Stimulant vs Non-Stimulant Medications
Stimulants
Fast-acting and first-line for most patients. They increase dopamine and noradrenaline, improving focus and impulse control. About 70–80% of children respond well.
- •Act quickly but may require multiple daily doses
- •Schedule 8 controlled drugs
- •Examples: methylphenidate, dexamphetamine, lisdexamfetamine
Non-Stimulants
Work differently, act more slowly, and offer 24-hour coverage. Used when stimulants are unsuitable or as add-ons.
- •Take weeks to work but offer smoother, lasting control
- •Schedule 4 medications
- •Examples: atomoxetine, guanfacine
Stimulant Medications
Methylphenidate
(Ritalin®, Concerta®)
Improves focus and reduces hyperactivity by boosting dopamine/noradrenaline. Available in short- and long-acting forms.
Duration
3-4 hrs (immediate), 6-12 hrs (extended)
Side Effects
Appetite loss, insomnia, headaches, irritability
Effectiveness
High. Often first-line treatment
Long-term Safety
Safe when monitored; may slightly slow growth
Dexamphetamine
Also boosts dopamine and noradrenaline, similar to methylphenidate but with a slightly different mechanism.
Duration
4-6 hrs (immediate release only)
Side Effects
Similar to methylphenidate
Effectiveness
High. Some respond better to this than methylphenidate
Long-term Safety
Safe under supervision. Tolerance possible
Lisdexamfetamine
(Vyvanse®)
A long-acting prodrug of dexamphetamine. Taken once daily, offering smoother effect.
Duration
12-14 hrs
Side Effects
Similar to other stimulants, often fewer peaks/troughs
Effectiveness
Very high; preferred for full-day coverage
Long-term Safety
Safe with ongoing monitoring
Non-Stimulant Medications
Atomoxetine
(Strattera®)
A norepinephrine reuptake inhibitor. Often used when stimulants are not tolerated.
Use
ADHD with anxiety/tics or preference for non-controlled meds
Side Effects
Drowsiness, nausea, mood swings
Duration
24 hrs per dose after buildup
Long-term Safety
Generally safe. Rare liver or mood issues—monitor
Effectiveness
Moderate to high. Works over weeks
Guanfacine
(Intuniv®)
A selective alpha-2A agonist originally used for blood pressure.
Use
For hyperactivity, aggression, or sleep issues; often in children
Side Effects
Drowsiness, low blood pressure, dizziness
Duration
24 hrs
Long-term Safety
Safe with monitoring. Don't stop suddenly—tapering needed
Effectiveness
Moderate. Good for impulsivity, irritability
Off-Label Medications
Used when first-line medications fail or cause side effects.
Clonidine
Similar to guanfacine. Useful for sleep/tics but sedating. Requires cautious dosing.
Modafinil
Wakefulness drug. May help attention in adults. Not approved for ADHD; avoid in children.
Antidepressants
e.g. bupropion, TCAs: Occasionally used in adults with ADHD and comorbid depression. Lower effectiveness; more side effects.
Others
Risperidone (for aggression), melatonin (sleep), and omega-3 (mild benefit) are sometimes used adjunctively.
Safety Reminders
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