ADHD Medications and Treatments
ADHD affects an estimated 3% to 5% of children and adults in the U.S. Dr. Richard Sogn shares information and advice about attention deficit hyperactivity disorder, including its causes, diagnosis, and promising ADHD treatments
Tuesday, August 29, 2006
Daytrana
People with AD/HD have symptoms all day long, but taking medications several times a day, especially at school or at work, is inconvenient, is frequently "forgotten," and can be stigmatizing. Some people taking multiple doses of shorter-acting preparations feel as if they are on an "emotional rollercoaster," with symptoms increasing and decreasing as each dose is wearing off and the next dose is starting to work.
AD/HD is a life problem, not a school or work problem, and longer-acting preparations help people to normalize their life. Daytrana, a transdermal methylphenidate preparation, allows for a more flexible duration of effect - the longer you keep the patch on, the longer the effect.
Fast facts about Daytrana:
Daytrana is a clear adhesive patch containing methylphenidate that is applied to intact skin. Each area of the patch contains the same amount of medication, and dose is adjusted by wearing different patch sizes and by varying the wear time. It is available in four doses: 10, 15, 20, and 30 mg.
The 10 mg patch releases 1.1 mg of methylphenidate per hour and contains 27.5 mg per patch; the 15 mg patch delivers 1.6 mg/hr and contains 41.3 mg; the 20 mg patch delivers 2.2 mg/hr and contains 55 mg; and the 30 mg patch delivers 3.3 mg/hr and contains 82.5 mg of methylphenidate.
Daytrana is applied to the hip for nine hours. The mean peak concentrations of methylphenidate is nearly two times higher with Daytrana than with other once-daily methylphenidate preparations, thus the effective dose of Daytrana is often lower than an effective dose of Concerta or somewhat equivalent to an effective dose of Focalin XR.
Peak concentrations were also higher with Daytrana with chronic administration compared to peak concentrations after a single dose, and were higher in 6 year olds than in 12 year olds.
Daytrana is generally effective about two hours after the patch is applied. It should always be applied to intact skin, as application to inflamed skin increases the rate and extent of absorption, with peak concentrations up to 3 times higher. Heat should not be applied to the patch after application, as it would also increase the rate and extent of absorption of medication. Daytrana should always be applied to the hip as different areas of the body have different absorption rates. The patch should be removed after about 9 hours, and the medication remains effective for about 3 hours after its removal.
Potential side effects to Daytrana are similar to other methylphenidate preparations and include nausea, abdominal cramping, headache, nasopharyngitis, decreased appetite and weight loss, affect lability (increased sensitivity, emotional instability), tearfulness, insomnia, increased tics, and nasal congestion.
Daytrana is a skin irritant and the majority of people will develop erythema (redness) at the patch site that causes little discomfort. On rare occasions, contact sensitization could develop, and edema, papules, vesicles and other intense skin reactions could occur in addition to erythema. If such a reaction occurs, the patch should be removed and the doctor should be contacted. Patients who develop allergic contact dermatitis to Daytrana might develop an allergic reaction to methylphenidate in general, and might not be able to subsequently take oral methylphenidate.
Applying the Patch Properly
Daytrana is usually started at the 10 mg dose, then the dose is increased weekly until there is an appropriate effect. The patch should be placed on a clean, dry area of the hip and the skin should not be oily, damaged, or irritated. The waistline should be avoided as the patch might be rubbed off by clothing. The alternate hip should be used the following day. The patch should be held firmly in place with the palm of the hand for about 30 seconds to make sure there is good contact. After application, bathing or swimming don't affect patch adherence. If a patch does fall off, a new patch can be placed at a different site, but the total daily time of use shouldn't exceed nine hours. If a shorter duration of effect is desired, or if insomnia occurs, the patch can be removed earlier than 9 hours. The patch can also be removed early if someone experiences initial side effects, which would lower the total daily dose received and might decrease side effects until tolerance to them can develop.
Methylphenidate and other stimulants should not be used by people with heart disease, glaucoma, tics, by someone with significant anxiety, tension, or agitation, by someone taking a monoamine oxidase inhibitor (MAOI), or by someone with a history of psychosis. Daytrana has not been studied in children below six years old.
Related Topics: New Heart Alert for Some ADHD Drugs, Back to School with ADHD
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Monday, August 07, 2006
AD/HD Medications During Pregnancy
Stimulant medications, including methylphenidate (Ritalin, Concerta, Metadate CD, and others), mixed amphetamine salts (Adderall, Adderall XR), and dextroamphetamine (Dexedrine) remain the first-line medication for treatment of AD/HD.
There have been no well-controlled studies of stimulant use during pregnancy (ethically, a study giving a stimulant medications to pregnant women would not be authorized by the FDA). Stimulants are classified as Category C by the FDA (Animal studies show adverse effects, but there are no controlled human studies).
Amphetamines (Adderall and Dexedrine) given to mice in doses much higher than the usual human dose have reported cardiac defects. Studies of women addicted to amphetamines have shown higher rates of low birth rate and pregnancy complications. Another study found that children of women exposed to Dexedrine had a higher incidence of heart defects at three-year follow-up. A study of 48 women exposed to methylphenidate during pregnancy found higher rates of premature birth, growth retardation, and symptoms of withdrawal in the infants.
Modafanil (Provigil) and atomoxetine (Strattera) are also category C drugs, with inadequate information available to assess risk. There is also not enough information about bupropion (Wellbutrin) to assess risk, and although it's a category B drug (preferred over category C drugs), there is some concern about its use during pregnancy and a potential for congenital heart defects.
All medications are excreted into breast milk, exposing them to the infant. Amphetamines are concentrated in breast milk which causes concern about typical side effects of stimulant medications as well as withdrawal symptoms. There is no information about methylphenidate during nursing. There is too little information available about atomoxetine and modafanil to recommend their use during breastfeeding.
More information is needed regarding medications used to treat AD/HD during pregnancy and while nursing. Although the risks versus the benefits of using medications during pregnancy and while nursing should be thoroughly discussed with someone's physician, there is currently no information to indicate that treatment of AD/HD with medication is a safe choice.
Alternatively, I recommend working with an ADD Coach/ Organizer (or experienced therapist) on skills for planning, organization, time management, and follow-through.
Dr. Richard Sogn
Related Topics: Pregnancy Antidepressants: Baby Risk, Dads Get PostPartum Depression, Too
Technorati Tags: AD/HD, pregnancy, stimulant medication
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