Dr. Kenny Handelman
So if we look at the medications we use to treat adhd we’ve got three categories here sorry three medicines really two categories we’ve got the stimulants and the non-stimulant medicines in the stimulant medicines we’ve got methylphenidate we’ve got riddle and riddle and slow-release in canada by fenton and concerta i’ve put the date tran of methylphenidate patch
That’s the patch of methylphenidate that’s available in the us that was the company that that markets that medicine and created that medicine has applied for approval in canada that we’ve put their application on hold i don’t know if we’ll ever get that medicine in canada so if anybody’s holding out for that i just can’t tell you we’ll have it for sure that’s why
It’s in a different color when it comes to the amphetamine medicines or you’ve got dexedrine dexter and spansules adderall xr and vyvanse and the non-stimulant strattera these are the medications that we have in canada right now that are officially approved for use in adhd this next slide we look at the duration of action and this is tremendously important we look at
You know the riddle ins for hours riddle and sr6 by fenton is approximately 10 hours and concerta 12 the asterisks doesn’t mean it’s really special i put the asterisks there to say that it’s a sprinkle capsule so for little kids who can’t swallow the capsule can be opened and sprinkled in a spoonful of applesauce or yogurt so by fenton has that concern is a 12-hour
Medicine for the amphetamines we’ve got these medicines here at rlx hours 12 hours vyvanse is 13 hours plus and these three here can be sprinkled and then the strattera the non-stimulant can work for up to 24 hours so that’s the duration of action and this is important and it’s you know some people often think that well if somebody went from ritalin in the morning
And ritalin at lunch if they take a concern of first thing in the morning it’s just for their convenience right if so they don’t have to remember a pill in the middle of the day well it’s not just convenience first of all there are many kids who would get teased and bullied because they had to go to the office the school would make the absolute unbelievable mistake
Of announcing over the overhead come downstairs to the office right and the kids are like oh get your chill pill right which can be absolutely devastating for a kid who’s you know i really at any age in school but there’s also a lot more data that show that with these long-acting medicines people don’t get the peaks and valleys of the medication concentration in
Their blood so they get a much better symptom control throughout the course of the day so these medicines work better now this is remember i told you it was coming the main point that i want you to remember this is it okay so all eyes on the board it worked you see i i kind of primed you for this twenty odd minutes ago okay so how to think about medications for
Adhd now i have to admit on this slide i put in a couple of the american medicines but you can ignore those if they weren’t on the earlier slide here’s how to think about medicines for adhd there are three medicines for adhd they’re marketed in different packages like concern up i fenton ritalin they are all methylphenidate medicines though they come in different
Delivery systems right makes sense there’s f ed amine medicines these are all very much the same there’s minor differences amongst the effete amine medicines that if any of you are interested in come up and talk to me later we won’t take the time for that now but they’re essentially the same the amphetamine medicines and then we’ve got the non-stimulant strattera
So sometimes i get a referral from people from a doctor or pediatrician who says please assess this twelve-year-old with adhd he is done poorly on ritalin by fenton and concerta please advise okay so let me just point this out for you for all of you ritalin concerta by fenton okay let’s just say these are my easier consultations because i can kind of figure out
Pretty darn quick like maybe even before the person comes into the office what i may recommend what may i recommend right trying one of the medicines and one of the other categories right make sense so here’s here’s the finer point to this if somebody’s on concerta and it works great for them but they don’t get to sleep till midnight and this is really hard for a
12 year old what might i suggest take a shorter acting version of the same medicine right so buy fenton works a little less long-acting so maybe that would work okay right now if they take concerta and they’ve terrible side effects terrible headaches you know feeling awful moody crying whatever the side effect may be and they say well we heard about this by fenton
Somebody told us would i suggest the by fenton no i’m not gonna suggest by finding cuz it’s essentially the same medicine in a different package so then i would say well let’s jump over to one of these right let’s either try the one of the other stimulants the adderall or vyvanse or let’s try the non-stimulant strattera and then the discussion becomes you know
When i say it’s one of the easier consultations it’s actually a wonderful opportunity because now you know i confirm the diagnosis check for coexisting conditions and take a lot more time to talk about how i can help them and educate them about adhd though the recommendations the treatment recommendations you guys all know now those can be that decision can be made
Pretty darn quick so when it comes down to it for somebody to say they’ve got trouble with taking adhd medicines i use a very simple protocol have they been on at least one of the methylphenidate medicines at an adequate dose have they been on an amphetamine medicine on an adequate dose for long enough have they been on strattera at an adequate dose for long enough
When strattera really does have to be long enough it’s got to be at least four to six weeks if not eat to really know if it’s going to work so if they’ve been all those on all of those medications for long enough then i have to look at secondary you know so-called third-line medicines if they haven’t it’s very simple i go back and fill in the gaps if they hadn’t
Been if they tried adderall xr but i only got up to ten milligrams well that’s probably not enough you know if they stopped it because it was pulled off the market in canada which was a fiasco and and unnecessary you know then we got to go back and try that category of medicines that clear to everybody so when a new medicine comes to market the first question
I want each of you to ask is which medicine is it right because is it just methylphenidate in an in package is it an amphetamine in a new package or is it a non stimulant now there is a chance we may get non stimulants that work in different ways for example dr. brown mentioned intuniv that is a non stimulant available in the us that we don’t have in canada yet
Though it’s still a non stimulant but it works slightly differently and we’ll talk about that in a little bit but for now keep this framework in mind three medicines for adhd packaged all differently make sense everybody you’re gonna remember this tip today tomorrow next week right this is in your head three types of medicines this is your big takeaway
Transcribed from video
Medications Used to Treat ADHD g By CADDAC Centre for ADHD Awareness Canada
