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ADHD Medications List: Approved & Off-Label Treatments

ADHD (Attention Deficit Hyperactivity Disorder) is characterized by symptoms of inattentiveness and hyperactivity. Most professionals would agree that there are at least three subtypes of ADHD including: inattentive-type, hyperactive/impulsive-type, and a combined type. While ADHD was once thought to be a problem at only affected children, it is now widely accepted that people of any age can be diagnosed with the condition – including teenagers and adults.

There are a number of contributing factors that may cause or increase ADHD symptoms such as: dietary intake, exercise habits, brain waves, and genetics.  Although making healthy lifestyle changes such as: optimizing your diet, getting plenty of sleep, and exercising regularly could reduce symptoms of ADHD, these changes may not be enough to fully get the condition under control.  Those who suffer from extreme forms of ADHD may benefit significantly from considering pharmaceutical ADHD medications.

ADHD Medications List

Below is an extensive list of ADHD medications. Keep in mind that not everyone responds the same to medications. For one person a psychostimulant may be exactly what their brain chemistry needed to improve inattentive symptoms, while for another person an alternative classification of medication may offer superior benefit.

Psychostimulants

This class of medication functions by increasing the amount of dopamine in the brain and stimulating the central nervous system. As dopamine levels increase, a person is better able to concentrate, organize their thoughts, and stay productive. This is perhaps the most potent, and also the most effective class of ADHD medications.

1. Amphetamines

Amphetamines are the most common class of ADHD medications and function by stimulating the central nervous system. Amphetamine was founded in the late 1880s and was documented as having multiple stereo-isomers including: “dextro”-amphetamine and “levo”-amphetamine. “Amphetamines” is a term that is generally used to describe any combination of these stereo-isomers.

This classification of medications is known to be the most potent, and most effective for treating symptoms of attention-deficit hyperactivity disorder. However, due to the strong potential for abuse and rapid-tolerance development, many countries consider them a “controlled substance.” The amphetamines generally increase stimulatory neurotransmitters of both dopamine and norepinephrine.

Adderall (Mixed Amphetamine Salts)

This is perhaps the most popular pharmaceutical medication prescribed for the treatment of attention-deficit disorders. It is also prescribed for an array of other conditions such as narcolepsy. It is known to significantly improve cognition when taken at an acceptable dosage. This medication contains 75% dextroamphetamine salts and 25% levoamphetamine salts; it is often referred to as “mixed amphetamine salts.”

Most people who take Adderall notice substantial improvement in their ADHD symptoms, which is why the drug has become the most popular. Most doctors will consider this medication a first-line treatment option for patients that have clear-cut ADHD diagnoses with non-addictive personalities. Adderall is sold in the form of “immediate-release” (IR) which works immediately and lasts several hours, as well as “extended release” (XR) which lasts for 10 to 12 hours.

Dexedrine (Dextroamphetamine)

This is a very potent stimulant used for the treatment of ADHD among individuals of all ages. Like other psychostimulants, it is also used for cases of narcolepsy. While Adderall actually contains 75% of this formulation, this formulation doesn’t contain the “levo”-stereoisomer.

Some people may find that a pure form of the “dextro”-stereoisomer may work better than the mixed salts of Adderall. For this reason, many people still take this drug to treat their ADHD symptoms. Like other psychostimulants, it does pose risk for rapid-tolerance and abuse, hence it being a controlled substance.

Dexedrine comes in the form of “Dextrostat” which is essentially a name brand with the same formulation as Dexedrine, lasting between 4 to 6 hours. However, there is a formulation called “Dexedrine Spansule” that is longer-lasting, between 6 and 8 hours.

Vyvanse (Lisdexamfetamine)

This is a newer medication that is prescribed for ADHD and is manufactured by Shire. It is considered a “prodrug” and is thought to have smoother absorption and eliminate some of the euphoric effects of other stimulants. Some may consider this medication to be an improved version of other amphetamines.

Vyvanse is comprised of the amino acid L-lysine and dextroamphetamine. They way this pro drug works is that the “Lisdexamfetamine” is fully absorbed and then your body (liver) manufactures the dextroamphetamine. The greater the amount of the drug you take, the longer your body produces the dextroamphetamine.

Some people actually prefer this medication over Adderall due to the fact that it has a smoother release, longer lasting effect (10-12 hours), and less of a crash. Additionally it is thought to be of less potency than Adderall, and thus may be preferred for younger individuals.

2. Methylphenidates

There is another commonly prescribed class of medications that contain “methylphenidate” – a psychostimulant. While methylphenidate may not be an amphetamine, it is considered very similar in that it promotes wakefulness, increased concentration, stimulation of the central nervous system, and increases concentrations of dopamine in the brain. The “methylphenidate” chemical has been around for nearly half a century and is considered highly effective and safe for managing symptoms of ADHD.

