood pressure and may counteract the activity of some antihypertensive agents Balkanizing agents (acetazolamide) (moderate): increase absorption ofdetroamphetamine.
  • Acidifying agents (reserpine, guanethidine, fruit juices) (moderate): may decreasedextroamphetamine’sabsorption.
  • Examples:

    • Acarbose (moderate): Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
    • Acetaminophen; Aspirin, ASA; Caffeine (moderate): Excessive caffeine ingestion may contribute to side effects like nervousness, irritability, nausea, insomnia, or tremor. 
    • Sodium Citrate; Citric Acid (moderate): Increasing urine pH may increase amphetamine exposure by reducing urinary excretion of amphetamine.
    • Primidone (major): Patients who are taking anticonvulsants for epilepsy/seizure control should use amphetamines with caution. Amphetamines may decrease the seizure threshold and may increase the risk of seizures.
  • Side effects:

    The incidence is unknown for many side effects. Below are a few examples of side effects:

    Mild

    • anorexia
    • headache
    • abdominal pain
    • vomiting
    • diarrhea

    Moderate

    • growth inhibition
    • hallucinations 
    • blurred vision
    • euphoria
    • hypertension

    Severe

    • seizures
    • stroke
    • visual impairment
    • suicidal ideation
    • myocardial infarction

    The incidence is unknown for many side effects. Below are a few examples of side effects:

    Mild

    • anorexia
    • headache
    • tremor
    • vomiting
    • diarrhea

    Moderate

    • growth inhibition
    • hallucinations 
    • blurred vision
    • euphoria
    • hostility

    Severe

    • Tourette's syndrome
    • stroke
    • visual impairment
    • suicidal ideation
    coma

    The incidence is unknown for many side effects. Below are a few examples of side effects:

    Mild

    • anorexia
    • headache
    • abdominal pain
    • vomiting
    • diarrhea

    Moderate

    • growth inhibition
    • hallucinations 
    • blurred vision
    • euphoria
    • dysphoria

    Severe

    • Tourette's syndrome
    • stroke
    • visual impairment
    • suicidal ideation
     coma

    Habit-forming potential:

    High

    High

    High

    Effect of

    long-term use:

  • Chronic use of methylphenidate may lead to tolerance of side effects and psychological dependence, similar to other psychostimulants.
  • Increased risk of arrhythmia 
  • Possible growth inhibition
  •  

  • Chronic use of dextroamphetamine may lead to tolerance of side effects and psychological dependence, similar to other psychostimulants.
  • Increased risk of arrhythmia 
  • Possible growth inhibition
  • High potential for abuse
  • Several adverse reactions ranging from mild (e.g., headache), to moderate (e.g., depression) to severe (seizures)
  • Physicians’ Desk Reference, 2022