|Generic Name||Brand Name|
|dextroamphetamine||Dexedrine, Dextroamphetamine, Dextrostat|
|methylphenidate||Concerta, Daytrana, Metadate CD, Methylin, Ritalin|
|mixed salts amphetamine||Adderall|
How It Works
Stimulants affect how the brain controls
impulses and regulates behavior and attention. They do this by influencing the
availability of certain chemicals, called neurotransmitters, in the
Why It Is Used
Stimulants are considered for people
with moderate to severe
attention deficit hyperactivity disorder (ADHD) who
have difficulty in at least two different settings, such as school and
home.3 Stimulant medicines with amphetamine, such as
Adderall, that are used for the treatment of ADHD are approved by the U.S. Food
and Drug Administration (FDA) for children age 3 and older. Stimulant medicines
with methylphenidate, such as Ritalin, are approved for children age 6 and
older. A doctor may prescribe Ritalin for a child under age 6 based on the
child's specific needs.
- Methylphenidate (such as Ritalin or Concerta)
is often the preferred choice for treating ADHD, because it has fewer side
effects than other medicines and generally works well to control
- Dextroamphetamine or the combination dextroamphetamine
and amphetamine (Adderall) is usually the second choice when the person does
not improve with methylphenidate. But either may be the preferred medicine for
older children. The long-acting form of dextroamphetamine controls behavior for
a longer period of time, so fewer doses are required during the
- The dextroamphetamine and amphetamine combination medicine
(Adderall) is used when other stimulants have not improved symptoms or when the
combination of medicines may be more helpful.
Stimulants may be used in people with ADHD who also have
mood disorders, such as depression. The priority of which condition is treated
first usually depends on which is thought to be the main disorder.
Stimulants may be used in adults when antidepressants fail to control
ADHD symptoms. If antidepressants alone are not controlling symptoms,
stimulants may be added.
How Well It Works
Stimulants may be the most
effective treatment for the symptoms of ADHD:
hyperactivity. These medicines can suddenly and
dramatically improve behavior. But some people need to try different types and
dosages of stimulants to find the one that works best for them. If treatment
with a stimulant is successful, it usually helps control symptoms over time
without increasing the dosage.3
70% of people with ADHD, stimulant medicines improve symptoms.3
Children often become calmer,
more organized, and less stubborn. Examples of behaviors that improve
- Less interrupting, fidgeting, and finger
tapping at school; increased on-task behavior.
- Better relationships
at home with parents and siblings; better focus and on-task behavior; better
compliance with parent requests and authority.
- Improved social
relationships; increased attention during sports and other activities.
Although stimulants may also improve social adjustment or
academic performance for some children, they have not been shown to maintain
this benefit over the long-term.
One study found that
children with ADHD whose symptoms were predominantly related to inattention
showed significant improvement when they took lower doses (36 mg or lower) of
long-acting methylphenidate (Concerta) and had less benefit from higher doses.
In children with ADHD who had symptoms of both hyperactivity and inattention,
most showed increased improvement in symptoms when they took higher doses (36
mg to 54 mg). But higher doses resulted in increased insomnia and decreased
appetite in both groups of children.2
The most common side effects (affecting
about 50% of people) of stimulants are usually related to the dose and go away
after the first 2 to 3 weeks on the medicine. Persistent side effects can
usually be relieved by changing the dosage level, changing when the medicine is
given, or trying a different type of stimulant. The most common side effects
- Decreased appetite. About 80% of people have
decreased appetite. The appetite is usually least during the daytime,
increasing in the evening. If the medicine is given after meals and snacks are
added, especially in the evening, it may help improve the child's appetite and
prevent weight loss.
- Difficulty falling asleep.
Other side effects are also usually temporary or go away
with dosage adjustment. These include:
increased blood pressure (in black males).
Long-term use of stimulant medicine appears to be safe and effective.4
Stimulant medicines may be related to slower growth in children, especially in the first year of taking the medicine. But most children seem to catch up in height and weight by adulthood. Your doctor will keep track your child's growth and watch for problems.4
See Drug Reference for a full
list of side effects. (Drug Reference is not available in all systems.)
What To Think About
All medicines approved for the
treatment of ADHD come with a U.S. Food
and Drug Administration (FDA) warning about possible heart-related or
mental problems. Before starting a medicine for ADHD, tell your doctor if your
child or you have any heart problems, heart defects, or mental health
Methylphenidate and dextroamphetamine usually take
effect within 1 hour after the first dose. Talk to your doctor about the best
time to take the medicine.
Treatment with stimulants may be
continued as long as the symptoms are present, the medicine continues to work,
and there are no significant side effects.
People with ADHD do not
tend to abuse stimulant medicine and very rarely develop dependence on (addiction to)
on the medicine. Also, there is no evidence that people with ADHD who
take stimulants are at greater risk for abusing other drugs. In fact, people
who take stimulants for ADHD may be less likely to abuse drugs.1
Some people buy or steal stimulant medicines.
Parents need to be certain that their child takes his or her medicine and does
not share it with or sell it to anyone else. If this is a concern, talk to your
doctor about your child taking a medicine in a safer form.
Canadian health authorities stopped sales of Adderall XR in Canada, but
after carefully reviewing the data, the drug was returned to the market. Health
Canada withdrew the medicine from the market after learning that Adderall XR
and Adderall (sold in the United States, not in Canada) have been linked to 20
sudden deaths and 12 strokes in children and adults in the U.S. After reviewing
the Canadian decision and the medical reports, the FDA has not recommended any immediate changes in the FDA
labeling or approved use of this drug. The FDA recommends that you talk to your
doctor if you have any questions or concerns about using this medicine.5
When stimulants are used to treat ADHD, remember
- If a dose is missed, do not increase doses to
catch up. If several doses are missed, begin taking the medicine again on the
- Methylphenidate often needs to be given every 3
hours to prevent the symptoms of ADHD from coming back.
Tips for giving methylphenidate or dextroamphetamine to
- It is best to start the medicine on the weekend
so you can better see how the child reacts to the medicine.
- A low
dose of methylphenidate is usually given at first. The dose is increased until
the child's behavior is controlled. It is important to follow the prescribed
dosage schedule and watch for changes in behavior.
- A typical
schedule for giving the medicine is after breakfast and lunch and in the
afternoon. Schedules may be changed to suit the needs of the child, his or her
family, and school. It is better to give the medicine after meals rather than
before so it doesn't interfere with the child's appetite and weight
- Most children who take stimulants for ADHD function best when
medicines are used continuously. But some children may function well enough to
take a break from medicines on weekends and holidays. Even for these children,
it is usually helpful to continue the medicine on weekends if activities are
planned that require concentration and attention, such as team sports, church
activities, or educational programs.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Upadhyaya HP (2008). Substance use disorders in children and adolescents with attention-deficit/hyperactivity disorder: Implications for treatment and the role of the primary care physician. Primary Care Companion Journal of Clinical Psychiatry. 10(3): 211-221.
Stein MA, et al. (2003). A dose-response study of OROS
methylphenidate in children with attention-deficit/hyperactivity disorder.
Pediatrics, 112(5): e404-e413.
American Academy of Child and Adolescent Psychiatry
(2002). Practice parameter for the use of stimulant medications in the
treatment of children, adolescents, and adults. Journal of the American Academy of Child and Adolescent Psychiatry, 41(2, Suppl):
Greenhill LL, Hechtman LI (2009). Attention-deficit/hyperactivity disorder. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 3560-3572. Philadelphia: Lippincott Williams and Wilkins.
U.S. Food and Drug Administration (2005). FDA Statement: Statement on Adderall. Available online: