ADHD Medicines (for Teens) – Nemours KidsHealth

What Is ADHD Medicine?

After someone is diagnosed with ADHD, doctors may prescribe medicine to treat it. Medicine doesn’t cure ADHD. But it does help boost the ability to pay attention, slow down, and have more self-control.

Why Do People Need ADHD Medicine?

Not everyone with ADHD needs medicine. But medicine can help most people with ADHD stay focused longer, listen better, and fidget less.

People also benefit from therapy to learn and practice skills like staying organized, managing schoolwork, or dealing with stress. Medicine isn’t a shortcut to mastering these skills. But it does help people stay focused on learning them.

How Does ADHD Medicine Work?

ADHD medicines improve attention by helping normal brain chemicals work better.

The medicines target two brain chemicals, dopamine and norepinephrine. These chemicals affect a person’s attention and concentration.

How Do People Take ADHD Medicine?

People with ADHD can take different medicines. All of them need a prescription, and most are taken by mouth. They’re available as a tablet that is swallowed, chewed, or dissolved, or capsules that can be swallowed or opened and sprinkled on food. Some come in a liquid or a patch that is placed on the skin.

People usually take ADHD medicines once or twice a day, depending on the medicine.

Stimulants

These medicines include methylphenidate (brand names include Ritalin, Concerta, Focalin, Daytrana), and amphetamines (e.g.,  Adderall, Dexedrine, Vyvanse).

Stimulants work as soon as you take them. How long they last depends on the medicine:

• Short-acting formulas last for about 3–6 hours.
• Long-acting formulas stay in the body for up to 12 hours. They can be helpful for people who have a long school day and need the medicine to stay focused for homework or after-school activities.

Non-stimulants

These medicines include atomoxetine (Strattera), clonidine (Kapvay), guanfacine (Intuniv), and viloxazine (Quelbree). Non-stimulants can take up to a few weeks to start working. Then, they work for 24 hours.

Before prescribing medicine, the health care team will ask if you are taking any other medicines. This includes over-the-counter medicines and supplements (like vitamins or herbal medicines). The care team will also want to know about your family’s medical history, especially if any family members had or have heart disease.

Doctors usually start by prescribing a low dose of a stimulant medicine. If you are taking a new ADHD medicine or dose, the doctor will want you and your parent to watch and see if the medicine helps.

People respond differently to medicines. If the first medicine doesn’t seem to work, even at the highest dose, then a doctor may try a different medicine. Some people need to take more than one ADHD medicine to get the best result.

What Else Can I Do?

You and your parents should watch for any
side effectsif you take a new ADHD medicine. Your doctor will adjust the dose and how often you take the medicine based on how much the medicine helps and if you have side effects.

You may need to go for several visits with the doctor over weeks or months to find the right medicine and dose. After that, the care team will want to see you every 3–6 months.

Going to all follow-up visits is important so the care team can check your height, weight, blood pressure, and heart rate. The care team will also monitor side effects and adjust the medicine dose, as needed.

To prevent problems, always do these things when taking ADHD medicine:

• Take the recommended dose.
• Take each medicine at the right time.
• Talk to a doctor before stopping the medicine or changing the dose.
• Keep all medicines in a safe place where others can’t get to them.
• Don’t give any of your medicine to anyone else.

Medicine is one part of treatment for ADHD. Treatment also can include therapy, parent support, and school support. Medicine works best when parents, teachers, and therapists help you learn any social, emotional, and behavioral skills that aren’t easy because of ADHD.

Are There Any Risks?

Like any medicine, ADHD medicines can have side effects. Not everyone gets side effects, though.

The most common side effects are loss of appetite and trouble sleeping. Other ADHD medicine side effects include jitteriness, irritability, moodiness, headaches, stomachaches, fast heart rate, and high blood pressure.

Side effects usually happen in the first few days of starting a new medicine or taking a higher dose. They often go away on their own after a few days or weeks as the body adjusts to the medicine.

If a side effect doesn’t go away, a doctor may decide to lower the dose or stop that medicine and try another. ADHD medicines only stay in the body for a few hours, so the side effects wear off as the medicine leaves the body.

Your health care team will give you more information about possible side effects for the medicine they prescribe. If you notice anything that worries you, tell your parent and talk to your doctor right away.

Some people don’t like the idea of taking medicine for ADHD. But the right medicine can make a big difference. Talk to your doctor if you have concerns. Ask questions. Your health care team can help you and your parent decide if trying a medicine for ADHD is right for you.