Most people are familiar with the drug “Ritalin” which was among the most common medications in the 1990s to treat hyperactivity and attentional deficits. The way methylphenidate functions is primarily by blocking the reuptake of the neurotransmitters catecholamine, dopamine, and norepinephrine. Since many individuals with ADHD may have lower levels of these neurotransmitters, this medication increases them to adequate levels.

  • Concerta: This is a brand-name form of methylphenidate that is manufactured by Watson. The tables are considered approximately 22% immediate-release, with the other 78% being gradually released over a period spanning between 10 and 12 hours. The idea behind this medication is to provide an individual with immediate relief of ADHD symptoms and also provide relief throughout the day.
  • Daytrana (Patch): This is methylphenidate in the form of a transdermal patch that was created by Noven Pharmaceuticals. It was initially approved for the treatment of ADHD in 2006 and is sometimes called “MTS” (methylphenidate transdermal system). While transdermal patches have some appeal compared to oral formulations, they are not often utilized unless oral formulations are poorly tolerated. The patches work for an approximate 9 hour period and some prefer them for the sake of convenience.
  • Focalin (Dexmethylphenidate): This is a unique formulation that contains the “dextro” stereoisomer of methylphenidate. It functions primarily as a NDRI (norepinephrine-dopamine reuptake inhibitor) and results in stimulation of the central nervous system. It was created by Novartis and is approved for the treatment of ADHD. It is also manufactured in an “extended release” (XR) formulation that lasts up to 10 hours.
  • Metadate: This is yet another formulation of methylphenidate that is manufactured in various forms. The “CD” (controlled-release) version of the drug contains different types of beads. Approximately 30% of the beads are “immediate-release” and the remaining 70% are thought to be “sustained release.” Thus, this formulation provides immediate relief from symptoms as well as longer-lasting relief when the sustained release beads kick in. The “CD” version is thought to last 8 to 10 hours, which is longer than the “ER” (extended-release) version at 6 to 8 hours.
  • Methylin: This is another brand-name formulation of methylphenidate that is manufactured for the treatment of ADHD. It is manufactured by Mallinckrodt Pharmaceuticals and generally is called “Methylin ER” or “extended-release.” Its effect lasts approximately 6 to 8 hours, which is relatively similar to other forms of methylphenidate on the market.
  • Ritalin: This is perhaps the most common methylphenidate medication on the market. It peaked in popularity throughout the 1990s, but is still regarded as a very effective pharmaceutical option for managing symptoms of ADHD. It comes in several formulations that are prescribed based on individual needs. The “immediate release” (IR) formulation of Ritalin works approximately 2 to 4 hours, while the “sustained release” (SR) version is capable of working between 3 and 8 hours. Another version known as (LA) “long acting” Ritalin is capable of working between 8 and 10 hours. While the formulation of Concerta is thought to last the longest between 10 and 12 hours.
  • Quillivant XR: This is a brand-name formulation of methylphenidate that is manufactured by Pfizer. It is considered unique because it is a liquid formulation that is taken once-daily and offers an “extended release.” It was approved in 2012 by the FDA for the treatment of attention-deficit hyperactivity disorder. A bottle of Quillivant contains a combination of 20% instant-release methylphenidate, with the remaining 80% being extended-release methylphenidate. The bottle comes with an oral syringe to help you measure dosages.

3. Alternative/Atypical ADHD Medications

Although psychostimulant medications are considered the best at reducing symptoms of ADHD, some people do not like the idea of the drugs lowering their dopamine levels over the long-term.  Others may not be well-suited for psychostimulants due to the fact that they have a preexisting anxiety disorder and/or an addictive personality.  Alternative or atypical ADHD medications have different mechanisms of action compared to psychostimulants and are considered non-addictive with more favorable side effect profiles.

  • Clonidine (Catapres / Kapvay): This is an antihypertensive medication that also is approved by the FDA to treat ADHD. It functions as an Alpha-2 agonist and can be used as a standalone treatment option or prescribed with a psychostimulant like Adderall. This medication is known to be helpful for cases of hyperactivity because it reduces activity in the central nervous system, leading some to feel a “calm” focus. It is considered relatively safe over the long-term and has been in medical use for decades.
  • Intuniv (Guanfacine): This is a medication that is considered atypical compared to most that are used to treat attention-deficit hyperactivity disorder. It is also clinically approved for the treatment of hypertension, and there is mounting evidence to suggest that it may be effective for various types of anxiety. It functions as an Alpha-2A receptor agonist and is known to lower blood pressure. Those who don’t tolerate and/or like the effects of psychostimulants may prefer a medication like Intuniv. The drug is considered long-acting and its effects last 24 hours, therefore there is no crash throughout treatment.
  • Strattera (Atomoxetine): This is another medication that is considered highly unique in regards to the mechanism by which it works to treat ADHD. It functions as a norepinephrine reuptake inhibitor (NRI), thus increases the amount of norepinephrine between synapses. This leads to increased levels of arousal and stimulation within the central nervous system. Many doctors prefer this medication to others because it is thought to have minimal abuse potential and significantly less withdrawal symptoms than psychostimulants. The only drawbacks are that it doesn’t tend to directly influence dopamine and it may take several weeks before it elicits a therapeutic effect.  There is also some evidence to suggest that Strattera may improve depression in certain individuals.

