ADHD Medications

The ADHD Medication Guide is a visual aid for those with ADHD. The guide includes only medications indicated for the treatment of ADHD by the FDA. (To limit plagarism of this wonderful chart, you must click on the user agreement in the center of the page. It is free and easy.)

This guide may help assist patients in identifying medications previously tried, and may in identifying ADHD medication options for the future. Medications have been arranged on the card for ease of display and comparison, but dosing equivalence cannot be assumed.

For information/help on swallowing pills, see Learning to Swallow Pills from Dr. Stuppy's blog.

Understanding treatment options and what to expect from medications used for ADHD can help you make the best decisions for ADHD management.

How ADHD Medications Work in the Brain

ADHD medications help improve attention, reduce impulsivity, and decrease hyperactivity by affecting brain chemicals called neurotransmitters—specifically dopamine and norepinephrine.

• Stimulant medications (methylphenidate and amphetamines) work by increasing the levels of these brain chemicals in areas responsible for attention and self-control. They help the brain's "control center" (the prefrontal cortex) work more effectively. These medications start working within 30-60 minutes of taking them. They stop working in 4 hours (short acting) or 8-12 hours (long acting).
• Non-stimulant medications work more slowly and through slightly different mechanisms, but they also increase dopamine and norepinephrine activity in the brain. These medications typically take 1-4 weeks to reach their full effect.

Types of ADHD Medications

Stimulant Medications

Methylphenidate-based medications include:

• Ritalin, Concerta, Focalin, Daytrana (patch), and others
• Available in short-acting (4 hours) and long-acting (8-12 hours) forms

Amphetamine-based medications include:

• Adderall, Vyvanse, Dexedrine, and others
• Available in short-acting (4-6 hours) and long-acting (12-16 hours) forms

Stimulants are recommended as first-line treatment because they are the most effective medications for ADHD.

Non-Stimulant Medications

FDA-approved non-stimulants include:

• Atomoxetine (Strattera): Taken once or twice daily
• Guanfacine extended-release (Intuniv): Taken once daily
• Clonidine extended-release (Kapvay): Taken once or twice daily
• Viloxazine extended-release (Qelbree): Taken once daily

These medications may be preferred if stimulants don't work well, cause unacceptable side effects, or if there are concerns about medication misuse.

Sometimes both stimulants and non-stimulants are used if one is not sufficient on its own, but it is recommended to only start or adjust one medication at at time.

Comparing Stimulants and Non-Stimulants

Effectiveness

Stimulants are more effective at reducing ADHD symptoms than non-stimulants. Studies show:

• Amphetamines and methylphenidate have large effect sizes (meaning they work very well)
• Non-stimulants have moderate effect sizes (they work, but not as strongly)
• About 40% of patients respond equally well to both methylphenidate and amphetamine, while some respond better to one or the other

Speed of Action

• Stimulants: Work within 30-60 minutes (Jornay PM is an exception - it is given at bedtime and starts working 10-12 hours later)
• Non-stimulants: Take 1-4 weeks to reach full effect

Common Side Effects

Both stimulants and non-stimulants can cause:

• Decreased appetite
• Stomach upset or nausea
• Headaches
• Sleep problems

Stimulants and atomoxetine may cause:

• Small increases in heart rate and blood pressure
• Weight loss (initially)

Guanfacine and clonidine may cause:

• Drowsiness or tiredness
• Small decreases in heart rate and blood pressure
• Dry mouth

Most side effects are mild and improve over time or with dose adjustments. It is important to monitor for side effects and talk to your prescriber about them. There are effective ways to help manage many side effects, but we need to know about them to help. 

If you are starting a new medication, changing doses or a medication, or want to track side effects and benefits, use one of the Medication Tracker Sheets: 

• Version 1 is best to track when you take multiple medications that affect your mood and focus.
• Version 2 is best to track when you are titrating different amounts of a single medication.

Long-Term Safety

Growth Effects

Stimulant medications may slow growth slightly during the first 2-3 years of treatment. On average, children may be about 1-3 cm (less than 1 inch) shorter as adults compared to what was expected. This effect is:

• Most noticeable in the first 2-3 years
• Less pronounced after year 3
• Can be reduced by taking "medication breaks" during school holidays if growth is significantly impaired

Atomoxetine has similar effects on growth.