ADHD Medications List: Stimulants and Nonstimulants

Stimulants are the most common ADHD medications, but they don’t work for everyone. Non-stimulants have fewer side effects but take longer to work. Making certain lifestyle changes may also help reduce symptoms.

Attention deficit hyperactivity disorder (ADHD) is a mental health disorder that causes a range of symptoms.

These include:

• problems concentrating
• forgetfulness
• hyperactivity
• an inability to finish tasks

Medications can help decrease ADHD symptoms in children and adults. In fact, many drugs are available to treat ADHD.

While not every person with ADHD takes the same drugs, and treatment approaches can vary between children and adults, the following list of drugs for ADHD can help you talk to your doctor about the options that are right for you.

Stimulants are the most commonly prescribed medications for ADHD. They’re often the first course of drugs used for ADHD treatment.

You might hear this class of drugs called central nervous system (CNS) stimulant medications. They work by increasing the amounts of two neurotransmitter hormones called dopamine and norepinephrine in the brain.

This effect improves concentration and decreases the fatigue that’s common with ADHD.

Many brand-name stimulants are now only available as generic versions, which cost less and may be preferred by some insurance companies. However, other drugs are only available as brand-name products.

Amphetamines

Amphetamines are stimulants used for ADHD. They include:

• amphetamine
• dextroamphetamine
• lisdexamfetamine

They come in immediate-release (a drug that’s released into your body right away) and extended-release (a drug that’s released into your body slowly) oral forms. Brand names of these drugs include:

• Adderall XR (generic available)
• Dexedrine (generic available)
• Dyanavel XR
• Evekeo
• ProCentra (generic available)
• Vyvanse

Methamphetamine (Desoxyn)

Methamphetamine is related to ephedrine and amphetamine. It also works by stimulating the CNS.

It’s not known exactly how this drug works to help ADHD symptoms. Like other stimulants, methamphetamine may increase the amounts of hormones like dopamine and norepinephrine in your brain.

It can reduce your appetite and increase your blood pressure. This drug comes as an oral tablet taken once or twice per day.

Methylphenidate

Methylphenidate works by blocking the reuptake of norepinephrine and dopamine in your brain. This helps increase levels of these hormones.

It’s also a stimulant. It comes in immediate-release, extended-release, and controlled-release oral forms.

It also comes as a transdermal patch under the brand name Daytrana. Brand names include:

• Aptensio XR (generic available)
• Metadate ER (generic available)
• Concerta (generic available)
• Daytrana
• Ritalin (generic available)
• Ritalin LA (generic available)
• Methylin (generic available)
• QuilliChew
• Quillivant

Dexmethylphenidate is another stimulant for ADHD that’s similar to methylphenidate. It’s available as the brand-name medication Focalin.

Nonstimulants affect the brain differently than stimulants do. These drugs also affect neurotransmitters, but they don’t increase dopamine levels. In general, it takes longer to see results from these drugs than from stimulants.

These drugs come in several classes. A doctor might prescribe them when stimulants aren’t safe or are ineffective. They may also prescribe them if a person wants to avoid the side effects of stimulants.

Atomoxetine (Strattera)

Atomoxetine (Strattera) blocks the reuptake of norepinephrine in the brain. This lets norepinephrine work longer.

The drug comes as an oral form you take once or twice per day. This drug is also available as a generic.

Atomoxetine has caused liver damage in a small number of people. If you have signs of liver problems while taking this drug, your doctor will check your liver function.

Signs of liver problems include:

• a tender or swollen abdomen
• yellowing of your skin or the whites of your eyes
• fatigue

Clonidine ER (Kapvay)

Clonidine ER (Kapvay) is used to reduce hyperactivity, impulsiveness, and distractibility in people with ADHD. Other forms of clonidine are used to treat high blood pressure.

Because it also lowers blood pressure, people taking it for ADHD may feel lightheaded.

This drug is available as a generic.

Guanfacine ER (Intuniv)

Guanfacine is normally prescribed for high blood pressure in adults. This drug is available as a generic, but only the time-release version and its generics are approved for use in children with ADHD.

The time-release version is called Guanfacine ER (Intuniv).

This drug may help with memory and behavioral problems. It may also help improve aggression and hyperactivity.

Q&A

Are the same drugs that are used to treat ADHD in children used to treat adult ADHD?

