ADHD Medications

ADHD Medications for Adults and Children: ADD Stimulants, Nonstimulants & More

Adderall. Vyvanse. Ritalin. Strattera. Concerta. The number of ADHD medication options is staggering, and finding the right treatment feels overwhelming at times. Here, an ADHD specialist explains the stimulant and nonstimulant options for adults and children in terms we can all understand.

pharmacy shelves full of ADHD medications - should you switch to a different ADD medication?
illustration of pharmacy shelves full of ADHD medication options

ADHD Medications for Adults and Children: Which Are Best?

The number of medications available to treat attention deficit hyperactivity disorder (ADHD or ADD) is overwhelming at best, and the process for selecting the best ADHD medication for you or your child, or deciding to medicate at all, is incredibly personal.

The ADHD medications prescribed to both children (as young as age 6) and adults are broadly categorized as

  • Stimulants – considered the first-line treatment for ADHD. Amphetamines fall under this category, along with methylphenidate, the most widely used treatment for ADHD, and their derivatives.1
  • Nonstimulants – prescribed to patients who don’t tolerate or see benefits from stimulant medications (up to 30 percent of patients do not respond to stimulants2). Three nonstimulants are approved to treat ADHD: atomoxetine, guanfacine, and clonidine. Nonstimulants, may also be prescribed for use alongside stimulants to treat symptoms that the latter do not alleviate.

Selecting the “best” ADHD medication can be a lengthy trial-and-error process of dosage and timing that is often related to a patient’s history, genetics, experienced side effects, and unique metabolism. ADHD medication is also often accompanied by behavioral therapy and other non-pharmacological treatments.

The most popular ADHD medications among ADDitude readers include (in alphabetical order):

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

Many parents and adults with ADHD remain confused about the distinctions and similarities between these and other treatment choices for ADHD. Our ADHD medication chart offers a side-by-side comparison of the most popular stimulants and nonstimulants in the treatment of ADHD.

What Are the Newest ADHD Medications?

The newest ADHD medications on the market include Jornay PM and Adhansia XR – stimulant medications approved in 2019 by the Food and Drug Administration (FDA) for use in children and adults. Unlike most stimulants, Jornay PM is taken in the evening; the medication begins working by the time the patient wakes and through the rest of the day. Adhansia XR is available in six extended-release capsules, which include some of the highest dosage strengths currently on the market.

[Free Download: The Ultimate Guide to ADHD Medication]

How Do Stimulant Medications Treat ADHD?

ADHD is a neurological disorder, resulting from the deficiency of a neurotransmitter, or a group of neurotransmitters, in specific areas of the brain. Neurotransmitters are chemicals that transmit signals between nerve cells by bridging the synapse (or gap) between them.3

One key neurotransmitter often deficient in individuals with ADHD is norepinephrine, along with its building blocks, dopa and dopamine. In theory, the primary stimulant medications used to treat ADHD stimulate specific cells within the brain to produce more of this deficient neurotransmitter. That’s why these medications are called stimulants — though it’s unknown exactly how they work to relieve ADHD symptoms.

The two main classes of stimulant medications, methylphenidate and dextro-amphetamine — both generic names — have been used since the 1930s.4 All brand-name stimulants are variations of these two medications. The ADHD medication Adderall for instance, is a modification of dextro-amphetamine. Methylphenidate, on the other hand comes in many forms (including a chewable tablet, a liquid, and a skin patch) with each variation having its own name.

How Do Nonstimulants Work to Treat ADHD?

Atomoxetine (brand name Strattera) is a selective norepinephrine reuptake inhibitor (SSRI) that works, in theory, by increasing concentrations of norepinephrine and dopamine in the prefrontal cortex, which is believed to regulate behavior and thus helps with ADHD symptoms1.

[Watch: Stimulants vs. Nonstimulants: –Understanding ADHD Medications]

Clonidine (Kapvay) and guanfacine (Intuniv) are alpha2-agonists. The prevailing theory is that these medications work by mimicking the effects of norepinephrine in the prefrontal cortex’s receptors.1

Bupropion (Wellbutrin), while not approved for ADHD treatment, is an antidepressant that clinicians commonly prescribe off-label to treat ADHD.

How is ADHD Medication Dosed?

The FDA requires, among other provisions, that a medication be labeled according to its5:

  • Dosage Form/Route of Administration: Capsule, tablet, liquid, patch, etc. 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. Daytrana 30 mg contains about 30 mg of methylphenidate, and releases about 3.3 mg of it per hour.
  • Dose Quantity/Strength: The specific amount of medication released into the blood over a given period of time. In other words, the number value for each product represents the total amount of the medication in the tablet/liquid/capsule/patch, not the amount in the blood at any one time. If methylphenidate, for example, 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, on the other hand, that releases 10 mg immediately and 10 mg four hours later is called Adderall XR 20.
  • Release mechanism/Duration of Administration (released immediately or over an extended period of time): The length of time a medication will remain available and active. Stimulants release medications over many time frames, including an hour, four hours, or over eight or 12 hours. 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. Different names, even though both contain the same medicine — methylphenidate.

