L This Strattera titration schedule applies to children and adolescents > 70 kg, and to adults. (Indications for use: Monotherapy [off-label:Īdjust dosage every 7–14 days to 60 mg, then 80 mg/day l

© 2018 CADDRA–Canadian Attention Deficit Hyperactivity Disorder Resource Alliance Second-line/adjunctive agent-long-acting non-psychostimulant – selective norepinephrine reuptake inhibitor Adapted with permission from Canadian ADHD Practice Guidelines, 4th ed., p.

Indications for use: (a) as needed for certain activities b) to augment g long-acting formulations early or late in the day, or early in the evening c) when long-acting agents are cost prohibitive) © 2018 CADDRA–Canadian Attention Deficit Hyperactivity Disorder Resource Alliance Second-line/adjunctive agents-short-acting and intermediate-acting psychostimulants k Some adults may better tolerate a lower starting dose of 25 mg. j Ritalin SR may help cover the noon period, but clinical experience suggests an effect similar to short-acting preparations. h bid refers to qam and qnoon tid refers to qam, qnoon and q4pm. To augment Biphentin or Concerta, short-acting methylphenidate products can be used. g To augment Adderall XR or Vyvanse, short-acting and intermediate-acting dextro-amphetamine products can be used. f Vyvanse 70 mg is an off-label dosage for ADHD treatment in Canada. e For the most recent CADDRA dosing, see edition 4.1 of the Canadian ADHD Practice Guidelines, released in autumn 2019. d Titration schedule is every 5 days, not every 7 days. Therefore, long-acting psychostimulant generics are considered second-line agents. The Canadian ADHD Practice Guidelines (CADDRA, 2018) committee reported loss of symptom control in some patients when switched from original to generic drugs. Doses per CADDRA (2018) that are over or under product monograph maximum or minimum doses should be considered off-label use. b A consensus decision has been made based on clinical use and research data. Adult ADHD: Where To Go When You're Looking for Help PDFįirst-line agents-long-acting psychostimulantĪ CADDRA (2018) generally recommends starting at the lowest dose available.Adult ADHD: Resources for Your Patients.Table 1 Medical treatment for ADHD - adults (18+) Related Research has found that medication blocks reward pathways and prevents the binding of other energizing substances ( Volkow, 2009). However, the more common and ideal situation is that medication is used to promote functional behaviour patterns.ĪDHD medications have a protective role in preventing the patient from self-medicating. Some patients only need medications in situations of high attentional load. Monitor patients every two weeks until they are at their correct dose, and every three months thereafter.You can use the medication form from the etoolkit that accompanies the Canadian ADHD Practice Guidelines. Do pre- and post-reviews of medication efficacy and side-effects.Non-stimulants (non-dopamine-based agonists) can be used with stimulants. While long-acting medications are preferred, augmentation with short-acting psychostimulants could be used to account for variations in day-to-day attention loads.Combining ADHD medications with antidepressants, mood stabilizers or other psychiatric medications is common.For simplicity, try to use only one medication if multiple family members are on medication.Use long-acting medications over short-acting ones because they improve compliance and have better effects.Resist the urge to “see if a little more makes a difference.”.a typical target symptom may be the ability to sit down and pay bills and invoices every day, so the proper dose presents itself the moment this ability appears).

Increase the dose and stop when the target symptoms are better (e.g. However, some patients are at a higher risk and should be referred for assessment before treatment if they have any of the following: history of unresolved structural cardiac problems, family history of known cardiac conduction problems, unexplained syncope. It is not necessary to do a pre-treatment ECG. All ADHD medications are known to have risk to the cardiovascular system-they all increase blood pressure and heart rate. Always ensure the patient is medically stable before medications are started because there are known risks that must be reviewed.Text adapted from: 'The adult patient with attention-deficit/ hyperactivity disorder,' in Psychiatry in primary care by Umesh Jain (CAMH, 2019).

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