Yes, in most cases. However, the dosages of many of these drugs are different for kids than they are for adults. Also, the side effects of these drugs are different in adults than they are in children. Your medical history can limit your treatment options. It’s important to talk to your doctor about your medical history to get an idea of which of these drugs is likely to work best for you.

— Healthline Medical Team

Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Was this helpful?

Your doctor may suggest other ADHD treatments along with medications.

For instance, a 2012 article said that changing your diet may alleviate some ADHD symptoms.

A 2014 study found that taking omega-3 supplements may also modestly improve symptoms in children with ADHD. However, newer research has found that diet changes may not improve ADHD symptoms. Further research is needed.

Talk to your doctor about your drug options as well as the alternatives, such as these natural remedies. It’s important to discuss all ADHD treatment options with your doctor to gain the best results.

About medicines

Attention! The trade names of all drugs in this article are for illustration purposes only and are not intended as an indication of the benefits of using any particular drug.

About trade and international names of preparations

All medicines presented on the Russian pharmaceutical market have two names – a trade name and an international non-proprietary name (INN). INN designates the active substance of the drug – the medicinal substance, which has the necessary therapeutic effect. As the term implies, the INN of a drug will be the same in all countries where the drug is available. As a rule, the INN is selected on the basis of the chemical name of the active substance of the drug.

The manufacturing company may not register an additional trade name of the drug and release it under the INN. In this case, its trade name will coincide with the INN, often the name of the manufacturer is added to the name of the active substance to identify such drugs.

On the market, one INN can be presented under many trade names. A trade name refers to a drug that is produced by a specific manufacturer. Let’s suppose that a doctor prescribed Femara® for a diagnosis of breast cancer, but when you came to the pharmacy, the pharmacist told you that Femara® was not available, and suggested its analogue – letrozole. In this situation, the pharmacist suggested that you use a drug similar to the one prescribed – containing the same active substance – “generic”.

Doctors often use trade names rather than international names of drugs in their speech, not referring to the drug of a specific manufacturer (for example, the trade names “Xeloda” or “Tutabine” instead of the INN capecitabine).

About originators and generics

Many pharmaceutical companies are developing new drugs. In addition to the development process itself, in order to prove the effectiveness and safety of a new drug, they conduct clinical trials (for more details, see the section “How are clinical trials carried out?”). They are time consuming and very costly. In addition to the direct costs of developing a new molecule and conducting research before a drug enters the market, its price includes the costs of developing all drugs that turned out to be “unsuccessful” and did not pass all stages of clinical trials. A drug developed and brought to market for the first time is called an “original drug”.

In order to support the development of new drugs that patients need, a system of patent protection of original drugs has been adopted. It implies that the company that first developed and launched a new drug on the market receives the exclusive right to manufacture and sell it for a certain period of time. The term of such patent protection in different countries is not the same, for example, in the USA it is 12 years, in Russia it can be up to 25 years.

During the period of the patent, only the original drug is present on the market, the manufacturing company, having a monopoly on its production, seeks to recoup its costs for its development and research (and also for all its drugs that have not reached the market). The consequence of this is the high price of original drugs.

After the expiration of the patent, the company that first developed and launched the drug on the market loses the exclusive right to sell it, and reproduced drugs – “generics” or analogues of the original drug – may appear on the market. Generics can be produced by any pharmaceutical company that has the technology needed to synthesize the desired chemical. “Generic drugs” undergo a simplified registration procedure – since the main biological effects of the active substance of these drugs are already known, there is no need to conduct large-scale and costly clinical trials.

Most often, “generics” are registered on the basis of the results of clinical studies of bioequivalence – small studies, the number of participants in which, as a rule, does not exceed a few dozen. As part of these studies, pharmacokinetic properties (absorption characteristics, distribution of the drug in the body, its metabolism and excretion) are compared, and not pharmacodynamic properties (main biological effects) of the original and generic drugs.

What are generics for?

If the generic manufacturer provides data that the drug is similar to the original drug, it is registered and can be freely sold on the market, competing with the original drug. As follows from the above, the main advantage of “generics” is their relatively low cost – reproduced drugs can be several times cheaper than original ones, since their manufacturers incur minimal costs for putting their drug on the market.

Theoretically, the use of “generics” instead of original drugs is beneficial for both patients and the healthcare system, since the price of a “generic” is always lower than the price of the original drug – why overpay for a “brand”, knowing that exactly the same medicine can be bought much cheaper ? In addition, competition and the loss of a monopoly position in the market force the manufacturer of the original drug to reduce the price.

