ebook_ADHD2019

The World Federation of ADHD Guide 85 1 Medications available for treating ADHD 2 Understanding howADHDmedications work and how to use them effectively 3 Deciding on the initial targets for treatment 4 Starting treatment with medication 5 Monitoring treatment and side effects 6 Adjusting and switching treatments 7 Special circumstances 8 Unlicensed medications for ADHD In each section, we will break down the guidance into the tasks that have to be addressed at each stage of the clinical process. The advice should not be seen as prescriptive and, as noted above, we suggest that it is used to stimulate discussion within teams and services and to facilitate problem-solving any barriers to practice and aid the development of evidence-based care pathways that can work within their own particular systems and circumstances. MEDICATIONS AVAILABLE FOR TREATING ADHD Both stimulant and non-stimulant medications are licensed for the treatment of ADHD. Not every medication is available in every country. The broadest range of medications is available in North America whilst in some low and middle-income countries, no medications are licensed to treat ADHD and those that are licensed in other countries are unavailable. In this chapter, we will focus on the most com- mon medications as these are also the best studied and understood. At the end of the chapter we will briefly discuss other medications that are sometimes used off-label to treat ADHD. The most frequently used medications in most countries are the psychosti- mulants comprising methylphenidate, dexamfetamine/amphetamine and several other amphetamine derivatives. Racemic amphetamine was the first stimulant me- dication used to treat ADHD since the seminal observations of Bradley in 1937. Methylphenidate is the most widely available medication for ADHD across the world. It is licensed in the US and in most European countries as part of com- prehensive treatment programs in children (over 6), adolescents and adults. There are several different extended release formulations of methylphenidate that are differentially available across the globe. Although more potent than methylpheni- date, the amphetamines are less used in most countries and due to concerns about abuse potential and diversion are not commercially available in many countries. Whilst mixed amphetamine salts are popular in the USA, immediate release de- xamfetamine is the most common amphetamine across the rest of the world. There are several long acting extended release amphetamine products availa- ble in the US but these are not widely available in other countries. Lisdexamfeta-