Attention-Deficit/Hyperactivity Disorder Drug Summary

Drug	Dosage	Remarks
Clonidine	Regular-release ≤45 kg: Initial dose: 0.05 mg PO 24 hourly at bedtime May sequentially increase dose every 3-7 days by 0.05 mg increments 12 hourly, then 8 hourly, then 6 hourly Max dose: 0.2 mg/day >45 kg: Initial dose: 0.1 mg PO 24 hourly at bedtime May sequentially increase dose every 3-7 days by 0.1 mg increments 12 hourly, then 8 hourly, then 6 hourly Max dose: 0.4 mg/day	Adverse Reactions CV effects (orthostatic hypotension, bradycardia, arrhythmia, syncopal events); CNS and behavioral effects (aggression, depression, agitation, drowsiness, dizziness, headache, anxiety, fatigue, sleep disturbances, hallucinations); GI effects (anorexia, abdominal pain, dry mouth, constipation, nausea/vomiting); GU effects (urinary retention, incontinence); Dermatologic effects (rash, dermatitis); Endocrine effect (impotence) Has been associated with serious CV adverse events (including sudden death) at normal doses in children with structural cardiac abnormalities Special Instructions Thorough CV assessment prior to initiation of therapy Use with caution in patients with CV disease, coronary insufficiency, recent MI, cardiac conduction disturbances, renal and hepatic impairment; in patients with history of hypotension, bradycardia, syncope, depression; in patients receiving concomitant antihypertensive drugs Taper dose gradually For extended-release formulation, taper daily dose by <0.1 mg every 3-7 days May take 6-8 weeks to see effect Monitor for signs of depression Monitor heart rate and BP regularly; perform electrocardiogram at appropriate intervals
	Extended-release ≥6 years old: Initial dose: 0.1 mg PO 24 hourly at bedtime May increase dose by 0.1 mg/day increments every 7 days Doses should be administered 12 hourly (either split equally or higher split dosage at bedtime) Max dose: 0.4 mg/day
Guanfacine	Immediate-release ≥6 years old, ≤45 kg: Initial dose: 0.5 mg PO 24 hourly at bedtime May increase dose by 0.5 mg/day increments every 3-4 days to 12 hourly, then 8 hourly, then 6 hourly dosing Max dose: 2-3 mg/day ≥6 years old, >45 kg: Initial dose: 1 mg PO 24 hourly at bedtime May increase dose by 1 mg/day every 3-4 days to 2, 3, or 4x daily dosing Max dose: 4 mg/day
	Extended-release 6-17 years old: Initial dose: 1 mg PO 24 hourly in the morning May increase dose by ≤1 mg/week increments Maintenance dose: 0.05-0.12 mg/kg/day (1-7 mg/day) Max dose for 6-12 years old: 4 mg/day Max dose for 13-17 years old: 7 mg/day

Drug	Dosage	Remarks
Amphetamine salts mixture	Regular-release Children 3-5 years old: Initial 2.5 mg PO 24 hourly in the morning May increase by 2.5 mg/day at weekly intervals Max dose: 40 mg/day PO divided 8-24 hourly Children ≥6 years old: Initial 5 mg PO 12-24 hourly (morning and noon) May increase by 5 mg/day at weekly intervals Max dose: 40 mg/day PO divided 8-24 hourly	Adverse Reactions Occur early in treatment and tend to decrease over time. If persistent, consider decrease in dose or adjust dosing schedule CV effects (serious CV events, tachycardia, hypertension); GI effects (decreased appetite, abdominal pain, dry mouth); CNS effects (insomnia, headaches, irritability, anxiety); Ophthalmologic effects (blurred vision, difficulty in accommodation); Other effects (motor tics, growth suppression) Dose dependent: Over-focused, overly inhibited, rarely psychotic reactions, hallucinations, mood disorders Has been associated with sudden death at normal doses in children with structural cardiac abnormalities Special Instructions Before initiation of treatment with stimulants, do the following: (1) screen for personal past history and family history of cardiac problem, (2) obtain measurement of BP and pulse rate, (3) perform a simple cardiac physical exam, (4) ECG or further investigation if cardiac problem is suspected Avoid in patients with moderate-severe hypertension, cardiac arrhythmia, heart failure, severe angina, recent MI, glaucoma, tics, diagnosis or family history of Tourette syndrome, hyperthyroidism, thyrotoxicosis, with marked agitation, tension and anxiety, pre-existing psychosis and patients concomitantly taking MAO inhibitors or within 2 weeks of discontinuing MAO inhibitors Use with caution in patients with history of seizures Start with low dose and titrate based on patient response. Continue to increase dose to achieve maximum response. May need to decrease dose if side effects occur If relief of symptoms is only necessary for school environment, may administer drug on school days only Monitor BP and heart rate, weight and growth rate regularly Marked variability in dose-response relationship Avoid abrupt withdrawal due to potential for drug dependency