In practice, however, there are some nuances. From the point of view of chemistry, the active substance in the preparations is the same. By law, the same excipients (“fillers”, additional ingredients such as sucrose, colorants, etc.) must be used.

Possible disadvantages of using “jerenics” and briefly about their production

Nevertheless, some differences are possible, which may result in differences in the effectiveness and safety of original drugs and “generics” associated with the technology of their production – the same substance can be obtained using different methods of its synthesis and subsequent purification.

In addition, a peculiar national feature of the pharmaceutical market in the Russian Federation is the actual lack of control over the quality of the production of medicines. That is, at the stage of conducting bioequivalence studies, a generic drug is always of high quality, since otherwise its manufacturer risks “failing” the study. However, in the future, no one can guarantee that the manufactured drug will be subjected to the necessary cleaning and produced properly, on high-quality equipment and in compliance with sanitary and hygienic standards and production process standards. The widespread introduction of production standards can help solve this problem.

Good Manufacturing Practice – GMP (Good Manufacturing Practice)

Currently, “generics” are used in clinical practice in all countries of the world, this can significantly save money for the healthcare system and patients. The safety and effectiveness of their use does not raise questions – if they are properly produced.

To ensure the high-quality production of medicines, both original and “generics”, so-called. Good Manufacturing Practice (GMP) standards. They regulate the requirements for the organization of the production of medicines. In accordance with the principles of GMP, the manufacturer of the drug must produce medicinal products in such a way as to guarantee their compliance with their intended purpose, the documents that were used in the registration of the drug, use only high-quality pharmaceutical substances for the production of drugs. The main purpose of this is to eliminate the risks associated with the unsatisfactory properties of drugs, their safety, quality or efficacy. The manufacturer must continuously monitor the quality of drug production processes, ensure the availability of qualified personnel, etc. Unlike spot checks on samples, the principles of GMP are aimed at ensuring quality throughout the entire period of release of the drug. In Russia, for the production of “generics”, as a rule, ready-made pharmaceutical substances are used, which are the synthesized active ingredient of the drug in large packaging (for example, 1 kg). Most often, these drugs are imported into the territory of the Russian Federation from other countries; in Russia, they are packaged in consumer packaging at the factories of the final manufacturer. In order to keep the price low, generic companies most often use cheap pharmaceutical substances produced in India or China.

Despite the fact that the Order of the Ministry of Industry and Trade of the Russian Federation No. 916 “On Approval of the Rules for the Organization of Production and Quality Control of Medicines” has been in force in Russia since 2013, the manufacturer’s compliance with these requirements remains at its discretion, and Russian supervisory services (for example, Roszdravnadzor) actually do not have the ability to control the quality of drugs.

Lack of compliance with production norms and GMP standard carries the following main risks :

• Purchase and use of low-quality pharmaceutical substance – the active substance of the drug, which may be ineffective or unsafe;
• Poor storage and transport of medicinal products, which may result in degradation of the drug’s active ingredient – for example, the commonly used cytotoxic drug 5-fluorouracil is destroyed by sunlight;
• Bacterial contamination of the drug during the production of the drug and its packaging in the final consumer packaging, destruction of the drug in case of poor-quality packaging;

Why do oncologists use these drugs? Often they don’t have a choice. In accordance with federal law, healthcare institutions purchase medicines under special competitive procedures – tenders. The tender is won by the manufacturer who offered the lowest price for the supply of medicines, while the fact that the production has a GMP certificate is not taken into account. Firms that produce high-quality drugs incur high costs for their production, so they often do not have the opportunity to compete with cheap “Russian-Chinese” drugs. Thus, a “vicious circle” is formed in the system of patient treatment. The current procurement model incentivizes companies to produce drugs as cheap as possible rather than better ones, encouraging unscrupulous companies and depriving consumers of access to quality drugs.

How do I know if a drug is of good quality?

In the Russian Federation, there is a special database that contains information about all drugs that are in circulation on the pharmaceutical market in our country – the State Register of Medicines (GRLS). It is publicly available at
link. On the same site, the latest versions of instructions for the medical use of drugs are available for review.

It allows you to search for drugs by trade name, international name, drug manufacturer, etc. The GRLS interface is shown in Figure 1.