Even with the FDA’s guidelines, the average consumer may find labels on ADHD medications confusing. Take 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.

The number value assigned to each dose is where the confusion tends to lie. 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 figured 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.

What Are The Side Effects of ADHD Medication?

Generally, stimulant medications have similar side effects that include1

  • decreased appetite
  • stomach pain
  • sleep disturbances
  • headaches

Some side effects associated with nonstimulants include1:

  • fatigue
  • stomach pain
  • decreased appetite
  • nausea

It is common for patients to experience side effects when trying and adjusting stimulant medications. Clinicians may start with small doses and increase dosing if the patient does not see benefits and if side effects are tolerable. Many side effects are also temporary until the patient adjusts. The American Academy of Pediatrics (AAP) notes that clinicians should titrate doses of ADHD medication to achieve maximum benefit with tolerable side effects.6

If adverse reactions persist, the clinician can make the switch to another stimulant, or to a nonstimulant.

ADHD Medications List: Stimulants

Methylphenidate

  • Generic: tablet; immediate release; lasts about four hours; comes in 5, 10, 15 mg dosages
  • Adhansia XR: brand name; capsule; extended release; lasts about 16 hours; comes in 25 mg, 35 mg, 45 mg, 55 mg, 70 mg, and 85 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
  • Cotempla XR-ODT: brand name; extended release orally disintegrating table; comes in 8.6mg, 17.3mg, and 25.9mg
  • Daytrana: brand name; skin patch; lasts about eight hours; comes in 10, 15, 20, 30 mg dosages
  • Jornay PMbrand name; delayed release extended release capsule; comes in 20mg, 40mg, 60mg, 80mg, and 100mg
  • 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
  • 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

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

Dextro-Amphetamine/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 ER: brand name; extended release oral suspension; 1.25 mg/ml
  • 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
  • Dexedrine Spansule: brand name; capsule; immediate release followed by gradual release; lasts eight hours; comes in 5, 10, 15 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
  • Generic; tablet; immediate release; lasts four hours; comes in 5, 10 mg dosages
  • Mydayis: brand name; long-acting capsule; comes in 12.5mg, 25mg, 37.5 mg, and 50mg dosages
  • ProCentra: brand name; liquid; immediate release; lasts four hours; comes in 5 mg/tsp dosage
  • Vyvanse: brand name; capsule and chewable tablet; lasts 10 to 12 hours; comes in 20, 30, 40, 50, 60, 70 mg dosages
  • Zenzedi: brand name; immediate release tablet; 2.5mg, 5mg, 7.5mg, 10mg, 15mg, 20mg, and 30mg

ADHD Medications: Nonstimulants

Atomoxetine

  • Strattera: brand name; capsule; long acting; 24-hour duration; 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg

Clonidine

  • Kapvay: brand name; extended release tablets; 24-hour duration; 0.1mg and 0.2 mg

Guanfacine

  • Intuniv: brand name; extended-release tablets 1mg, 2mg, 3mg, 4mg; 24-hour duration

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

 

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


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Sources

1 Briars, L., & Todd, T. (2016). A Review of Pharmacological Management of Attention-Deficit/Hyperactivity Disorder. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 21(3), 192–206. https://doi.org/10.5863/1551-6776-21.3.192

2 Mohammadi, M. R., & Akhondzadeh, S. (2007). Pharmacotherapy of attention-deficit/hyperactivity disorder: nonstimulant medication approaches. Expert review of neurotherapeutics, 7(2), 195–201. https://doi.org/10.1586/14737175.7.2.195

3 Curatolo, Paolo et al. “The neurobiological basis of ADHD.” Italian journal of pediatrics (Dec. 2010) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016271/

4 Kolar, Dusan et al. “Treatment of adults with attention-deficit/hyperactivity disorder.” Neuropsychiatric disease and treatment (Apr. 2008) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518387/

5 General Labeling Provisions, 21 CFR §201.5. https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=&SID=3023b9178a21af215b85e0f947c64c74&mc=true&n=pt21.4.201&r=PART&ty=HTML#se21.4.201_15

6Wolraich ML, Hagan JF, Allan C, et al; Subcommittee on Children and Adolescents with Attention-Deficit/Hyperactive Disorder. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 2019;144(4):e20192528; https://doi.org/10.1542/peds.2019-2528

Updated on September 1, 2020

8 Related Links

  1. Are there any studies that look at the long-term health effects of taking either methylphenidate or dextro-amphetamine for an extended period? Changes in aging stress hormones or metabolism?

  2. >>> I hope parents of children on ADHD stimulants read this, especially if they are punishing their child for stimulant-rebound meltdowns. <<<

    Vyvanse is “slow-on, slow-off,” with about a 2-hour ramp-up/ramp-down time. That means that you don’t get nearly the medication rebound that happens with other stimulants. Having experienced the rebound of short-acting stimulants myself, I am amazed that doctors still prescribe them. (It may be due to expense/insurance, but that needs to change.) Talk about “do no harm.” It is a horrible experience; you feel like dirt. (See below for a detailed description of my experience.) And it is happening to young kids who can’t describe their experience.

