Inside the ADHD mind

ADHD Medication & Treatment

ADD MEDICATIONS

ADHD or ADD Medications for Adults and Children: Stimulants,

Nonstimulants & More
Vyvanse. Ritalin. Concerta. Adderall. Strattera. And myriad others. The number of ADHD medication
options is so large that finding the right treatment feels overwhelming at times. Here, an ADHD
specialist explains the options for adults and children in terms we can all understand.

BY LARRY SILVER, M.D.

ADHD or ADD Medications for Adults and Children: Which Are

Best?
The attention de cit hyperactivity disorder (ADHD or ADD) medications prescribed to both children and
adults are categorized as stimulant — amphetamine or methylphenidate — or non-stimulant.
Stimulants are commonly considered the rst-line ADHD treatment, with non-stimulants prescribed to
those patients who don’t tolerate or see bene ts from stimulants. The most popular ADHD medications
among ADDitude readers include:

1. Adderall XR (amphetamine)
2. Concerta (methylphenidate)
3. Dexedrine (amphetamine)
4. Evekeo (amphetamine)
5. Focalin XR (methylphenidate)
6. Quillivant XR (methylphenidate)
7. Ritalin (methylphenidate)
8. Strattera (atomoxetine hydrochloride)
9. Vyvanse (lisdexamfetamine dimesylate)

Many parents and adults are similarly confused by these and other treatment choices for ADHD. The Food
and Drug Administration (FDA) requires that a medication be given a di erent name according to its form
(capsule, tablet, liquid, patch) or release mechanism (released immediately or over an extended period of
time). Here’s an example: The ADHD medication Ritalin is a tablet that is released immediately into the
bloodstream and works for four hours. Ritalin LA, on the other hand, is a capsule that releases over a
longer period of time and works for eight hours. Di erent names, even though both contain the same
medicine — methylphenidate.
Before we go any further, I want to give you a quick refresher on why doctors prescribe stimulants for the
condition.

How Do Stimulant Medications Treat ADHD?

ADHD is a neurologically based disorder, resulting from the de ciency of a neurotransmitter, or a group
of neurotransmitters, in speci c areas of the brain. Neurotransmitters are chemicals that transmit
signals between nerve cells by bridging the synapse (or gap) between them.

The key neurotransmitter involved is norepinephrine, along with its building blocks, dopa and dopamine.
The primary medications used to treat ADHD stimulate speci c cells within the brain to produce more of
the de cient neurotransmitter. That’s why these medications are called stimulants.

[Free Download: The Ultimate Guide to ADHD Medication]

The two main classes of stimulant medications, methylphenidate and dextro-amphetamine — both are
generic names — have been used since the 1960s. All brand-name stimulants are variations of these two
medications. The ADHD medication Adderall is a modi cation of dextro-amphetamine, for instance,
while methylphenidate comes as an immediate-release tablet, a chewable tablet, a liquid, a skin patch,
an intermediate-acting (extended-release) tablet, a long-acting (extended-release) capsule, and a long-
acting (extended-release) tablet. Each variation has its own name, but the medicine that treats
symptoms is the same — methylphenidate.

How is ADHD Medication Dosed?

Parents of children with ADHD ask me: “My child was on Adderall 10 mg, and my doctor changed her
prescription to Vyvanse 60 mg. Why was the dose increased?” The reasons for the numbers have to do
with target dose and release mechanism.

Target dose: Each product releases a speci c amount of medication into the blood over a given period of
time. The FDA requires that the number value for each product represent the total amount of the
medication in the tablet/liquid/capsule/patch, not the amount in the blood at any one time. Thus, if the
medication, let’s say methylphenidate, is in the form of a four-hour tablet, and it releases 5 mg over that
time, it is called methylphenidate 5 mg. A capsule of Adderall that releases 10 mg immediately and 10 mg
four hours later is called Adderall XR 20. The number is not based on the amount released at any one time,
but on the total amount of the medication in the capsule.

Release mechanism: This indicates the length of time a medication will remain available and active.
Stimulants come in a variety of forms — tablet, capsule, liquid, skin patch — and release medication in
an hour, four hours, or over eight or 12 hours.

How Does Concerta Work? How Is It Di erent From Other ADHD

Medications?
Many people are confused about the ADHD medication Concerta. Designed to last 12 hours, Concerta has
a “sponge” on the bottom of the capsule, medication on top, and a tiny hole above the medication. As the
capsule passes through the gastrointestinal tract and absorbs moisture, the sponge expands and pushes
the medication out of the hole.

[Chart Comparing Popular ADHD Medications]

The number value assigned to each dose is confusing. Take Concerta 18 mg. If the goal is to release 5 mg
consistently every four hours over a 12-hour period, then there needs to be 15 mg in the capsule.
However, it takes time for the sponge to become moist enough to start to expand. So an initial release of
medication is needed until the sponge starts working. Researchers gured out that it should be 3 mg.
Thus, to release 5 mg over 12 hours, one needs the initial 3 mg, plus 5 mg every four hours during the 12
hours. The total amount of medication is 18 mg. That’s why the medication is called Concerta 18.

Same ADHD Medication, Di erent Formulations

Medications such as methylphenidate and dextro-amphetamine also come in liquid forms. The patient
information sheet inside the medication’s box or packaging states how much medication is in each unit
of liquid; for example, 5 mg per 5 ml of liquid. Another methylphenidate product — Daytrana* — is a
patch that releases medication through the skin and into the bloodstream. It should start to work in
about one hour, and remain e ective until about one hour after being removed (usually around nine
hours). Daytrana 30 mg contains about 30 mg of methylphenidate, and releases about 3.3 mg of it per
hour.

