STIMULANTS — Stimulants are the drugs of choice for treatment of ADHD. Some patients may respond better to amphetamines than to methylphenidate, and vice versa. The choice between them should be based on individual responses and preferences.

Factors to consider in choosing a stimulant formulation include onset and duration of action, ease of administration, and cost. Long-acting formulations are appropriate for most school-age children and adults. Short-acting formulations are sometimes used in addition to longer-acting ones to improve symptom control early in the morning or to prolong the duration of action and smooth withdrawal in the late afternoon.2

SHORT-ACTING STIMULANT ALTERNATIVES — Currently available short-acting stimulants that may be used as alternatives to Adderall include dexmethylphenidate (Focalin, and generics), methylphenidate (Ritalin, Methylin, and generics), and dextroamphetamine (Zenzedi, ProCentra, and generics); their onset of action occurs within 30-60 minutes and their duration of action is similar to that of Adderall (see Table 1).

Dosing requirements for stimulants are highly variable. They should be started at the lowest recommended dose, which can be increased every 7 days (in urgent cases every 3 days) until a substantial improvement in symptoms is achieved.

LONG-ACTING MIXED-AMPHETAMINE SALTS — Two long-acting formulations of mixed amphetamine salts are available in the US. Adderall XR (and generics), which contains both immediate- and delayed-release beads, has a duration of action of 10 to 12 hours, and Mydayis, which is formulated as capsules containing immediate-release beads and 2 variations of delayed-release beads, has a duration of action of up to 16 hours. Mydayis is FDA-approved only for use in patients ≥13 years old.

OTHER ALTERNATIVES — Many other long-acting stimulant products and nonstimulant options available for treatment of ADHD were reviewed in our Drugs for ADHD article.2