    I feel so sad for all the young kiddoes suffering daily rebounds, often at homework time, and the parents who are trying to manage the meltdowns.

    Vyvanse is the only medication that has been effective for my two daughters w/o significant side effects. I started taking it 3 years ago, and now both of my daughters as well as my sister do. She thanked me profusely for telling her about it – she had been taking Ritalin and didn’t like it so she had given up. She did have to go through a big rigmarole with her insurance, but they did approve it.

    I wish it had existed in 2014 when my younger daughter was diagnosed with ADHD at the end of 1st grade. Due to ineffectiveness and/or intolerable side effects of the medications we tried (several stimulants of each type, as well as each of the non-stimulant ADHD medications), we gave up on medication and she has gone untreated for nearly 4 years, poor thing (until just recently, when we tried Daytrana — ineffective, and now Vyvanse). However, she managed well (good grades, good behavior — but would fall apart after school) until this year – 5th grade was just more than she could handle untreated, and she was diagnosed with anxiety and depression.

    When we learned last year that my middle school daughter had stealth ADHD, I couldn’t believe that our then-psychiatrist gave her Ritalin with the instruction to go to the nurse’s office during her (very short) lunch. Needless to say, she didn’t go, and he wouldn’t prescribe Vyvanse. I figured it wasn’t used in kids.

    When we recently switched to a pediatric psychiatrist with a top-notch reputation, she prescribed Vyvanse for both girls without blinking an eye.

    I would say that Vyvanse has changed our lives. (I have no affiliation with any pharmaceutical company or anything else remotely related.)

    I hope my recounting of our experience helps someone else. Our lives would have been so much better had Vyvanse been available in 2012.

    ———

    Here’s an email I wrote to a parenting coach / child therapist who specializes in challenging children:

    “I now know how HORRIBLE [my daughter] felt during 1st grade, and thousands of other kids feel when they take short-, mid-acting stimulants and they wear off (right at homework time). It’s really rough and unlike any physical illness you might be familiar with. I felt sick, but not like a flu. Metaphorically, kind of like bad nausea if applied to the whole body and brain/mind. A state that a child’s brain really shouldn’t have to be in (but of course I recognize the need and advantage of stimulants) and that a child shouldn’t have to experience.

    “I wish I had a way to tell all the parents, so they could really sympathize with their children. I know that we found the horrible rebound behavior [my daughter] had, to be stressful for US, but didn’t REALLY get how horrible she must have felt.

    And her response:

    “Thanks for the info on the rebound.  I have witnessed and heard countless stories of the crash that occurs when kids’ meds wear off but didn’t know the chemical reason and so it is helpful to hear from an articulate adult on it so that I can share it with parens whose kids cannot explain it.”

  3. You left out #10 – Tenex (gunafacine) another non-stimulant medication

    #11 – clonidine another non-stimulant used as an alternative /add on med

    It would have been useful to include those in this article. Makes it out of date.

  4. My 12 year old son has been on various forms of stimulants for 6 years. His level of focus has barely improved. Worse, I am now far more concerned that his growing body is not getting the nutrition it needs during this critical part of his life. And this is something I know about. As an aside, my mother came from a poor farm family with 9 kids. With the exception of the two oldest, the other 7 were all put up for adoption. The youngest were all adopted immediately (at that time age 4 and under). The older children (age 7-14) took longer to adopt. The 3 youngest (boys) all grew up to be over 6′ tall. None of the others grew to be taller than 5’3. That was all due to diet and the availability of nutrition. Luckily my mother and a younger brother were the next to go and only had to wait a year to be adopted and both were adopted into families that were able to provide proper nutrition and educational support. The older 4 children were all dead by age 60. With the exception of one killed in military service, the younger ones (and her brother) have all lived to be over 85. So now here is my son, whose primary dosage has been Focilin and Focilin XR. He is 58″ tall which puts him on the smaller side (39th decile – normal). But he only weights 60 lbs putting him in 0.75 percentile for weight. His BMI is 12.5. That puts him so low on the BMI scale that it if anyone were to see him, you’d think he was anorexic. This is completely due to his medication. How able to focus will he be if his brain doesn’t get enough protein to form. These drugs are as much a part of the problem. Worse yet, they are only treating a symptom, not the root cause. He is also diagnosed with Aspergers. Against his physicians request and his mother’s, I have been able to get a court to allow him to be treated by a respected Children’s Hospital in our area on a new program that seeks to prove that the increases in spectrum disorders and ADHD are due to a microbiome imbalance. With any luck, he will be off these terrible prescriptions.

  5. Been on Vyvanse for 7 years and in the last year i have noticed some changes. It is making me mentally spiral and generally feel dysphoria. I have been taking instant release dex instead to avoid these negative side effects. i have discussed with a fellow adhd’er and she noticed a similar change at the same time i did. when i am on it I have no natural confidence despite being very confident the days i don’t take… it on these days i have zero focus. Any theorys/ suggestions?

    i feel like the formula has changed honestly

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