ebook_ADHD2019

106 Rohde, Buitelaar, Gerlach & Faraone ted with caution and under close supervision. Atomoxetine is unlikely to be abu- sed and extended-release stimulants or lisdexamfetamine are less capable of being abused than their immediate-release counterparts. In some regions (e.g. Western Australia), patients who take un-prescribed medications are not allowed stimulant medications and need to have evidence of this through regular drug testing. OTHER MEDICATIONS USED OFF LICENSE TO TREAT ADHD Bupropion Bupropion, an antidepressant, has been shown to be better than placebo in tre- ating ADHD symptoms in children. Its efficacy is however smaller than that of stimulants. Bupropion can cause nausea, insomnia, and palpitations; it can also trigger tics and cause dermatological reactions, such as rash and urticaria, which may be severe and require discontinuation. Bupropion also increases the risk of seizures, but this effect is minimised if the dose is maintained within 300 mg/day. Tricyclic antidepressants Imipramine, desipramine, nortriptyline, amitriptyline and clomipramine have all been demonstrated to be superior to placebo for the treatment of ADHD symp- toms, but they are less effective than stimulants. They are rarely used due to realis- tic concerns about potential cardiotoxicity. Sudden and unexplained deaths have been reported in children receiving therapeutic doses of tricyclic, most often de- sipramine and they are also very dangerous in overdose. Despite these concerns, there may still be a limited place for tricyclics in countries where no other ADHD medications are available. Whilst the clearest evidence for efficacy relates to de- sipramine, the potential for sudden death limits its use and it may be prudent, if a tricyclic is to be used at all, to consider imipramine or nortriptyline ahead of desipramine. A starting dose of between 10-25 mg once a day is usual, this can be Link in this https://www.youtube.com/ watch?v=rD9qK8-sMGQ