Figure 1. General view of the interface of the State Register of Medicinal Products

As an example, consider one of the most commonly used drugs in oncological practice – paclitaxel. Having searched for the INN of this drug, you can see that many of its trade names are represented on the pharmaceutical market of the Russian Federation. Figure 2 shows an example of a search for this drug.

Figure 2. An example of paclitaxel preparations (presented for all names) registered in the territory of the Russian Federation. Trade names of drugs are highlighted in red, countries in which manufacturing companies are registered are in green

It is worth noting that the fact of registration of a manufacturer in any country does not always mean that the drug is completely produced on its territory. As an example, we can take the drug Intaxel manufactured by Fresenius Kabi (Germany). By opening detailed information on the drug, you can see that the pharmaceutical substance and the drug itself were manufactured in India (in itself this does not mean that the drug is of poor quality, see below). A similar situation, as a rule, is observed with drugs produced in Russia.

With the help of GRLS you can find all generic drugs registered in Russia. How to choose the best one? Having chosen any reproduced drug (“generic”), look for information about the company that produces it, try to find information about whether the manufacturer has a GMP certificate. If the generic manufacturer does not have such a certificate, this is a serious reason to think about whether to purchase its products. The list below shows some of the companies that manufacture in accordance with GMP standards (the list is not complete):

• TEVA
• Actavis/Allergan
• Fresenius Kabi (Fresenius Kabi)
• Sandoz/Ebewe
• BIOCAD

It should be borne in mind that compliance with the above algorithm is not a guarantee of the quality of drugs. Even manufacturers of original drugs are not immune from errors in the production process, although it can significantly reduce its likelihood.

In addition, counterfeit medicines are also found in the pharmacy network – fakes that may differ significantly in their composition from the drug they claim to be. With this in mind, if you purchase drugs yourself, it is worth doing this in specialized oncology pharmacies, private or public network pharmacies – in many cases they work directly with manufacturers.

Summary

In the absence of state control over the quality of medicines and the massive influx of cheap drugs of dubious quality into oncological institutions, patient awareness of this problem is critical. Ask your doctor about what drugs and how much you are prescribed. Be sure to specify the specific trade name of the drug. If you have any doubts that the drug offered to you is of high quality, remember that you have the right to purchase the necessary drugs yourself.

It is not necessary to purchase expensive original drugs. The best choice is high-quality “generics” produced by well-known companies that have a GMP certificate. Taking care of your own health is an important part of successful treatment.

Selection- Model List of Essential Medicines

Essential medicines are needed to meet the population’s priority health care needs. They are expected to be continuously available in functioning health systems in appropriate dosage forms, of guaranteed quality and at affordable prices for both individuals and health systems. They are selected with due regard to disease prevalence and public health significance, evidence of efficacy and safety, and cost.

WHO updates the Model List of Essential Medicines (EML) and the Model List of Essential Medicines for Children (EMLc) every two years to serve as guidance to countries to develop their own national lists of essential medicines according to local needs, priorities and treatment recommendations.

To learn more about choosing essential medicines, please visit the WHO website

WHO Model List of Essential Medicines

Current versions of the Model Lists of Essential Medicines were published in October 2021. Opioid analgesics have been included in the Model List of Essential Medicines since its first edition was published in 1977 and were included in the first Model List of Essential Medicines for Children in 2007.

An indicative list of essential medicines includes naturally occurring opioids such as codeine and morphine, as well as synthetic opioids such as fentanyl and methadone. The indicative list of essential medicines for children includes morphine and methadone for use in children. Synthetic opioids such as hydromorphone and oxycodone are listed on the Schedules as possible therapeutic alternatives to morphine for pain relief. The synthetic opioid buprenorphine is included on the Model List of Essential Medicines as a therapeutic alternative to methadone for the treatment of opioid dependence. For more information, please visit the WHO website

The Model List of Essential Medicines is also available online as a searchable, downloadable and customizable electronic database.

Morphine

Both the 22nd WHO Model List of Essential Medicines and the 8th WHO Model List of Essential Medicines for Children include morphine (hydrochloride or sulfate) for injection, 10 mg in 1-ml ampoules for short-term treatments. In addition, morphine is included in both schedules as an opioid analgesic for pain management and palliative care.

For more information on the current situation and trends in morphine, click here

Codeine agents include codeine phosphate as an opioid analgesic for pain management and palliative help (Section 2.2). Codeine is indicated for the treatment of mild to moderate pain. Codeine was formerly on the Model List of Essential Medicines as an antitussive and antidiarrheal but has been removed for these indications in 1997 year.