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Clinical Assistant Professor, Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, State University of New Jersey, Piscataway, NJ
Assistant Professor, Department of Pharmacy and Health Outcomes, Touro College of Pharmacy, New York, NY
Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Connecticut, Storrs, CT
Ernest Mario School of Pharmacy, Rutgers, State University of New Jersey
Ernest Mario School of Pharmacy, Rutgers, State University of New Jersey
Ernest Mario School of Pharmacy, Rutgers, State University of New Jersey
Ernest Mario School of Pharmacy, Rutgers, State University of New Jersey
Reprints: Dr. Chavez, Monmouth Medical Center Pharmacy Department, 300 Second Ave., Long Branch, NJ 07740, fax 732/923-7810, bchavez{at}rci.rutgers.edu or ufrxchavez{at}aol.com
OBJECTIVE: To review recent literature on the different stimulant preparations regarding efficacy and safety in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) and describe advantages and disadvantages of the many available dosage formulations.
DATA SOURCES: Literature retrieval was performed through PubMed/MEDLINE (2005-December 2008) using the terms methylphenidate, amphetamines, central nervous system stimulants, and attention-deficit/hyperactivity disorder. In addition, reference citations from publications identified were reviewed and drug manufacturers were contacted for any possible additional references.
STUDY SELECTION AND DATA EXTRACTION: Double-blind clinical trials found using the search criteria listed above were included for review. Open-label studies and studies prior to 2005 were included if no double-blind trials were published for that formulation within the time period reviewed.
DATA SYNTHESIS: The literature reviewed here demonstrates the efficacy and safety of stimulant medications in children and adolescents with ADHD. However, there are 19 different formulations of stimulants, leading to confusion and errors in prescribing and dispensing of these drugs. Knowing and understanding the advantages and disadvantages of the different formulations can lead to individualized treatment. Formulations like Concerta, Focalin-XR, Adderall-XR, and Vyvanse provide the convenience of once-daily dosing. Each of these provides varying amount of stimulants at different times of the day. Vyvanse has a unique delivery system that may lower the risk of patients abusing their medication. Daytrana gives patients more control over their dosing by being able to choose when the patch is removed; it is also a feasible alternative for children who cannot swallow pills. For patients who cannot swallow tablets or capsules, the capsules of Focalin-XR, Adderall-XR, Metadate-CD, and Ritalin-LA can be opened and sprinkled on applesauce.
CONCLUSIONS: Stimulants are effective medications to treat the symptoms of ADHD. The multiple available dosage forms allow for individualization of treatment.
Key Words: amphetamine, attention-deficit/hyperactivity disorder, central nervous system stimulants, methylphenidate
Published Online, May 26, 2009. www.theannals.com, DOI 10.1345/aph.1L523
THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE
UNIVERSAL PROGRAM NUMBER: 407-000-09-009-H01-P
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