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Pharmacotherapy for attention-deficit/hyperactivity disorder

Article information

J Korean Med Assoc. 2019;62(1):49-55
Publication date (electronic) : 2019 January 21
doi : https://doi.org/10.5124/jkma.2019.62.1.49
Bongseog Kim, MDorcid_icon
Department of Psychiatry, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
Corresponding author: Bongseog Kim. kimbs328@paik.ac.kr
Received 2018 December 21; Accepted 2018 January 11.

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder defined by impairing levels of inattention, disorganization, and/or hyperactivity-impulsivity. ADHD often persists into adulthood, with resultant impairments of social, academic and occupational functioning. ADHD is a very common disease during childhood and, the pooled overall prevalence of ADHD was found to be 5.29%. When screening for ADHD, clinicians should try to develop rapport with patients and their caregivers to increase the likelihood that they will follow the diagnostic process and treatment. The current drugs that have received Food and Drug Administration-approval for ADHD include stimulants (methylphenidate and dextroamphetamine) and non-stimulants (atomoxetine, guanfacine, and clonidine). Stimulants improve inattention, hyperactivity, and impulsivity in addition to decreasing disruptive behaviors and promoting academic achievement and the maintenance of appropriate friendships. In order to enhance drug compliance, the use of long-acting stimulants is increasing. Atomoxetine is a selective norepinephrine reuptake blocker, the effects of which may take 2 to 6 weeks to be noticeable. Furthermore, α2 agonists may help to improve behavioral side effects, tics, and sleep problems during stimulant or atomoxetine use. Common side effects of stimulants and atomoxetine include headache, stomachache, and loss of appetite. Routine electorcardiography before medication is not recommended unless there is a specific indication. Methylphenidate and atomoxetine are safe as first line therapies, and their side effects are well tolerated.

Keywords: Attention deficit disorder with hyperactivity; Pharmacotherapy; Methylphenidate; Atomoxetine hydrochloride

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Table 1

Drugs with Korean Ministry of Food and Drug Safety approval for attention-deficit/hyperactivity disorder [1213]

Table 1

MPH, methylphenidate; IR, immediate release; ER, extended release; OROS, osmotic controlled-release oral delivery system.

a)The usual dose should not be interpreted as a cap or a minimal effective dose if a higher or lower dose is clinically indicated in individual cases.