DEXEDRINE TABLETS (dextroamphetamine)

Form: Short-acting tablets administered by mouth. Dexedrine tablets 5 mg. Dosage: Very individual: Average 1-3 tablets each dose. Duration of Action: Rapid onset of action 20-30 minutes. Lasts 4 hours. Effects: Same as Ritalin. Possible Side Effects: Same as Ritalin Pros: Excellent safety record. Rapid acting. Some patients who do well on Dexedrine prefer the tablets over the Spansules. The more rapid rate of onset is apparently more effective for these individuals. Cons: Same as Ritalin.

CYLERT (pemoline)

Form: Long-acting tablets administered by mouth. Cylert 37.5, 75 mg. Dosage: Very individual. Duration of Action: Slow onset of action, thought to be a medication that will last all day, but in most cases lasts 6-8 hours. Effects: Same as Ritalin Possible Side Effects: Same as Ritalin. However, has been known to cause mild liver damage. Pros: Long acting, may eliminate lunch dose. Cons: Not as safe as the other stimulants. Would only use if other stimulants are not effective. Should NEVER be first drug of choice. Has caused hepatitis and death. Must do liver function blood test every six months.

TOFRANIL and NORPRAMINE (imipramine and desipramine)

Form: Tablets administered by mouth. 10, 25, 50, and 100 mg tablets. Dosage: Very individual. I start with a low dose 10-25 mg, and raise slowly as needed. Duration of Action: Variable. Often has a 24-hour effect, and therefore can be administered at night. Some patients prefer to split the dose and take every 12 hours. Effects: Often relatively low doses can improve ADHD symptoms within a few days, but may take 1-3 weeks for full effect. Higher doses may improve depression symptoms and mood swings, which are often seen in ADHD individuals. Possible Side Effects: Nervousness, sleep problems, tiredness, and upset stomach, dizziness, dry mouth, unusually fast heart rate. May affect conduction time of the heart, leading to irregular heart rate. May affect blood count (rare). Pros: Often works when stimulant medications are not helpful, and may be the drug of choice for many individuals. Prolonged duration eliminates school dose. Smoother course of action. Often helps with mood swings and depression. May be used in conjunction with stimulant medications. Cons: Can affect the heart conduction rate, therefore requires an EKG prior to the medication trial and after treatment level has been established. Can affect the blood count, therefore requires a complete blood count with all illnesses. Need to be careful when taking other medications. Consult doctor for list of medications to avoid. Medication needs to be increased and decreased gradually. Should not start and stop abruptly.

CLONIDINE (catapres)

Form: Patches applied to back of shoulder. Catapres TTS-1, TTS-2, TTS-3 (expensive). Tablets administered by mouth. Catapres tablets--1 mg., 2 mg., 3 mg. (low price) Duration of Action: Patches will last 5-6 days. Tablets are short acting, last 4-6 hours. Effects: Often will improve ADHD symptoms, although not always as dramatically as Ritalin. Decreases facial and vocal ties in Tourette Syndrome. Often has a dramatic positive effect on oppositional defiant behavior and anger management. Possible Side Effects: Major side effect is tiredness, particularly if raised too quickly. Will normally disappear with time. Some patients may notice dizziness, dry mouth. Some will notice increased activity, irritability, conduct disorder and should discontinue the medication. Pros: Excellent delivery system if patch is used. No pills required. Frequent positive effect on oppositional defiant behavior, and obsessive compulsive behavior. Does not effect sleep or appetite. Positive effect on tic behavior. Cons: Does not usually work as well as Ritalin for ADHD symptoms. Patch causes skin irritation in many and cannot be tolerated.

ADDERALL (four amphetamine salts)

Form: Long-acting tablets: 10 mg and 20 mg Dosage: Very individual, usually between 5 mg and 20 mg, once or twice a day Duration of Action: Usually last 6-12 hours. May be given once or twice a day, depending on length of therapeutic effect. Duration of effect varies from person to person. Effects: Same as Ritalin Possible Side Effects: Less affect on sleep, appetite, growth and rebound. No roller coaster effect. Pros: Only needs to be given once or twice a day, often fewer side effects. Very nice medication when effective. Cons: Does not work well for everybody. Relatively new on the market and not much clinical experience at this time.

WELLBUTRIN (bupropion hcl)

Form: 75 mg (yellow-gold) 100 mg (red) Dosage: 75-300 mg daily (average) in three divided doses Duration of Action: Long acting medication (half-life of 24 hours) Effects: A few studies suggest improvement in ADHD. In general, not as good as stimulants. Very helpful in conjunction with stimulants for depression. Possible Side Effects: Can cause seizures (1/4000) if dose STARTED too rapidly. Raise dose slowly. Cannot use if seizure disorder is present. May cause dry mouth, anorexia, rash, sweating, tremors, tinnitus Pros: Very good medication to use for treatment of depression Cons: Very little evidence that it is helpful for ADHD. Studies are still in progress.

WELLBUTRIN SR (bupropion hcl long-acting)

Form: 100 mg (blue) 150 mg (purple) Dosage: 100-150 mg twice a day Duration of Action: Effective for over 24 hours Effects, Possible Side Effect, Pros, Cons: Same as Wellbutrin

Dr. Mandelkorn trained in pediatrics and adolescent medicine and was a mental health fellow under Dr. Michael Rothenberg. An adult with ADHD who has a son with ADHD, Dr. Mandelkorn specializes in the diagnosis and treatment of ADHD in children and adolescents. He maintains a private practice in Mercer Island, Washington. His ADHD clinic presently follows over 600 children with ADHD. Dr. Mandelkorn lectures nationwide about management.

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