New Treatment for ADD?
by John H. Samson, M.D., F.A.A.P.
January 14, 2008
Last week a mother brought her son in for a routine four month evaluation for children on stimulant mediation. The 10-year-old boy was doing fine on his current medication. But they had heard that there was a brand new, totally different medication for attentionally deprived children.
“Dr. Samson,” she said. “Why haven’t you suggested this new medication for ADD patients? It is called…”she paused and rifled through her purse, fishing out a crumpled bit of paper from which she read, “…wynate. My friend said it was great and really helped her son!”
She was referring to Vyvanse. This is an amphetamine-related product introduced in the past year. It was designed to reduce the annoying side effects of appetite suppression and insomnia by modifying the molecule of the amphetamine drug. It was also proposed to provide a more even effect during the day and have less impact on behavioral side effects.
The jury is still out on whether it accomplishes all of the above goals. However, there is little reason to change the medication in a patient who is currently well controlled and free of unwanted side effects.
In this child’s case I encouraged the mother not to introduce a new drug. When a new drug is started one must go through the time consuming search for the optimum dose if, in fact, the new medication is effective. In reality this was not truly a new medication for this child, but a “modification” of an old one. Nevertheless, if Vyvanse lives up to its claims it should prove helpful in providing us with another alternative.
This would be a good time to take an overall look at the most commonly used medications currently available for the treatment of ADD (ADHD).
|
METHYLPHENIDATE |
approximate duration of action |
|
Ritalin |
4 hrs. |
|
Concerta |
12 hrs. |
|
Focalin XR |
12 hrs. |
|
Ritalin LA |
12 hrs. |
|
Focalin |
6 hrs. |
|
Metadate CD |
6 hrs. |
|
Daytrana patch |
12 hrs., until patch is removed |
|
|
|
|
AMPHETAMINE |
|
|
Dexedrine |
4 hrs. |
|
Adderall XR |
12 hrs. |
|
Vyvanse |
12 hrs. |
|
Adderall tabs |
6 hrs. |
|
|
6 hrs. |
|
STRATTERA |
|
|
Strattera |
12 hrs. |
|
|
|
|
WELLBUTRIN |
|
|
Wellbutrin |
Given 2/day |
|
Wellbutrin SR |
Once/day |
|
Wellbutrin XL |
Once/day |
This is not an exhaustive list, but it covers the commonly used medications for ADD/ADHD. Some patients only respond to Ritalin and not Dexedrine. Some are effected by neither and have good results with Strattera or Wellbutrin. Finding the proper medication and dosage requires time and careful evaluation at home and at school. Treating these patients is not simply writing a prescription and seeing them in six months.
Just as the evaluation must be complete and compulsively pursued, so too must the optimal medication program be developed. With all the medications available no patient should have to endure unwanted and deleterious side effects to control the ADD symptoms. Never accept “You’ll just have to live with the side effects if we are to control the ADHD!” We can usually find a dose and medication that does not burden the patient with unwanted side effects. In some cases optimizing the dose alone gives us the desired effect. In general, do not change something that is working well just to try a new product.
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