Heart and Blood Pressure

Large studies have been very reassuring about heart safety:

• ADHD medications do not increase the risk of serious heart problems like sudden death, heart attack, or stroke
• Stimulants and atomoxetine cause small increases in heart rate (about 6 beats per minute) and blood pressure (about 2 mm Hg)
• About 5-15% of children have larger increases that need monitoring
• Guanfacine and clonidine may lower heart rate and blood pressure

Your doctor will check heart rate and blood pressure:

• Before starting medication
• After each dose change
• Regularly during treatment

Substance Use Risk

Good news: Stimulant treatment does not increase the risk of drug or alcohol problems later in life. In fact, studies show that taking ADHD medication may actually lower the risk of substance abuse.

Long-Term Effectiveness

ADHD medications continue to work well over many years of treatment. About half of people use ADHD medication for more than 5 years. Studies show that people who continue medication maintain better symptom control than those who stop. Although it was initially thought that people outgrew ADHD, studies show that it persists in a significant number of adults.

Monitoring During Treatment

We will monitor:

Height and weight:

• Height every 6-12 months
• Weight every 3-6 months depending on age (home scales may be used for telehealth visits)

Heart rate and blood pressure:

• After each dose change
• At least annually during stable treatment

Symptom improvement and side effects:

• Regular check-ins to ensure the medication is working well and side effects are manageable

Which Medication Is Right for You or Your Child?

For children ages 6-11:

• Stimulants are recommended first (strongest evidence)
• Methylphenidate is often tried first 
• Amphetamines are used if it is the family's choice or if methylphenidates aren't tolerated or don't work
• Non-stimulants are good alternatives if both types of stimulants don't work or cause problems or can be added to a stimulant if better symptom control is needed or to help the times of day the stimulant is not able to cover

For adolescents and adults:

• Stimulants remain the most effective option
• Either methylphenidate or amphetamines may be the first choice in adolescents
• Amphetamines may work slightly better than methylphenidate in adults
• As with children, if the first stimulant does not work or is not tolerated, the other type of stimulant is often tried before a non-stimulant
• Non-stimulants are generally the third-line medication, but can be used first if there are concerns (see below) or as an add-on to stimulants as with children

Non-stimulants may be preferred if:

• Stimulants cause unacceptable side effects
• There is a history of substance abuse
• There are concerns about medication diversion or misuse
• The patient prefers a medication that lasts all day without needing to remember doses
• There are certain heart conditions (discuss with your prescriber)

Important Points to Remember

• Finding the right medication takes time. It may take several tries to find the medication and dose that works best with the fewest side effects.
• Medication is most effective when combined with behavioral strategies like parent training, school accommodations, and organizational skills training.
• Side effects are usually manageable. Most side effects are mild and can be addressed by adjusting the dose, changing the timing of medication, or switching to a different medication.
• Regular monitoring is important to ensure your child is growing well and the medication continues to work effectively.
• ADHD medications are safe when used as prescribed. Decades of research support their safety and effectiveness.

Questions to Ask Your Prescriber

• Which medication do you recommend starting with, and why?
• What side effects should I watch for?
• How will we know if the medication is working?
• How often will we need follow-up appointments?
• What should I do if I notice side effects?
• Are there any activities or foods to avoid while taking this medication?

Additional Resources

Talk to your healthcare provider about:

• Behavioral therapy and parent training programs
• School accommodations and support services
• Support groups for families affected by ADHD
• Strategies for managing medication at school

Remember: This handout provides general information. Always follow your prescriber's specific recommendations for your individual situation.

If medicine is started, frequent communication is needed to titrate to the best dose. Portal messaging and appointments in the office or by telemedicine can be used.

Once a stable dose is reached, a visit (either in the office or by telemedicine) is done every 3 months to be sure the medicine is still at the appropriate dose.

If any medication dose change is needed, be sure to discuss with your prescriber before making any changes.

Enough prescriptions are usually given to last until your next visit unless there is a plan to adjust medicine with phone/portal communication. Please schedule in advance for best scheduling availability.

When you request refills for stimulants at the pharmacy, do not use the word "refill". You cannot use the automatic refill phone line- you must talk to a pharmacist or tech. We cannot refill stimulant medications, but we can send three prescriptions at a time with instructions to fill monthly.

If your child struggles to maintain weight on medications, please see our page for tips on improving weight gain.

We also sometimes use cyproheptadine to stimulate appetite. See our Cyproheptadine page. 

ParentsMedGuide.org has free downloadable guides for ADHD medications, Depression medications, and Bipolar Medications.

CHADD has a podcast to explain ADHD medications.