Strattera

Strattera, developed by Eli Lilly and Company (NYSE:LLY & UK), is the first licensed treatment for ADHD that is not a stimulant medication.

Strattera, a selective norepinephrine reuptake inhibitor, has a different pharmacologic mechanism than other currently approved ADHD treatments. It's not known precisely how atomoxetine reduces ADHD symptoms. Scientists believe it works by blocking or slowing reabsorption of norepinephrine, a brain chemical considered important in regulating attention, impulsivity and activity levels. This keeps more norepinephrine at work in the tiny spaces between neurons in the brain.

Side effects can include: Most people in clinical studies who experienced side effects were not bothered enough to stop using atomoxetine. The most common side effects in children and adolescents were decreased appetite, nausea, vomiting, tiredness and upset stomach. In adults, the most common side effects were problems sleeping, dry mouth, decreased appetite, upset stomach, nausea or vomiting, dizziness, problems urinating, and sexual side effects. 

Ritalin S.R.

Slow Release Ritalin is now available in the UK, the only problem is that to obtain this means that you need to take a prescription to your pharmacist who then has to fax it to BR Pharma on the following number (UK Only), 020 8207 5557 (Tel:020 8238 6770). BR Pharma then deliver to the pharmacist the next day. They can only provide this service for prescriptions for 3 months supply, (approx 120 tablets). The advantage of SR is it could remove the need for a mid-day dose at school, by allowing a slow released stream of medication into the system for about 6 hours, it does however take longer to get into the system to start with.

Be aware that Ritalin SR may not work for all.

Dexedrine (Dextroamphetamine Sulfate)

Dexedrine affects the neurotransmitter Norepinephrine primarily, and secondarily Dopamine, which is significantly different than Ritalin, and can produce very different results for patients. Dexedrine is only similar to Ritalin in that the same type of side effects can occasionally be seen. Dexedrine also appears to stay in the blood longer than Ritalin reducing the frequency of the dose.

Indications: narcolepsy, adjunct in the management of refractory hyperkinetic states in children (under specialist supervision)

Cautions: mild hypertension (contra-indicated if moderate or severe)-monitor blood pressure; history of epilepsy (discontinue if convulsions occur); tics and Tourette syndrome (use with caution)-discontinue if tics occur; monitor growth in children (see also below); avoid abrupt withdrawal; data on safety and efficacy of long-term use not complete.

SPECIAL CAUTIONS IN CHILDREN. Monitor height and weight as growth retardation may occur during prolonged therapy (drug free periods may allow catch-up in growth but withdraw slowly to avoid inducing depression or renewed hyperactivity).

In psychotic children may exacerbate behavioural disturbances and thought disorder.

Contra-indications: cardiovascular disease including moderate to severe hypertension, hyperexcitability or agitated states, hyperthyroidism, history of drug or alcohol abuse, glaucoma, pregnancy and breast-feeding.

DRIVING. May affect performance of skilled tasks (e.g. driving); effects of alcohol unpredictable.

Side-effects: insomnia, restlessness, irritability and excitability, nervousness, night terrors, euphoria, tremor, dizziness, headache; convulsions; dependence and tolerance, sometimes psychosis; anorexia, gastro-intestinal symptoms, growth retardation in children; dry mouth, sweating, tachycardia (and anginal pain), palpitations, increased blood pressure; visual disturbances; cardiomyopathy reported with chronic use; central stimulants have provoked choreoathetoid movements, tics and Tourette syndrome in predisposed individuals (see also Cautions above); overdosage: Stimulants AMPHETAMINES - These cause wakefulness, excessive activity, paranoia, hallucinations, and hypertension followed by exhaustion, convulsions, hyperthermia, and coma. The early stages can be controlled by diazepam or lorazepam; advice should be sought from a poisons information centre on the management of hypertension. Later, tepid sponging, anticonvulsants, and artificial respiration may be needed.

Dose: Hyperkinesia, CHILD over 6 years 5-10 mg daily, increased if necessary by 5 mg at intervals of 1 week to usual max. 20 mg daily (older children have received max. 40 mg daily); under 6 years not recommended

Adderall

A single entity amphetamine product combining the neutral sulfate salts of dextroamphetamine and amphetamine, with the dextro isomer of amphetamine saccharate and d, l-amphetamine aspartate.

A recent study in the U.S. which was published in the Journal of the American Academy of Child and Adolescent Psychiatry in May 2000, said: "Adderall(R) (mixed salts of a single-entity amphetamine product) is significantly more effective at reducing inattention, oppositional behaviour, and other symptoms of attention deficit/hyperactivity disorder (ADHD) than methylphenidate, an older ADHD treatment.

The study of 58 children with ADHD also found that the benefits of Adderall last longer than those of methylphenidate (which is sold under the brand name Ritalin(R)). In fact, 70 percent of patients taking a single morning dose of Adderall found significant improvement in ADHD symptoms, while just 15 percent of patients taking methylphenidate improved significantly with only one dose."

Side effects can include:

• Cardiovascular: Palpitations, tachycardia, elevation of blood pressure. There have been isolated reports of cardiomyopathy associated with chronic amphetamine use.
• Central Nervous System: Psychotic episodes at recommended doses (rare), overstimulation, restlessness, dizziness, insomnia, euphoria, dyskinesia, dysphoria, tremor, headache, exacerbation of motor and phonic tics and Tourette's syndrome.
• Gastrointestinal: Dryness of the mouth, unpleasant taste, diarrhea, constipation, other gastrointestinal disturbances. Anorexia and weight loss may occur as undesirable effects when amphetamines are used for other than the anorectic effect.
• Allergic: Urticaria.
• Endocrine: Impotence, changes in libido.

See Shire Pharmaceuticals for more information.

Adderall is now available off licence in the UK though only on the same basis as Ritalin SR i.e. your pharmacist has to fax your prescription to BR Pharma on the following number (UK Only), (Tel:020 8238 6770). BR Pharma then deliver to the pharmacist the next day. Also, only packs of 100 tablets are available in both 5 and 10 mg doses. ADDerall XR is now also available in 10, 20 and 30mg doses. This formulation provides an all day treatment with one morning dose. There is an immediate 50% release of the active ingredient followed by a further 50% being released at midday.