Background

• Many children do NOT outgrow ADHD
• Diagnostic criteria
• Symptoms present > 6-mos
• Signs and symptoms present before age 7
• Impairment present in 2 or more settings
• Significant impairment in social, academic, occupational function

 

Non-stimulant

• Atomoxetine (Strattera)
  • BBW: suicidal risk
  • CI: MAOI inhibitor,2-wk washout period
  • Capsules cannot be opened (irritant)
  • SE similar to stimulant
• Fish oil
• Antidepressant
• Clonidine ER (Kapvay)
  • 1-0.2mg BID, start HS
  • SE: bradycardia, dry mouth, drowsiness, psychotic reaction, depression.
• Guanfacine ER (Intuniv)
  • Do not take w/ high fat meal (increased absorption)
  • 3A4 substrate

 

Stimulants

• Drugs: amphetamine/ dextroamphetamine(Adderall), dextroamphetamine IR (Dexedrine, Dextrostat), dexmethylphenidate (Focalin), lisdexamfetamine (Vyvanse), methylphenidate (Ritalin, Methylin, Metadate, Concerta, Daytrana patch).
• MOA: stimulate release of norepinephrine and dopamine lead to CNS stimulation.
• BBW: sudden death, stroke/heart attack, increased BP&HR, worsening of psychiatric problem; Dispense MedGuide
• SE: increased BP/pulse, decreased appetite, weight loss, anxiety, insomnia, tics, personality change (think about ramp your body up)

 

Narcolepsy

• Stimulant used to improve wakefulness associated w/ sleep apnea/hypopnea syndrome and sleep disorder

modafinil (Provigil) armodafanil (Nuvigil)- R-isomer of modafinil

C-IV SE: insomnia Dispense w/ MedGuide

 

 

 

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