Category: Intermediate stimulants
Short- and Intermediate-Acting Stimulants for ADHD
Transcript: Theresa Cerulli, MD: How about the stimulants? You’ve shared, Andy, the information on the nonstimulants. Ann, would you like to begin talking about the short- and intermediate-acting stimulant medications we have?
Ann C. Childress, MD: Sure, Theresa. We have methylphenidates and we have amphetamines. They’re old staples. They’ve been on the market for a long time. Amphetamines were first looked at with Benzedrine in the 1930s. And in the methylphenidate class, Ritalin. Immediate-release methylphenidate was first approved by the FDA in 1955.
The methylphenidates come in several different formulations. There is a liquid formulation, there are chewable tablets, and there are tablets that you swallow. They start working pretty quickly. Their onset of effect is between 30 and 45 minutes. Their duration isn’t too long. It’s between 3 and 4 hours, so folks often need to take the medication 2 or 3 times a day. Methylphenidate is approved up to 60 mg by the FDA. That’s really important because when people are getting treated, I often will see somebody who comes in on 5 mg twice a day, or 10 mg twice a day. Those are fine as starting doses, but that’s not enough to get extended efficacy.
As far as other methylphenidates, there’s Focalin. That’s actually a dexmethylphenidate, and it really is intermediate. It’s duration of effect is 4 to 6 hours, and it is approved only up to 20 mg. Normally, folks start with a 2.5-mg dose twice a day and then go up from there.
If you look at the amphetamines, there’s dextroamphetamine. This drug lasts about 3 to 5 hours. It’s approved up to 40 mg for ADHD [attention deficit hyperactivity disorder] and up to 60 mg for narcolepsy. If you look at the package insert, 1 of the things it says is you shouldn’t need more than 40 mg to treat ADHD. It doesn’t necessarily say you can’t go above that.
Dextroamphetamine comes in a number of different tablet sizes—from 2.5-mg tablets all the way up to 30-mg tablets. The generic dextroamphetamine, which isn’t too expensive, is available as 5- and 10-mg doses. Then there is a branded formulation that has a number of different tablet strengths. This option is called Zenzedi. Adderall is more of an intermediate-acting drug. It lasts for about 4 to 6 hours. It is available as 5-mg tablets up to 30-mg tablets. It’s onset of effect really isn’t as quick as with Dexedrine [dextroamphetamine] and immediate-release methylphenidate. It’s probably about an hour, or an hour and a half. Its duration is about 5 to 7 hours. If you look at 1 of the newer ones that is branded, Evekeo [amphetamine sulfate], that is 50/50, regarding d- [dextroamphetamine] and l-amphetamine [levoamphetamine]. Adderall is 3 to 1, in regard to d- [dextroamphetamine] and l-amphetamine [levoamphetamine]. Evekeo has an onset somewhere between 30 and 45 minutes. In a classroom trial that I was the lead investigator on, we were able to squeeze about 10 hours out of it. That is when everybody is dose optimized and, in the best of all situations, compared with placebo. But if you look at things in general, it’s probably more like 5 or 6 hours that folks are going to get out of it. You can dose it once or twice a day. And you can start at 5 mg and go all the way up to 40 mg. You can increase all these medications on a weekly basis. You don’t have to start low and go slow. You can start low and ramp things up pretty quickly. It’s really important to do that to get the best therapeutic effect.
Andrew J. Cutler, MD: You know, Ann, I’m surprised by how commonly the immediate-release preparations are still used today. I know not just for augmentation, sometimes we’ll use them to extend the duration. But there are a lot of people who are just managed on immediate-release preparations.
Ann C. Childress, MD: That’s true. I’m sure Tim wants to bang his head on the wall when he hears that, looking at substance abuse.
Theresa Cerulli, MD: We will absolutely cover that topic.
Transcript Edited for Clarity / Intermediate stimulants / Intermediate stimulants
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DYANAVEL XR (amphetamine) extended release oral suspension, a CNS stimulant, is an extended-release liquid formulation containing a 3.2 to1 ratio of d- to l-amphetamine.
Each 1 mL of DYANAVEL XR contains 2.5 mg of amphetamine which is the same as the amount of amphetamine (base equivalent) found in a 4 mg strength amphetamine mixed salts product.
DYANAVEL XR (amphetamine) Structural Formula Illustration
DYANAVEL XR utilizes an ion exchange resin where the drug is bound to the resin (sodium polystyrene sulfonate) through an ionic binding reaction. DYANAVEL XR contains immediate release and extended-release components. The extended-release component is coated with an aqueous, pH-independent polymer. After drug release the ion-exchange resin is excreted in the feces.
Inactive Ingredients: anhydrous citric acid, bubblegum flavor, glycerin, methylparaben, modified food starch, polysorbate 80, povidone, polyvinyl acetate, propylparaben, sodium lauryl sulfate, sodium polystyrene sulfonate, sucralose, triacetin and xanthan gum.
Quantity Per unit Price 30 (5 x 6 each) $15.48 $464.27 Buy 3.1 mg Adzenys XR-ODT oral tablet disintegrating extended release online. This drug Extended Release Distintegrating Adzenys XR-ODT 3.1 MG 24HR Oral Tablet is an appetite suppressant and stimulant. It works by raising the amount of specific molecules in the body, which stimulates the …
Buy 40mg Aptensio XR Oral online. CNS stimulants used to treat ADHD, such as Aptensio XR, have been linked to peripheral vasculopathy, including Raynaud’s phenomenon. The signs and symptoms are usually sporadic and moderate; nonetheless, digital ulcers and/or soft tissue collapse are very unusual complications. APTENSIO XR is a central nervous system stimulant used to …
Prescription prices may vary from pharmacy to pharmacy and are subject to change. The pricing estimates given are based on the most recent information available and may change based on when you actually fill your prescription at the pharmacy. The day supply is based upon the average dispensing patterns or the specific drug and strength. The Program, as well as the prices and the list of covered drugs, can be modified at any time without notice.
Focalin XR is for oral administration once daily in the morning. Focalin XR may be swallowed as whole capsules or alternatively may be administered by sprinkling the capsule contents on a small amount of applesauce (see specific instructions below). Focalin XR capsules and/or their contents should not be crushed, chewed, or divided. Rx only Prescribing Information …
Mydayis (Generic Name: Mixed salts of a single-entity amphetamine product) is a long-acting, triple-bead, mixed amphetamine salts formulation used for once-daily treatment of symptoms of attention deficit disorder (ADHD or ADD) in adolescents and adults 13 and older. Mydayis [package insert]. Lexington, MA; Dream Pharmacy. Sign up to receive Mydayis (mixed salts of a single-entity …
Information for Vyvanse chewable tablets: Vyvanse chewable tablets must be chewed thoroughly before swallowing. Vyvanse capsules can be substituted with Vyvanse chewable tablets on a unit per unit/ mg per mg basis (for example, 30 mg capsules for 30 mg chewable tablet) [see Clinical Pharmacology. Lisdexamfetamine dimesylate is a white to off-white powder that is …
Lisdexamfetamine can pass into breast milk and may cause side effects in the nursing baby. You should not breast-feed while using this medicine. Vyvanse is not approved to treat ADHD in a child younger than 6 years old. Vyvanse is not approved to treat binge eating disorder in anyone younger than 18 years old. N208510 …