ADHD nugget No. 2

Here’s another conference nugget:

Here are some interesting facts about the two stimulant families, methylphenidate (Ritalin, Concerta, Metadate…) & Amphetamine (Adderall, etc.)

  • Stimulants appear to be less effective on ADHD in children who are also on the Autism Spectrum  and those who’s ADHD is brain injury related.
  • Stimulants don’t directly effect executive function.  (However, it is my non-scientifically validated opinion that being able to concentrate helps ADHD’ers work on their executive function issues.)
  • Metadate CD capsules can be opened and sprinkled on food for kids who have trouble with the pills.
  • New research indicates that there is no statistically relevant difference in hight with medicated kids.  There is a lag in growth, but it appears that we catch up. There is a slight difference in weight.
  • Generic drugs only have to be within 20 – 30% of the original’s effectiveness.  Most of them are made by the same drug makers that produce the name brand though.  However, my personal experience is that I respond differently to generic Ritalin, though my insurance won’t let me get the name brand any more.  (The same goes for Catapres/Clonadine.)  But, I’ve actually found that I respond better to specific generic producers.  When possible, I order these meds by producer.

Here are some interesting contrasts between the two families:

  • Dosing can be a little harder with the methylphenidate family.  (I’m going to call it the Ritalin family from now on to save on my typing.)  It is only 10 – 30% bioavailable.  That means that a relatively little amount of the drug the you take actually gets in to the blood stream.  It can be more effected by metabolism etc.  The Amphetamine family, (Adderall from not on,) is about 80% bioavailable.
  • Ritalin is not effected by being taken with food.  Adderall can be.  Some research indicates that Adderall is less effective in an acidic medium.  (So don’t take it with a huge glass of grapefruit juice.)
  • Our body adjusts to the Ritalin some time within the first 6-12 months.  Therefore, it is likely that the dosage will need to be adjusted upwards once in that period.  This is a one time body adjustment and will not need to be repeated   (There are other reasons why dosage might need to be raised at a later date though.)
  • The mechanism of action is different.  (It is my understanding that,) Adderall actually aids in dopamine production, while the Ritalin blocks dopamine’s re-uptake.

One last interesting note on extended release forms of Ritalin.  (I hope I get the actual numbers right.  I have to go on my ADHD affected memory because I can’t find my notes on this one…)

  • Ritalin LA is an 8 hr dose that give 50% of the drug at the beginning and 50% on the back end.
  • Concerta is a 10 – 12 hr dose and  Metadate is a 6 – 8 hr dose.  They give about 30% up front and 70% through the rest of the dose.

Hope this helps those who wanted to know more about ADHD meds.  I think the next post will be on ADHD and substance abuse…  but we’ll see what strikes my fancy!

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