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What are the benefits of stimulants?
For many people with ADHD, stimulants
dramatically improve their ability to focus at work, school and in their
social life. Symptoms that benefit include distractibility, short attention
span, hyperactivity, mood swings, and impulsivity. The medication may also
improve physical coordination, such as handwriting and ability in sports.
Are there non-stimulant options?
Atomoxetine (Strattera) is a non-stimulant medicine that appears to work as
well as stimulants for most people. Other medications can be helpful,
including antidepressants such as buproprion (wellbutrin), but they are generally not as effective for ADHD as
stimulants.
When should I see improvement?
Improvement in symptoms should
be noticeable within a few hours after taking a stimulant. If no change is
seen after a week, the medicine may need to be adjusted. After symptoms
improve, people with ADHD often find more benefits through changes they are
now able to make in their lives.
How should I take the medicine?
Dosing will depend on how long
its action lasts – see below for available options. The duration can
be improved (by about an hour) and the onset made smoother if it is taken
with food (30 min before a meal).
Some people only take stimulants on work or school days,
while others find the benefits extend into their leisure and social lives
and take them every day; either way is equally safe.
What if I miss a dose?
You may take the dose late or
wait for your next scheduled dose. Your decision will depend on how long
the medicine affects you (see chart), what activities you face that day,
and the possibility of sleep disruption if the dose is taken too late.
What side effects are possible?
Side effects include difficulty
sleeping, nervousness, appetite loss, dizziness, upset stomach, and
headache. Taking too much of the medicine can cause fear and agitation.
People with Tourette’s disorder may have more tics.
We can work together to find a dose that works with the
least side effects. If insomnia occurs, try taking the last dose before 6pm. If your appetite is lowered, you can avoid weight
loss by taking the medicine with food and continuing to eat snacks and full
meals.
Are stimulant medicines addictive?
When taken as prescribed to
treat the symptoms of ADHD, stimulants are not addictive. People with ADHD
rarely abuse stimulants, and in fact treatment lowers their rates of substance abuse. However, misuse of stimulants can lead to
abuse and addiction.
Will I need stimulants for life?
Symptoms of ADHD may improve as
you age, and trials without medication can be attempted to see if it is
still necessary. If taken as prescribed, stimulants can be safely stopped
at any time.
What types of stimulants are available?
There are three main types of
stimulants: ritalin (or methylphenidate), adderall, and dexedrine. These three medicines come in several
forms which differ in how slowly they are released in the stomach and how
long they last (see below). Although
each form often has a different brand name (e.g. concerta, metadate), the
medicine inside is the same. (An exception is Focalin which is an isomer of
methylphenidate. Each molecule comes in mirror image forms – right
and left. In Focalin, only the more
active form is used).
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Methylphenidate Compounds
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Name
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Reaches
its peak in (hours):
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Effects
last for (hours):
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Sizes
(mg)
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Methylphenidate
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1-2
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3-5
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Tablets: 5, 10, 20
Brands: Ritalin, Methylin chews
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Methylphenidate SR
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4-5
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4-8
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Tablets by brand:
Generic 20, Ritalin SR 20, Methylin ER 10, 20.
Metadate ER 20.
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Ritalin LA
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2, 5.5 (2 peaks)
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8-12
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Capsule: 20, 30, 40
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Concerta
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6-8
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12
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Capsule: 18, 27, 36, 54
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Metadate CD
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1.5, 4.5 (2 peaks)
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8
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Capsule: 20
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Focalin (an isomer, or chemical variant, called
dexmethyl-phenidate)
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1-2
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3-5
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Tablet: 2.5, 5, 10
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Dextroamphetamine and
Amphetamine Mixture
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Name
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Reaches
its peak in (hours):
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Effects
last for (hours):
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Sizes
(mg)
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Adderall
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3
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4-6
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Tablets: 5,
7.5, 10*, 12.5, 15, 20*, 30* (*scored tabs).
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Adderall XR
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7
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8-12
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Capsules: 5,
10, 15, 20, 25, 30
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Dextroamphetamine
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Name
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Reaches
its peak in (hours):
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Effects
last for (hours):
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Sizes
(mg)
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Dextroamphetamine
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3
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10-14
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Tablets: 5, 10
Brand:
Dexedrine
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Dextroamphetamine SR
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8
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10-14
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Capsules: 5,
10, 15
Brand: Dexedrine
Spansule
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What else should I know?
To learn specific information
about side effects, drug-interactions, pregnancy, and effects on medical
problems, go to Index of
Drug Information and look up your stimulant by name.
Resources for ADHD
Books:
Driven to Distraction by E.M. Hallowell & J. Ratey. (1994). Also Answers to Distraction by same
author.
Attention
Deficit Disorder in Adults by L. Weiss & K. Bonnet. (1997)
Out
of the Fog: Treatment Options and Coping Strategies for Adult Attention
Deficit Disorder by K.R. Murphy
& S. LeVert. (1995).
You mean I’m not lazy, stupid or crazy?!: A Self-help Book for Adults with
Attention Deficit Disorder, by K. Kelly & P. Ramundo. (1996).
Internet sites:
www.chadd.org/fs/fs7.htm
www.nimh.nih.gov/publicat/adhd.cfm
www.psych.org/public_info/adhdfactsheet42401.pdf
Organizations:
CHADD (Children and Adults w/ ADHD)
8181 Professional Place, Suite 201
Landover, MD 20785
(301) 306-7070, (800) 233-4050
www.chadd.org, email national@chadd.org
National Attention Deficit Disorder Association
1788 Second Street, Suite 200
Highland Park, IL 60035
(847) 432-2332
www.add.org,
email: mail@add.org
Updated 9/21/4 by Chris Aiken,
M.D.
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