Stimulant therapy is the most commonly used treatment for ADHD.
Stimulants are an effective way of managing ADHD symptoms such
as short attention span, impulsive behavior, and hyperactivity. They may be used
alone or in combination with behavior therapy.
These drugs improve ADHD symptoms in about 70% of adults and
70%-80% of children shortly after starting treatment. Improvements include
reduced interrupting, fidgeting, and other hyperactive symptoms, as well as
improved task completion and home relationships.
Improvements in behavior and attention span usually continue as
long as the medication is taken, although benefits in social adjustment and
school performance have not yet been shown to endure over the long term.
These medications are not considered to be habit-forming when
used to treat ADHD in children and adolescents, and there is no evidence that
their use leads to drug abuse. Nonetheless, there is a potential for abuse and
addiction with any stimulant medication, especially if a person has a history of
substance abuse. Recent research, nevertheless, shows that individuals with ADHD
had a lower incidence of substance use disorder if they were medically treated
than if they were not treated.
Common stimulants
There are many stimulants available: short acting (immediate-release), intermediate-acting, and long-acting forms. Common stimulants include:
- Adderall® (intermediate-acting)
- Adderall®XR (long-acting)
- Concerta® (long-acting)
- Daytrana® (long-acting patch)
- Dexedrine® (short-acting)
- Dexedrine® spansule (intermediate-acting)
- Metadate CD® (long-acting)
- Metadate ER® (intermediate-acting)
- Methylin ER® (intermediate-acting)
- Ritalin® (short-acting)
- Ritalin LA® (long-acting)
- Ritalin SR® (intermediate-acting)
- Vyvanse® (long-acting)
The short-acting forms of the drug are usually taken two or
three times a day and the long-acting ones just once a day.
Newer forms of some stimulant drugs may reduce side effects and
relieve symptoms for a longer period of time. They include Concerta (10-12 hour
duration), Ritalin LA (6-8 hours), Metadate CD (6-8 hours), and Adderall XR
(10-12 hours), Vyvanse (up to 13 hours), and Daytrana (10-12 hours).
How do they work?
Stimulants regulate impulsive behavior and improve attention
span and focus by increasing the levels of certain chemicals in the brain,
primarily dopamine, which transmit signals between nerves.
Who should not take a stimulant drug?
People with any of the following conditions should not take stimulants:
- Glaucoma (a condition that causes increased pressure in the eyes and can
lead to blindness)
- Severe anxiety, tension, agitation, or nervousness
- Treatment with a type of medication called monoamine oxidase inhibitors,
such as Nardil or Parnate, within 14 days of starting stimulant therapy
- People with motor tics or a personal or family history of Tourette's Syndrome
What are the side effects?
- Headache
- Upset stomach
- Increased blood pressure
These typically resolve after a few weeks of treatment as the body adjusts to the medication.
Other side effects may respond to a dosage adjustment or by
changing to another type of stimulant. They include:
- Decreased appetite. This affects about 80% of people who take stimulant therapy.
- Weight loss. This is an issue that can often be managed by taking the
medication after meals or adding protein shakes or snacks to the diet.
- Nervousness
- Sleeplessness
Growth reduction has been observed in some children and
adolescents who take stimulants, but it has not been shown to affect final
height. Children and adolescents should be followed for weight loss and growth
while taking stimulants.
Allergic reactions, with skin rashes and other, more serious allergic symptoms, can occur with stimulants, so it is best to notify your doctor if any new or unusual symptoms occur.
Tips and precautions
When taking stimulant therapy for ADHD, be sure to tell your health care provider:
- If you are nursing, pregnant, or plan to become pregnant
- If you are taking or plan to take any dietary supplements, herbal
medicines, or nonprescription medications
- If you have any past or present medical problems, including high blood
pressure, seizures, heart disease, glaucoma, or liver or kidney disease
- If you have a history of drug or alcohol abuse or dependency, or if you
have had mental health problems, including depression, manic depression, or
psychosis.
If you miss a dose, just go back to the regular prescribed
dosage schedule - don’t try to catch up by taking additional doses.
The following are useful guidelines to keep in mind when giving your child stimulants for ADHD:
- Always give the medication exactly as prescribed. If there are any
problems or questions, call your doctor.
- When starting stimulant therapy, do so on a weekend so that you will
have an opportunity to see how the child responds.
- Your doctor will probably want to start the medication out at a low dose
and increase gradually until symptoms are controlled.
- Try to keep to a regular schedule, which may mean that doses will have
to be given by teachers, nurses, or other caregivers.
- Children usually respond better to continuous medication use, but
"medication vacations" may be planned for a day or more for children who are
doing well when activities permit.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 10/13/2008…#11766
