Amfetamine and methylphenidate medications for attention-deficit/hyperactivity disorder: complementary treatment options

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders among school-aged children. It is highly symptomatic and associated with significant impairment. This review examines the role of stimulant medications in the treatment of children and adolescents with ADHD. Published clinical studies that compared methylphenidate- and amfetamine-based stimulants in children and adolescents with ADHD support the therapeutic utility of stimulant treatments, and suggest robust efficacy and acceptable safety outcomes in groups treated with either stimulant. Evidence-based guidelines agree that each patient with ADHD is unique and individual treatment strategies that incorporate both drug and non-drug treatment options should be sought. In seeking to optimize individual response and outcomes to stimulant therapy, important considerations include the selection of stimulant class, the choice of long- or short-acting stimulant formulations, addressing effectively any emergent adverse effects and strategies aimed at enhancing adherence to dosing regimen and persistence on therapy.

Fig. 1

Overlapping but distinct putative mechanisms of action of a methylphenidate (MPH) and b amfetamine (AMF) at the dopamine synapse. VMAT2 vesicular monoamine transporter 2

Fig. 2

Effect sizes and confidence intervals for ADHD-RS and CGI outcomes in children. Black diamonds and horizontal black lines represent standardized mean difference effect sizes and 95 % confidence intervals, respectively. Pooled results are depicted as open diamonds with the effect size in the centre of the diamond and the 95 % confidence intervals depicted by the left and right extremities of the diamond. ADHD-RS attention-deficit/hyperactivity disorder rating scale, CGI clinical global impressions of ADHD severity, LDX lisdexamfetamine dimesylate, MAS mixed amfetamine salts, MPH methylphenidate, OROS osmotic release oral system, TS transdermal system. Figure adapted from Faraone [37], with permission