Pharmacological Treatment of ADHD

Pharmacological Treatment of ADHD

Prateek Yadav (Government Hospital, India)
Copyright: © 2021 |Pages: 14
DOI: 10.4018/978-1-7998-5495-1.ch008
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Abstract

The pharmacological treatment for ADHD has been researched well and we have efficacious drugs. Drugs are the mainstay of treatment particularly for over 6 years of age. There are two broad classes of drugs that are used in the treatment, psychostimulants and non-stimulants. Transcranial current stimulation and neurofeedback are other mechanisms that have been tried. There are various formulations and doses available for each and only certain drugs are available in India. The various guidelines broadly put stimulant Methylphenidate as the first choice and recommend early shift to a longer acting formulation. Treatment, various comorbidities, and side-effects of these drugs have to be kept in mind and dealt accordingly. Further psychosocial treatments should be used concurrently to improve the outcome.
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Mechanism Of Action

ADHD is associated with lower levels of Dopamine and Norepinephrine (DA and NA) in prefrontal cortex (PFC) and both of these stimulants act by increasing concentration of DA and NA in the synaptic cleft; MPH acts on the reuptake channels allosterically, blocks both NA and DA reuptake, thus their levels increase in the synaptic cleft and these then engage dopamine (D1) receptors, improving neurotransmission. Amphetamines, on the other hand are competitive inhibitor and pseudosubstrate for reuptake channels of NE and DA and additionally also facilitates the release of DA via reverse transport.

FMRI study shows that MPH improves the response inhibition, frontal activation and increases striatal activity in ADHD children. The striatal activity is decreased if MPH is given to healthy controls (Vaidya et al, 1998). It also shows improvement in working memory and is related to reduction in rCBF in the dorsolateral prefrontal cortex and posterior parietal cortex.(Mehta et al 2006)

Table 1.
Stimulants available in India
(Shah, Grover, Avasthi, 2019)
FORMULATIONDOSAGE
1Methylphenidate Immediate ReleaseTab 10 mg5 mg OD or BD to 60 mg
2Methylphenidate
Intermediate Release
Tab 10mg,18mg,20mg10 mg to 60 mg
3Methylphenidate
Long acting (OROS)
Tab 18mg,36mg,54mg18mg to 72 mg

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