MedicationDosageCommentsCost of generic (brand)*
Stimulants
Immediate-release dextroamphetamineStart at 5 mg once or twice per day; recommended dosage of 0.3 to 1.5 mg per kg per day; maximal dosage of 60 mg per dayShort half-life of four to six hours requiring dosing two or three times per day
Functions by being exchanged for intracellular dopamine in synaptic cells, thus increasing the synaptic concentration
$60 (NA) based on 10 mg twice per day
Immediate-release dextroamphetamine/amphetamine (Adderall)$101 ($234) based on 10 mg twice per day
Extended-release dextroamphetamine/amphetamine (Adderall XR)20 to 60 mg per dayA mix of 75% dextroamphetamine and 25% levoamphetamine$165 ($238) based on 20 mg per day
May be used in patients with mild hypertension controlled with an antihypertensive medication
Lisdexamfetamine (Vyvanse)Start at 30 mg per day; can increase dosage by 10 to 20 mg per day weekly until optimal effect; maximal dosage of 70 mg per dayTherapeutically inactive moleculeNA ($174) based on 40 mg per day
Following oral ingestion, it is converted to l-lysine and active d-amphetamine
Although a small amount is hydrolyzed to d-amphetamine in the gastrointestinal tract, the conversion into active d-amphetamine occurs primarily in the blood
Duration of action of 12 to 14 hours
Immediate-release methylphenidate (Ritalin)Start at 10 mg per day; recommended dosage of 0.3 to 1.5 mg per kg per day; maximal dosage of 100 mg per dayCan be dissolved and injected as a form of abuse$48 ($44) based on 10 mg twice per day
Metabolically similar to cocaine
Functions by binding to dopamine transport proteins and blocking presynaptic dopamine reuptake
Extended-release methylphenidate (Concerta)18 to 108 mg per dayOral osmotic release system decreases potential for abuse and allows for 10 to 12 hours of activity$180 ($195) based on 36 mg per day
Nonstimulants
Atomoxetine (Strattera)Start at 40 mg per day; can increase up to 100 mg per day over two to four weeks; can take once or twice per daySelective norepinephrine reuptake inhibitorNA ($200) based on 60 mg per day
Only nonstimulant approved by the U.S. Food and Drug Administration for treatment of ADHD in adults
Duration of action up to 24 hours
Can take up to two months to stabilize symptoms
First-line treatment in those with concerns about drug abuse or diversion
Patients who also take medications that inhibit cytochrome P2D6 (e.g., fluoxetine [Prozac], paroxetine [Paxil]) may experience significant adverse effects, even with small doses
Antidepressants
Bupropion (Wellbutrin)Up to 200 mg twice per dayData from small studies only$76 ($227) based on 100 mg twice per day
Has an increased risk (0.4 percent) of drug-induced seizures compared with other antidepressants
Desipramine (Norpramin)200 mg per dayTricyclic antidepressant$200 ($270)
Good response rate in small studies
Most studied of tricyclic antidepressants