As if that weren’t challenging enough, amphetamine and methylphenidate are made of two isomers,
called dextro and levo isomers. When the rst amphetamine products used for ADHD were studied,
experts learned that the dextro form was more e ective in managing symptoms than the levo form.
Thus, dextro-amphetamine became the primary product used to treat the condition. (Adderall,
prescribed to many patients who have been diagnosed with ADHD, is a mixture of dextro- and levo-
amphetamine, plus other amphetamine salts.) A similar nding was recently made on methylphenidate.
Researchers learned that the dextro form was more e ective than the levo form. Dextro-
methylphenidate is manufactured under the name of Focalin.

*FDA is warning that permanent loss of skin color may occur with use of the Daytrana patch
(methylphenidate transdermal system) for Attention De cit Hyperactivity Disorder (ADHD). FDA added a
warning to the drug label to describe this skin condition, which is known as chemical leukoderma. See the
FDA Drug Safety Communication for more information.

Which ADHD Medication is Best?

In short, there’s no way to know which stimulant medication will work “best” for any one person’s
ADHD. It’s often related to your history, your genetics, and your or your child’s unique metabolism. The
next time a doctor rattles o medications and dosages that might be appropriate for you or your child,
consult this comprehensive list to give yourself a much better idea of what he’s talking about and how to
decide which might be the best choice.

I saw a child who, after receiving extensive evaluation, was diagnosed with inattentive attention de cit
disorder (ADHD or ADD). When I talked with his mother about starting him on the ADHD stimulant
medication methylphenidate, she asked, “Why not Vyvanse? That’s the one that Ty Pennington takes,
right? It works great for him!” I explained my reasons for prescribing methylphenidate, not Vyvanse, and
realized that the urry of ads for ADHD medications had confused her. Let’s set the record straight.

ADHD Medications: Methylphenidate

Generic: tablet; immediate release; lasts about four hours; comes in 5, 10, 15 mg dosages
Aptensio XR: brand name; capsule; immediate and extended release; lasts 12 hours; comes in 10,
15, 20, 25, 30, 40, 50, and 60mg dosages
Concerta: brand name; tablet; lasts about 12 hours; comes in 18, 27, 36, 54 mg dosages
Daytrana: brand name; skin patch; lasts about eight hours; comes in 10, 15, 20, 30 mg dosages
Ritalin: brand name; tablet; immediate release; lasts about four hours; comes in 5, 10, 15 mg
dosages
Ritalin LA: brand name; capsule; lasts about eight hours; comes in 10, 20, 30, 40 mg dosages
 Ritalin SR: brand name; tablet; lasts about eight hours; comes in 20 mg dosage
Metadate CD: brand name; capsule; lasts eight hours; comes in 10, 20, 30, 40, 50, 60 mg dosages
Metadate ER: brand name; tablet; lasts eight hours; comes in 10, 20 mg dosages
Methylin: brand name; liquid and chewable tablets; immediate release; lasts four hours; tablets
come in 2.5, 5, 10 mg dosages, liquid in 5 mg/tsp and 10mg/tsp dosages
QuilliChew ER: brand name; chewable tablet; extended release; lasts eight hours; comes in 20, 30,
and 40 mg dosages
Quillivant XR: brand name; liquid; extended release; lasts 12 hours; dosages range from 20 to 60
mg

ADHD Medication: Dextro-Methylphenidate

Focalin: brand name; tablet; lasts four hours; immediate release; comes in 2.5, 5, 10 mg dosages
Focalin XR: brand name; capsule; lasts eight hours; immediate release followed by second delayed
release; comes in 5, 10, 15, 20, 30, 40 mg dosages

ADHD Medication: Dextro-Amphetamine

Generic; tablet; immediate release; lasts four hours; comes in 5, 10 mg dosages
Dexedrine Spansule: brand name; capsule; immediate release followed by gradual release; lasts
eight hours; comes in 5, 10, 15 mg dosages
ProCentra: brand name; liquid; immediate release; lasts four hours; comes in 5 mg/tsp dosage

ADHD Medication: Modified Amphetamine Mixture

Adderall: brand name; tablet; immediate release; lasts four hours; comes in 5, 7.5, 10, 12.5, 15, 20,
30 mg dosages
Adderall XR: brand name; capsule; immediate and delayed release; lasts eight hours; comes in 5,
10, 15, 20, 25, 30 mg dosages
Adzenys XR-ODT: brand name; orally-disintegrating tablet; immediate and delayed release; lasts
up to 12 hours; comes in 3.1 mg, 6.3 mg, 9.4 mg, 12.5 mg, 15.7 mg, and 18.8 mg dosages
Dyanavel XR: brand name; liquid; extended release; lasts 13 hours; dosages range from 2.5 mg to 10
mg per day
Evekeo: brand name; tablet; immediate release; lasts four fours; comes in 5 and 10 mg dosages
Vyvanse: brand name; capsule and chewable tablet; lasts 10 to 12 hours; comes in 20, 30, 40, 50,
60, 70 mg dosages

Larry Silver, M.D., is a member of ADDitude’s ADHD Medical Review Panel.

[Read:ADHD Treatment: Medication, Diet, Therapy & More]

Updated on June 19, 2019

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