Off-Label ADHD Medications

There are a couple classes of drugs that are prescribed “off label” for the treatment of ADHD. These include (but are not limited to) antidepressants as well as eugeroics. Eugeroics are considered newer, and long-term effects of this class is somewhat unknown. However, many psychiatrists find them appealing because they improve cognition and have less abuse potential compared to psychostimulants.

4. Eugeroics

This class of medications is often prescribed to individuals with wakefulness disorders such as narcolepsy and/or shift-work sleep disorder. Despite the fact that the eugeroic class of medications is relatively new and long-term effects aren’t well established among these drugs, many people have success with them for managing symptoms of ADHD.

While they are not approved for the treatment of ADHD, there is some evidence to suggest that they may act as nootropics in certain individuals – increasing productivity, concentration, and overall cognitive function. Some doctors may actually prefer this class of medications to psychostimulants because they are not as potent, they are non-habit forming, and withdrawal is considered easier.

  • Nuvigil (Armodafinil): This is a eugeroic drug that was approved by the FDA in 2007 to treat excessive daytime sleepiness. It is considered a successor to the drug Provigil and contains only the “R”-stereoisomer. It functions similar to amphetamines, but clearly has different mechanisms of action. It promotes indirect agonism of dopamine receptors and prevents reuptake – leading to increases in dopamine levels.
  • Provigil (Modafinil): This is a eugeroic drug that has been around since 1998 in the United States. It is medically approved to treat wakefulness-related disorders and other forms of excessive daytime sleepiness. Research has shown that it is capable of treating ADHD and has a better side effect profile than other options. However, the FDA would not approve it due to the fact that in trials a small percentage of people developed a life-threatening skin condition called “Stevens-Johnson syndrome.” Psychiatrists have been prescribing this medication for years to treat ADHD to patients that don’t have any adverse skin reactions.

5. Antidepressants

In some cases antidepressant medications are thought to help people with ADHD. While many are not clinically approved by the FDA for the treatment of attention-deficit hyperactivity disorder, some people find them effective. Additionally, many are used as an augmentation strategy to treat individuals that have comorbid depression or difficulty concentrating as a result of their depression.

  • Desipramine: This is a tricyclic antidepressant (TCA) that functions primarily as a reuptake inhibitor of the neurotransmitter norepinephrine. It also affects serotonin, but to a significantly lesser extent. The fact that it prevents the reuptake of norepinephrine is why it has been thought to be effective in reducing certain symptoms of ADHD. While it is not approved for the treatment of ADHD, some have found it effective – especially in cases of comorbid depression. It is sometimes sold under the name-brand Norpramin.
  • Imipramine: This is a tricyclic antidepressant that is primarily prescribed to treat depression. However, due to the variety of neurotransmitters it affects, it may provide some benefit to those with symptoms of ADHD. Although it primarily affects serotonin to improve mood, the fact that it also is a potent norepinephrine reuptake inhibitor and increases concentrations of dopamine could account for its ability to mitigate ADHD symptoms in certain people.
  • Nortriptyline: This is another tricyclic antidepressant (TCA) that primarily affects norepinephrine. When taken at substantial dosages, this medication is very activating and provides individuals with increased stimulation. While it is primarily used as a second or third line treatment for depression, some speculate that it may provide benefit for individuals with ADHD. Many people know of this medication by its name “Pamelor.”
  • Wellbutrin (Bupropion): This is considered an atypical antidepressant medication and is primarily prescribed to individuals that fail to respond to an SSRI. It functions as an NDRI (norepinephrine-dopamine reuptake inhibitor), affecting norepinephrine to a significantly greater extent than dopamine. However, the fact that it increases concentrations of stimulatory neurotransmitters may lead to improvements of ADHD symptoms. Wellbutrin for ADHD has been investigated as an off-label treatment, and may be especially effective among individuals with comorbid depressive disorders.

Who should take ADHD medications?

Although people with ADHD may need medication to treat their symptoms, in many cases usage of these drugs, particularly stimulants will result in dependence over the long-term. While the safety and tolerability of these drugs are considered favorable, it is recommended to explore various Adderall alternatives prior to pursuing more potent pharmaceutical options. The only people that should really take ADHD medications are those who have already pursued alternative treatments without adequate success.

In general, individuals with ADHD do not need to pursue treatment for their disorder unless symptoms are interfering with important aspects of life such as: occupational functioning, school performance, and/or relationships. It is also recommended that a person with ADHD work with a psychiatrist as opposed to a general practitioner to devise a specific treatment strategy.  Psychiatrists are professionally trained to determine which medication and dosage would be optimal for your specific symptoms of ADHD.

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