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ADHD in Children Health Center

Nonstimulant ADHD Drug Studied

Alternative to Ritalin Eases Concerns of Parents, Some Doctors
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Oct. 28, 2002 -- If you have a child with attention deficit hyperactivity disorder (ADHD), you may find the medication for treating it presents a dilemma. You want your child to be focused and attentive in school, able to handle frustrations, and prepare for bedtime without being irritable. Yet when the physician first prescribed a medication such as Ritalin and explained that it's a stimulant, you may have stopped the doctor mid-sentence.

"A stimulant? For my child?" Instead of an improvement, you visualized more of the same hyper behavior, only worse. Other parents are concerned about the abuse potential for stimulant drugs, and many doctors are concerned the medication will be diverted to the ADHD child's friends who may want to borrow or buy it, thinking it will make them high.

While this thinking reflects a misunderstanding of stimulant therapy for ADHD, it creates enough confusion that many ADHD experts have been investigating nonstimulant drugs. One such drug, Strattera (atomoxetine), may be approved by the FDA next year. Studies of twice-daily treatments have shown it to be effective, and now a once-daily version appears to be safe and effective, too.

"The once-daily formulation appears to be as effective as twice-daily atomoxetine treatment," according to David Michelson, MD, speaking at the 49th annual meeting of the American Academy of Child and Adolescent Psychiatry in San Francisco. "We saw benefits of the once-daily medication into the evening, with children receiving the dose in the morning." He is the medical director of Lilly Research Laboratories in Indianapolis. Lilly is a sponsor of WebMD.

Strattera differs from other ADHD medications because it is in a different drug class and therefore works differently on ADHD symptoms than do stimulants. The twice-daily version was given before and after school, to avoid the stigma of trips to the health office in the middle of the school day.

Even more convenient is taking only one dose a day, and Michelson and colleagues sought to determine whether this would be as effective as the twice-daily dose.

They followed 171 children aged 6 to 16 who took either Strattera or a placebo. Neither the parents, the children, or the doctors knew which children received the medication or a sugar pill. Eighty-five children took Strattera and 86 took the placebo.

The study showed that the children who took Strattera had significantly superior outcomes to those who took a placebo and they received a benefit similar to the twice-daily dose of the drug. Parent diaries suggested that medication benefits were still seen late in the day after a morning dosing. In both groups less than 3% of subjects discontinued due to side effects; also no serious safety concerns were observed.

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