Medication | Dosage | Comments | Cost of generic (brand)* |
---|---|---|---|
Stimulants | |||
Immediate-release dextroamphetamine | Start 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 day | Short 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 day | A 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 day | Therapeutically inactive molecule | NA ($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 day | Can 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 day | Oral 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 day | Selective norepinephrine reuptake inhibitor | NA ($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 day | Data 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 day | Tricyclic antidepressant | $200 ($270) |
Good response rate in small studies | |||
Most studied of tricyclic antidepressants |