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Treating Attention-Deficit/Hyperactivity Disorder in Adults: Focus on Once-Daily Medications

Prim Care Companion CNS Disord 2011;13(6):doi:10.4088/PCC.11r01168
10.4088/PCC.11r01168

Objective: To review the efficacy, safety, and abuse liability of approved treatments in adults with attention-deficit/hyperactivity disorder (ADHD), with a focus on once-daily medications.

Data Sources: PubMed was searched for relevant studies/reviews in English from 2002 to 2011 on adult ADHD treatments.

Study Selection: Keywords used in the search were ADHD, adults, and treatment. Limits included only clinical trials, meta-analyses, randomized controlled trials, and reviews including adults (aged ≥ 19 years).

Data Extraction: Selection criteria returned 471 publications. Retrieved studies were excluded if they primarily focused on children, treatments not indicated for ADHD, or ADHD and comorbid conditions.

Data Synthesis: An epidemiologic survey revealed that 10.9% of adults identified with ADHD had received treatment during the prior 12 months. Treatments for ADHD in adults include pharmacologic and nonpharmacologic options. US Food and Drug Administration–approved long-acting stimulants and a nonstimulant with proven efficacy and safety profiles have been developed and include osmotic-release oral system methylphenidate hydrochloride (OROS-methylphenidate), extended-release dexmethylphenidate hydrochloride, mixed amphetamine salts extended release (MAS-XR), the nonstimulant atomoxetine hydrochloride, and the prodrug lisdexamfetamine dimesylate. Long-acting stimulants differ in formulation characteristics used to achieve extended release, with OROS-methylphenidate employing an osmotic-release technology, extended-release dexmethylphenidate hydrochloride and MAS-XR using pH-dependent beads, and lisdexamfetamine dimesylate using prodrug technology. These features variably affect pharmacokinetic characteristics, duration of action, and abuse liability. While all long-acting medications have varied pharmacokinetic features, mechanism of action, and duration of effect, all are generally efficacious and safety profiles are similar.

Conclusion: Approved long-acting treatments in adults with ADHD were effective in improving symptoms and were generally well tolerated.

Prim Care Companion CNS Disord 2011;13(6):doi:10.4088/PCC.11r01168

Submitted: February 15, 2011; accepted June 15, 2011.

Published online: November 17, 2011.

Corresponding author: Richard H. Weisler,MD, 700 Spring Forest Rd,Ste 125,Raleigh,NC 27609 (RWeisler@aol.com).