ADHD New Meds Roundup
It's time for my once-every-few-months New Medications Update. Here it is:
Sparlon (modafinil, Provigil) is still awaiting FDA approval for treatment of ADHD. It's currently authorized for treatment of daytime sedation related to narcolepsy. Approximately 50% of those with ADHD have shown moderate to good improvement. It will be a once-a-day preparation. As with other stimulants, decreased appetite and insomnia are the most common side effects, and there is sometimes a minor effect on blood pressure and heart rate. Sparlon has a low potential for abuse.
A new, long-acting preparation of Adderall will hopefully be released soon. On the plus side is that it can be dissolved in water, making it easier for children who have difficulty swallowing tablets and capsules. Since the drug has to be broken down and released by hydrolysis in the GI tract, and since little is released in the mucous membranes if it is snorted, or intravenously if it is injected, it has little abuse potential even though it's an amphetamine. The duration of action is approximately 12 hours, making it a once-a-day preparation.
Recent studies on Strattera (atomoxetine): A study by Hah and Chang published in the J. of Child and Adolescent Psychopharmacology, Vol. 15, No. 6, Nov. 6, 2005 reported on the use of atomoxetine for AD/HD in children and adolescents being treated for bipolar disorder with a mood stabilizer. Significant improvement in ADHD symptoms occurred in six of the seven patients studied, and addition of atomoxetine did not trigger hypomania or mania. Their conclusion was that Strattera might be safely and effectively added to a mood stabilizer in children and adolescents struggling with both Bipolar Disorder and ADHD. This is important because many children with Bipolar Disorder also struggle with ADHD.
Another study (J. Atten Disord. Oct. 2004;8(2):45-52 looked at the safety and efficacy of using atomoxetine in children and adolescents with ADHD and comorbid Oppositional Defiant Disorder. The conclusions of this study indicated that while Strattera was effective in treating ADHD in this group, and was well tolerated, it did not significantly improve symptoms of Oppositional Defiant Disorder.
Another study (Neurology. 2005 Dec 27;65(12):1941-9) looked at whether tics increased when atomoxetine was used to treat ADHD in children and adolescents with comorbid tic disorders. As expected, there was a significant reduction in symptoms of ADHD. Strattera did not increase tic symptoms in the 76 subjects studied (aged 7 - 17 y/o), and there was some evidence of a reduction of tic severity by the end of the 18 week study.
In March of 2004, the FDA advised close monitory of children and adolescents being started on one of the newer antidepressants for the potential of increased suicidal thinking and behavior. However, a new study by Dr. Gregory E. Simon and colleagues from the Group Health Cooperative in Seattle after doing a 10-year population based study of data on 65,000 patients, found that the highest risk for suicide is in the month prior to starting treatment. In the month following the start of treatment, the risk of suicide fell by half, and continued to fall over the next six months. The risk of a serious suicide attempt in the first month of treatment was much lower for the group treated with the newer antidepressants on the FDA's warning list, than for those treated with other medications. While anyone being started on any medication should be closely monitored for potential adverse side effects, many are worried that the dramatic increase in warnings about potential rare events might discourage effective treatment by many who need it. In this example, it appears that the risk of not being treated outweighs the risk of treatment.
Related Topics: Choosing the Right ADHD Medication for your Child, New Drugs Help Child, Adult ADHD
Sparlon (modafinil, Provigil) is still awaiting FDA approval for treatment of ADHD. It's currently authorized for treatment of daytime sedation related to narcolepsy. Approximately 50% of those with ADHD have shown moderate to good improvement. It will be a once-a-day preparation. As with other stimulants, decreased appetite and insomnia are the most common side effects, and there is sometimes a minor effect on blood pressure and heart rate. Sparlon has a low potential for abuse.
A new, long-acting preparation of Adderall will hopefully be released soon. On the plus side is that it can be dissolved in water, making it easier for children who have difficulty swallowing tablets and capsules. Since the drug has to be broken down and released by hydrolysis in the GI tract, and since little is released in the mucous membranes if it is snorted, or intravenously if it is injected, it has little abuse potential even though it's an amphetamine. The duration of action is approximately 12 hours, making it a once-a-day preparation.
Recent studies on Strattera (atomoxetine): A study by Hah and Chang published in the J. of Child and Adolescent Psychopharmacology, Vol. 15, No. 6, Nov. 6, 2005 reported on the use of atomoxetine for AD/HD in children and adolescents being treated for bipolar disorder with a mood stabilizer. Significant improvement in ADHD symptoms occurred in six of the seven patients studied, and addition of atomoxetine did not trigger hypomania or mania. Their conclusion was that Strattera might be safely and effectively added to a mood stabilizer in children and adolescents struggling with both Bipolar Disorder and ADHD. This is important because many children with Bipolar Disorder also struggle with ADHD.
Another study (J. Atten Disord. Oct. 2004;8(2):45-52 looked at the safety and efficacy of using atomoxetine in children and adolescents with ADHD and comorbid Oppositional Defiant Disorder. The conclusions of this study indicated that while Strattera was effective in treating ADHD in this group, and was well tolerated, it did not significantly improve symptoms of Oppositional Defiant Disorder.
Another study (Neurology. 2005 Dec 27;65(12):1941-9) looked at whether tics increased when atomoxetine was used to treat ADHD in children and adolescents with comorbid tic disorders. As expected, there was a significant reduction in symptoms of ADHD. Strattera did not increase tic symptoms in the 76 subjects studied (aged 7 - 17 y/o), and there was some evidence of a reduction of tic severity by the end of the 18 week study.
In March of 2004, the FDA advised close monitory of children and adolescents being started on one of the newer antidepressants for the potential of increased suicidal thinking and behavior. However, a new study by Dr. Gregory E. Simon and colleagues from the Group Health Cooperative in Seattle after doing a 10-year population based study of data on 65,000 patients, found that the highest risk for suicide is in the month prior to starting treatment. In the month following the start of treatment, the risk of suicide fell by half, and continued to fall over the next six months. The risk of a serious suicide attempt in the first month of treatment was much lower for the group treated with the newer antidepressants on the FDA's warning list, than for those treated with other medications. While anyone being started on any medication should be closely monitored for potential adverse side effects, many are worried that the dramatic increase in warnings about potential rare events might discourage effective treatment by many who need it. In this example, it appears that the risk of not being treated outweighs the risk of treatment.
Related Topics: Choosing the Right ADHD Medication for your Child, New Drugs Help Child, Adult ADHD
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4 Comments:
My 13 year old grandson was diagnosed with ADHD some years ago. He has difficulty pronouncing words correctly putting the letter "D" in front of words making it very difficult to understand him. Also talks very fast. Is this normal with ADHD.
To those of you asking specific questions about a condition or concern, try visiting our ADHD Medications and Treatments board and our Children with ADHD board for more information.
Thank you.
My Nine year old son has mild Tourettes, adhd, some ocd, and anxiety. So confused on which way to go. Think his neurologist are just throwing things at him so we are going to try a psychiatrist. He is moody, behavior is defiant, still ticking even though on Tenex which I think the effect is wearing off for that med. and very impulsive and hard to focus and stay on task. Help!! Thank you
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