Table 1.
Clinical characteristics of ADHD pharmacotherapies
| Pharmacotherapy | Molecular mechanisms [59-66] | Formulations | Efficacy (meta-analysis effect size) [74,70] |
Common adverse events [75-79] |
|---|---|---|---|---|
| Stimulants | ||||
| Methylphenidate | Blocks DA reuptake transporter, amplifies DA response duration, disinhibits D2 receptor, inhibits NE re-uptake | Immediate release | 0.92 (0.80, 1.05) | Decreased appetite, insomnia, abdominal pain, headache dizziness, reduced weight gain, affective symptoms |
| Osmotic release | 0.90 (0.76, 1.05) | Decreased appetite, abdominal pain, headache | ||
| Extended release | 0.85 (0.65, 1.05) | Decreased appetite, headache, abdominal pain | ||
| Long-acting | 0.96 (0.75, 1.16) | Headache, insomnia, upper abdominal pain, decreased appetite, anorexia | ||
| Transdermal patch | Not available | Appetite, nausea, vomiting, insomnia | ||
| Dexmethylphenidate | 0.76 (0.45, 1.08) | Decreased appetite, headache, abdominal pain, nausea | ||
| Dextroamphetamine | Increases release of DA and NE into synaptic cleft, decreases reuptake into presynaptic neuron, inhibits catabolism | Immediate release | 1.24 (0.88, 1.60) | Decreased appetite, insomnia |
| Extended release | 1.13 (0.57, 1.69) | Palpitations, tremor, insomnia, decreased appetite, headache, dizziness, dry mouth, weight loss, abdominal symptoms | ||
| Prodrug | 1.52 (1.34, 1.71) | Decreased appetite, headache, insomnia, abdominal pain, irritability | ||
| Mixed amphetamine salts | Increases release of DA and NE into synaptic cleft, decreases reuptake into presynaptic neuron, inhibits catabolism | Immediate release | 1.34 (0.95, 1.72) | Decreased appetite, agitation, insomnia |
| Extended release | 0.77 (0.59, 0.94) | Decreased appetite, headache, insomnia | ||
| Non-stimulants | ||||
| Atomoxetine | Selectively inhibits synaptic DA re-uptake |
Immediate release | 0.63 (0.57, 0.69) | Upper abdominal pain, decreased appetite, vomiting, somnolence, irritability, fatigue |
| Guanfacine | Selective alpha2A adrenergic receptor agonist | Immediate release | Not available | Sedation, insomnia, decreased appetite, dry mouth, constipation |
| Extended release | 0.8 (0.53, 1.07) | Somnolence, fatigue, upper abdominal pain, sedation | ||