Update on ADHD Medications
Sheila Woods MD, FAAP – SCAAP ADHD Liaison
Newer ADHD medications have arrived and will continue to arrive improving our choices of ADHD medications for children, adolescents, and adults. The Neos Therapeutics, makers of Adzenys XR-ODT and Cotempla XR- ODT offer savings cards regardless of a patient’s insurance approval or co-pay. First month is free and each month thereafter is $25. Shire offers savings cards on Vyvanse as well as Mydayis. Rhodes offers a savings card for Aptensio XR.
• Remember, that acidifying agents such as ascorbic acid, Vitamin C, in multivitamins and orange and other citrus juices will decrease the blood levels of amphetamines and methylphenidates.
• Also alkalinizing agents such as antacids will increase the blood levels of amphetamines and methylphenidates.
• Amphetamines and Methylphenidates block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extra neuronal space thus improving dopamine and norepinephrine levels. Low levels can cause hyperactivity, inattention, and impulsivity.
Newer Long Acting Amphetamines:
Vyvanse chewables (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. Approved for ages 6 and up. (Shire)
Dyanavel XR is a long acting amphetamine product with a ratio of 3.2 dextroamphetamine to 1 levoamphetamine 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 12 hour duration. Starting dose is 2 ml and titration is 1 ml every 4-7 days as needed. Approved for ages 6-17 years. (Tris)
Adzenys XR-ODT is a long acting amphetamine product comparable to Adderall XR except it is NOT a mixed amphetamine salt. The salt is dissolved in solution and the remaining amphetamine micro particles are embedded in an orally dissolving orange flavored tablet. This product has a rapid and smooth onset (no gut clinch as with older amphetamine products), smooth offset, and is consistent throughout the 8-10 hour 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 (5 mg of Adderall XR), 6.3 mg (10 mg of XR), 9.4 mg (15 mg of XR), 12.5 mg (20 mg of XR), 15.7 mg (25 mg of XR) and 18.8 mg (30 mg of XR). Approved for ages 6 and up. (Neos)
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 14-16 hour coverage. Approved for ages 13 and up. (Shire)
Newer Long Acting Methylphenidates:
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)
Aptensio XR is a long acting methylphenidate available in a capsule that can be opened and sprinkled. It is available in 10 mg, 15 mg, 20 mg, 30 mg, 40 mg 50 mg, and 60 mg capsules. Aptensio XR lasts 12 hours and seems to have about the same onset and offset as Concerta. Approved for ages 6 and up. (Rhodes)
If you have any questions regarding ADHD medications, please feel free to give me a call at Greenville ADHD Specialists, 864-305-1662.
This article was recently published in The South Carolina Chapter of the American Academy of Pediatrics (SCAAP) Winter newsletter. http://www.scaap.org/