by Natan Schleider, M.D. January 30th 2021 3 MINUTE READ
As the COVID19 pandemic worsens mental health, my NYC patients with Attention Deficit Hyperactivity Disorder (ADHD or ADD) are anxious, less focused, and need close follow-up.
As 2021 begins, many ‘new’ ADHD medicines have been advertised. Understanding which ADHD medication is best for my NYC patient involves understanding some chemistry. Know that pharmaceutical companies give the same medicine different names. So new medicines for ADHD: Adhansia XR, Aptensio XR, Concerta, Concerta XR-ODT, Daytrana, Metadate CD, Metadate ER,, Methylin, Methylin ER, Quillichew ER, Quillichew XR, and Ritalin ARE ALL MADE OF METHYLPHENIDATE.
So my first point: there are ONLY FIVE STIMULANT MEDICINES which form the roughly 25 different ADHD stimulant medicines available.
- Methylphenidate–First made in 1944, this is one of the most common ADHD stimulant medicines. The brand name known best is Ritalin but as stated above, twelve different medicines exist whose active ingredient in methylphenidate. I often use methylphenidate as a starting medicine for a new ADHD patient given it has an 80 year safety profile showing no evidence of permanent damage to the brain. [Source from Wikipedia]
- Amphetamine–Discovered in 1887, this is the oldest ADHD medicine. Amphetamine is actually a nonspecific term chemically and medically speaking, in my opinion. That’s because amphetamine exists as two different mirror image molecules (called enantiomers): dextroamphetamine (on the right) and levoamphetamine (on the left). In 2021, when a pharmacy uses the term amphetamine on their medicine bottle, they really mean levoamphetamine. Adderall is a combination of 25% dextroamphetamine–a stronger stimulant–and 75% levoamphetamine, a longer acting stimulant WITH MORE RISK OF ADVERSE EFFECTS ON HEART AND BLOOD VESSELS. Amphetamine prescribed alone in actually levoamphetamine. Evekeo are brand names of amphetamine (or I should really say levoamphetamine but that is not what it says on the bottle).
- Dextroamphetamine–As described above, this was discovered in 1887 and is a short acting stronger stimulant than its mirror image sister, amphetamine WITH LOWER CHANCE OF ADVERSE EFFECTS ON HEART AND BLOOD VESSELS. Dexedrine, ProCentra, and Zenzedi are brand name medicines for dextroamphetamine, approved for ADHD treatment.
- Dexmethylphendiate–Approved in the USA since 2001 for medical treatment of ADHD, this is a sister to methylphenidate commonly called Focalin or Focalin XR in NYC.
- Methaphetamine–Discovered in 1893 (also as two enantiomers), it is approved for treatment of ADHD under brand name Desoxyn.
- Lisdexamphetamine–Approved in the USA since 2007 for treatment of ADHD, this more specific molecular form of amphetamine, known as Vyvanse in NYC, has fewer side effects than most other stimulants but is inly currently available as a long acting capsule (although the books say a tablet exists, I have never seen it).
Apparently organic chemistry was not a complete waste of time when I was a pre-medical student. Understanding these six different medicines used for treatment of ADHD– sisters or first cousins so closely related most are mirror images of each other–helps me greatly choose which medicine may be the right fit for my patients.
Some NYC ADHD patient will swear by one medication. Reddit comments may tell horror stories about the same medicine.
The fact of the matter is, each of my NYC patient will metabolize an ADHD medicine differently. Do I always find the perfect medicine at my first treatment attempt with a new ADHD patient in NYC? No. But fortunately, the ADHD stimulant medicines will only last a few hours (unless they are bundled into an extended release form). Worst case scenario if a patient suffers a side effect from an ADHD stimulant medicine, I tell them to call me and not to take it again. It will be out of their system within a few hours and there are plenty of others to try.
Thanks for reading and click here for more information about ADHD treatment.