Article Sections

Introduction

Pharmacotherapy for attention deficit hyperactivity disorder (ADHD) includes stimulant and nonstimulant agents.  Stimulants are the most effective for treating ADHD.  Nonstimulant medications, such as atomoxetine (selective norepinephrine reuptake inhibitor) or clonidine and guanfacine (alpha-2 adrenergic agonists), may be favored depending on tolerability, comorbid conditions, and patient preference.

Stimulants

Indications
  • ADHD:  Stimulants are the first-line treatment for ADHD in both children (age ≥6) and adults, improving both inattentive and hyperactive symptoms.
  • Narcolepsy:  Stimulants improve daytime wakefulness.
Pharmacology

Stimulants improve ADHD symptoms by increasing synaptic concentrations of dopamine and norepinephrine.

The 2 main classes of stimulant medications are methylphenidates and amphetamines:

  • Methylphenidates (eg, dexmethylphenidate):  Block norepinephrine and dopamine reuptake at synapses in the prefrontal cortex.
  • Amphetamines (eg, dextroamphetamine, mixed amphetamine salts):  Block norepinephrine and dopamine reuptake at synapses in the prefrontal cortex, increase the release of norepinephrine and dopamine from presynaptic storage vesicles, and inhibit monoamine oxidase.

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