Update on ADHD Medications
Sheila Woods MD, FAAP – SCAAP ADHD Liaison
Newer ADHD medications have improved our choices of medications for children, adolescents, and adults.
Newer Short-Acting Amphetamines:
(No generics available yet)
- Evekeo is a balanced d-dextroamphetamine and l-levoamphetamine amphetamine sulfate (most amphetamines are 3:1 d- to l- amphetamine) in short acting category but lasting around 8 hours. Available in 5 mg and 10 mg tablets and now available in the new Evekeo ODT (orally dissolving tablets) in 5 mg, 10 mg, 15 mg, and 20 mg. Regular Evekeo 10 mg tablet is scored and able to be divided into fourths. Evekeo is one of a few ADHD medications approved down to age 3 and up to age 17.
- Zenzedi is a d-amphetamine sulfate also approved down to age 3 and available (but hard to find) in 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg and 30 mg dosage tablets. Approved ages 3-17. (Arbor Pharmaceuticals-Savings cards are available for Evekeo, Evekeo ODT, and Zenzedi)
Newer Long-Acting Amphetamines:
(No generics available yet)
- Vyvanse chewable (strawberry flavor) are the same product as Vyvanse capsules. Lisdexamfetamine is a long acting amphetamine usually lasting around 10-12 hours and is now available in chewables of 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, and 60 mg doses. Regular Vyvanse capsules are available in 10mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, and 70 mg doses. Vyvanse is a pro-drug and LESS likely to be abused. Approved for ages 6 and up. (Takeda Pharmaceuticals-Savings cards are available)
- Dyanavel XR is a long acting amphetamine product with a ratio of 3.2 dextroamphetamine (d-) to 1 levoamphetamine (l-) in a liquid that is bubblegum flavored and 2.5 mg per 1 ml. This product provides a smoother onset and smooth distribution of medication throughout the 12hour duration. Starting dose is 2 ml and titration is 1 ml every 4-7 days as needed. Approved for ages 6-17 years. (Tris Pharmaceuticals-Savings cards are available)
- Adzenys XR-ODT is a long acting amphetamine product comparable to Adderall XR except it is NOT a mixed amphetamine salt. This product is a 3:1 d- and l- amphetamine product embedded in an orally dissolving orange flavored tablet. This product has a rapid and smooth onset, smooth offset, and is consistent throughout the 8-10hour day. 50% of the 3 to 1 ratio of d- to l- amphetamine micro-particles are immediate release and 50% are extended release in dosages of 3.1 mg (equivalent to 5 mg of Adderall XR), 6.3 mg (equivalent to 10 mg of XR), 9.4 mg (equivalent to 15 mg of XR), 12.5 mg (equivalent to 20 mg of XR), 15.7 mg (equivalent to 25 mg of XR) and 18.8 mg (equivalent to 30 mg of
XR). Approved for ages 6 and up.
- Adzenys ER is a long-acting amphetamine product comparable to Adderall XR that is not an amphetamine salt and comes in an orange-flavored liquid. 1.25 mg/ ml of 3:1 d- to l- amphetamine liquid. 2.5 ml is equivalent to 3.1 mg of Adzenys XR-ODT or 5 mg of Adderall XR. (Neos Pharmaceuticals makes both the ODT and ER liquid product-Savings cards are available)
- Mydayis is a long acting amphetamine and contains equal amounts of four salts: dextroamphetamine sulfate, amphetamine sulfate, dextroamphetamine saccharate, and amphetamine aspartate monohydrate resulting in a 3:1 mixture of d- to l- amphetamine equivalent. Capsules contain immediate-release beads and 2 types of extended release beads. Capsules are available in 12.5 mg, 25 mg, 37.5 mg, and 50 mg and provide 14-16hour coverage. Approved for ages 13 and up. (Takeda Pharmaceuticals-Savings cards are available)
Newer Long-Acting Methylphenidates:
- Adhansia XR is a long-acting methylphenidate product with a mixture of d- and l- methylphenidate particles designed with 2 distinct peak concentrations that are smooth throughout the day and allow the medication to last 12-14 hours. Adhansia XR is available in capsules that can be opened and sprinkled on food or swallowed. Dosages are available in 25 mg, 35 mg, 45 mg, 55 mg, 70 mg, and 85 mg capsules and this drug is approved for ages 6 and up. (Adlon Therapeutics, a subsidiary of Purdue Pharma, has savings cards available)
- Cotempla XR-ODT is a long acting methylphenidate product with micro particles embedded in an orally dissolving grape flavored tablet. Cotempla XR ODT contains 25% immediate release and 75% extended-release methylphenidate. Tablets are available in 8.6 mg (10 mg of ER MPH), 17.3 mg (20 mg of ER MPH) and 25.9 mg (30 mg of ER MPH) with combined doses of 2 of 17.3 mg = 34.6 mg (40 mg of ER MPH) and 2 of 25.9 = 51.8 mg (60 mg of ER MPH). Cotempla XR ODT has very smooth and rapid onset and offset. This product lasts a full 12 hours and is approved for ages 6 to 17. (Neos Pharmaceuticals-Savings cards are available)
- Jornay PM is a UNIQUE methylphenidate being the first product given in the evening before bed. The methylphenidate mixture of d- methylphenidate and l- methylphenidate is absorbed such that the release into plasma occurs 10 hours after dosing. If given at 9 pm, the methylphenidate is released in a single peak around 7 am and lasts 12-14 hours during the next day. Available in dosages of 20 mg, 40 mg, 60 mg, 80 mg, and 100 mg and approved for ages 6 and up. (Ironshore Pharmaceuticals-Savings cards are available)
- Quillivant XR is a long-acting methylphenidate liquid suspension with 25 mg/ 5 ml or 5 mg/1 ml. Quillivant XR suspension is fruit flavored but tastes more like banana. Quillivant ER chewable are cherry flavored and come in scored 20 mg, 30 mg, and non-scored 40 mg dosages. Approved for ages 6 and up. (Tris Pharmaceuticals-Savings cards are available)
It is important to remember that medications are absorbed best with food that contains protein.
- Acidifying agents such as ascorbic acid, Vitamin C, in multivitamins and also in orange and other citrus juices will decrease the absorption and blood levels of amphetamines and methylphenidates.
- Also, alkalinizing agents such as antacids will increase the absorption and blood levels of amphetamines and methylphenidates.
- Amphetamines and Methylphenidates increase the release of dopamine and norepinephrine improving these levels in the brain. Low levels of dopamine and norepinephrine can cause hyperactivity, inattention,and impulsivity, all hallmark symptoms of ADHD.