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Compare ADHD Medications

Compare ADHD Medications: stimulants vs non-stimulants.
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ADHD, or Attention deficit hyperactivity disorder, is the most commonly diagnosed behavioral disorder, characterized by lack of concentration, impulsivity, and hyperactivity. Symptoms first appear before age 7 and may continue into adulthood. 

There are several stimulant and non-stimulant medications available for ADHD treatment. However, these ADHD medications come with some side effects and risks. 

It must be remembered that stimulant medication cannot treat ADHD completely. It can only alleviate symptoms while it’s being taken. 

Finding the right medication and dose for your child with ADHD can be difficult, but knowing the different types of ADHD medications and their benefits might help. 

Stimulant medications: 

Stimulants are perhaps the most effective and common medications used to treat ADHD. However, they also have the potential to be abused, particularly when used at higher-than-prescribed doses. 

All the stimulant medications available in the market are controlled substances, which mean there are special rules for prescribing and dispensing them. 

The stimulant are available in short-acting and long-acting forms. The short-acting ones must be taken two to three times a day, and they last 4 to 5 hours per dose. 

Long-acting stimulants are taken only once a day and they last between 7 and 12 hours. Sometimes doctors may prescribe a combination of long-acting and short-acting stimulant medications. 

For kids who have difficulty swallowing pills, you can use a patch that may be applied to the skin, liquid medications, chewable pills, or capsules that can be opened and sprinkled on food. 

Compare ADHD Stimulant Medications: 

Ritalin: 

Ritalin (methylphenidate hydrochloride) is a prescription medicine used for the treatment of ADHD or attention deficit hyperactivity disorder. 

Methylphenidate is a psychostimulant with a chemical structure similar to the amphetamines contained in Adderall. Just like the amphetamines, it inhibits the removal of dopamine and norepinephrine at the synapses of neurons in the brain.

However, it differs from the amphetamine in two ways. First, it binds to the transporters responsible for mopping up dopamine and norepinephrine at the synapses while the amphetamines simply serve as substitutes at the transporters in place of those neurotransmitters.

Secondly, methylphenidate targets the prefrontal cortex of the brain to produce its effect. Outside this part of the brain, Ritalin has very little effect. Since the prefrontal cortex is responsible for the abilities to make decisions, to focus and to control one’s impulses, Ritalin’s specificity is an advantage.

Ritalin has a secondary mechanism of action apart from blocking the removal of dopamine and norepinephrine from synapses. This other action involves stimulating the release of dopamine from nerve terminals.

The combined effect of Ritalin is, therefore, to increase the concentrations of these neurotransmitters at the synapses as well as allow them to persist there for longer.

According to Nemours Foundation, Ritalin works by maintaining normal levels of dopamine and norepinephrine within the brain. 

Children and adults suffering from ADHD are reported to have deficiencies in producing these neurotransmitters. 

For most children, this medicine is effective in alleviating ADHD symptoms, and they tolerate it well.  However, some side effects might occur, such as vomiting, nausea, dizziness, loss of appetite, headache, etc. 

Concerta: 

When you compare ADHD medications like Ritalin and Concerta, you will find differences even though they are similar.

Concerta also contains methylphenidate. Therefore, its mechanism of action and efficacy are similar to those of Ritalin.

Unlike Ritalin, Concerta comes in the form of capsule which slowly releases methylphenidate, over an extended period of time so your child does not have to keep taking Ritalin frequently. 

Concerta is the newer, long-acting preparation of methylphenidate. Its effect can last for up to 12 to 14 hours. 

Concerta is available in 27mg, 36mg, and 54mg pills to provide flexible dosing options. If you are unsure of the correct dosage, consult with your health care practitioner. 

Adderall: 

Adderall contains a mix of amphetamine salts, and it is known to work just like Ritalin. It is available in instant-release and extended-release form. 

Since its introduction in the 90s, Adderall has become increasingly popular; and it is just a little stronger than Ritalin. 

When compared, Adderall is slightly more potent than Ritalin. But this only means that you take less of it than Ritalin. 

Adderall is a psychostimulant containing four amphetamine salts. These are amphetamine aspartate monohydrate, amphetamine sulfate, dextroamphetamine sulfate and dextroamphetamine saccharate.

This drug contains 75% dextroamphetamine and 25% levoamphetamine.

The amphetamines serve as substrates for dopamine and norepinephrine transporters in place of those neurotransmitters. This means that they are removed from the synapses instead of dopamine and norepinephrine. In this way, Adderall allows the neurotransmitters to act longer.

However, the amphetamines in Adderall also have a secondary mechanism of action. This involves stimulating the release of dopamine and norepinephrine from brain cells into the synapses at nerve endings.

Therefore, Adderall’s overall effect is to increase both the duration of activity and levels of dopamine and norepinephrine at nerve endings.

Because Adderall contains amphetamines, it can be easily abused. College students are known to commonly use it as “study drug” to help improve alertness and concentration.

Some other common side effects include anxiety, insomnia, skin rashes, migraine headaches, dry mouth, and agitation. 

Vyvanse: 

Vyvanse is a central nervous system stimulant. It is known to affect chemicals in the brain and nerves which cause hyperactivity and impulsiveness in children. 

Vyvanse is used to treat ADHD or attention deficit hyperactivity disorder in adults and children above 6 years of age. 

Vyvanse contains lisdexamphetamine dimesylate, a produg made from the combination of dextroamphetamine and L-lysine.

The two main reasons for combining amphetamine with an amino acid are to protect dextroamphetamine from enzymes that can break it down before it reaches its target site of action and secondly, to reduce the abuse potential of dextroamphetamine.

Because Vyvanse contains only dextroamphetamine, it has fewer side effects than Adderall which contains the two forms of amphetamine. However, some people respond better to the mixture of amphetamines in Adderall.

Vyvanse is broken down by enzymes in the red blood cell into dextroamphetamine and lysine.

From there, the amphetamine produces effects similar to those of Adderall. This means that Vyvanse also increases the levels of dopamine and norepinephrine in the synapses as well as inhibit the action of the transporters responsible for removing these neurotransmitters.

Vyvanse is available in capsules of the following strengths: 20 mg, 30 mg, 40 mg, 50 mg, 60 mg and 70 mg.

Vyvanse should not be used if you have used an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), and rasagiline (Azilect), or selegiline (Eldepryl, Emsam) within the past 2 weeks. 

Compare ADHD Non-Stimulant Medications: 

Many parents and healthcare providers prefer non-stimulant ADHD medications for various reasons. The non-stimulants are much less likely to be abused, compared to the stimulants. 

Some of the commonly used non-stimulant ADHD medications are Strattera (atomoxetine hydrochloride), Intuniv (guanfacine ER), and Kapvay (clonidine ER). 

Strattera is approved for kids aged 6 and older, teenagers, and adults. Kapvay and Intuniv are approved to treat ADHD only in kids and adolescents 6 through 17 years of age.

Unlike the stimulants used for treating ADHD, Atomoxetine is a selective norepinephrine reuptake inhibitor.

Its mechanism of action is similar to the stimulants. Therefore, it inhibits dopamine and norepinephrine transporters. Atomoxetine also increases the levels of norepinephrine and dopamine in the prefrontal cortex by as much as three-folds.

Since it is not a psychostimulant, Atomextine can be stopped suddenly without a gradual reduction of its doses.

Strattera also differs from stimulants such as Adderall in other ways. For example, the drug takes a while to produce therapeutic effects and ADHD patients may have to use it for 6 to 8 weeks before determining whether it works for them or not.

Next Article: Concerta vs Vyvanse
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