	Extended-release Children ≥6 years old: Initial 10 mg/day PO in the morning May increase dose by 5-10 mg/day increments at weekly intervals Max dose: 40 mg/day Patients taking regular-release formula may be switched to extended-release formula using the same total daily dose (24 hourly) Adolescents: 10 mg PO 24 hourly in the morning May increase dose to 20 mg/day after 7 days if symptoms are not controlled Adults: Initial 20 mg PO 24 hourly in the morning
Dexmethylphenidate	Regular-release 2.5 mg PO 12 hourly May increase dose by 2.5-5 mg/day at weekly intervals Max dose: 20 mg/day	Adverse Reactions Occur early in treatment and tend to decrease over time. If persistent, consider decrease in dose or adjust dosing schedule CV effects (serious CV events, tachycardia, hypertension); GI effects (decreased appetite, abdominal pain, dry mouth); CNS effects (insomnia, headaches, irritability, anxiety); Ophthalmologic effects (blurred vision, difficulty in accommodation); Other effects (motor tics, growth suppression) Dose dependent: Over-focused, overly inhibited, rarely psychotic reactions, hallucinations, mood disorders Has been associated with sudden death at normal doses in children with structural cardiac abnormalities Special Instructions Before initiation of treatment with stimulants, do the following: (1) screen for personal past history and family history of cardiac problem, (2) obtain measurement of BP and pulse rate, (3) perform a simple cardiac physical exam, (4) ECG or further investigation if cardiac problem is suspected Avoid in patients with moderate-severe hypertension, cardiac arrhythmia, heart failure, severe angina, recent MI, glaucoma, tics, diagnosis or family history of Tourette syndrome, hyperthyroidism, thyrotoxicosis, with marked agitation, tension and anxiety, pre-existing psychosis and patients concomitantly taking MAO inhibitors or within 2 weeks of discontinuing MAO inhibitors Use with caution in patients with history of seizures Start with low dose and titrate based on patient response. Continue to increase dose to achieve maximum response. May need to decrease dose if side effects occur Dexmethylphenidate: Patients currently on Methylphenidate may initiate therapy with half the current dose of Methylphenidate If relief of symptoms is only necessary for school environment, may administer drug on school days only Monitor BP and heart rate, weight and growth rate regularly Marked variability in dose-response relationship Avoid abrupt withdrawal due to potential for drug dependency
	Extended-release Children: 5 mg PO 24 hourly Max dose: 30 mg/day Adult: 10 mg PO 24 hourly Max dose: 40 mg/day
Dextroamphetamine	Regular-release Children 3-5 years old: Initial dose: 2.5 mg PO 24 hourly in the morning May increase by 2.5 mg/day at weekly intervals Usual dose range: 0.1-0.5 mg/kg/dose PO 24 hourly in the morning Max dose: 40 mg/day PO divided 8-12 hourly Children ≥6 years old, adults: 5 mg PO 12-24 hourly (morning and noon) May increase by 5 mg/day at weekly intervals Usual dose range: 0.1-0.5 mg/kg/dose PO 24 hourly in the morning (5-20 mg/day) Max dose: 40 mg/day divided 8-12 hourly
	Extended-release Children ≥6 years old: 5 mg PO 12-24 hourly or 10 mg PO 24 hourly May increase dose by 5 mg/day increments at weekly intervals May use regular-release or extended-release formulation Max dose: 40 mg/day divided 12-24 hourly
	Transdermal Children ≥6 years old: Apply 4.5 mg patch 9 hourly May increase dose by 4.5 mg/day increments at weekly intervals Max dose: 18 mg patch 9 hourly Adults: Apply 9 mg patch 9 hourly May increase dose by 4.5 mg/day increments at weekly intervals Max dose: 18 mg patch 9 hourly
Lisdexamfetamine	Children ≥6 years old, adults: Initial dose: 30 mg PO 24 hourly in the morning May increase dose in increments of 10-20 mg/day at weekly intervals Max dose: 70 mg/day
Methylphenidate	Immediate-release (10 mg) Children ≥6 years old: Initial 5 mg PO 12-24 hourly (morning and noon) May increase dose with 5-10 mg increments at weekly intervals Total daily dose should be administered in divided doses Adults: 20-30 mg/day PO divided 8-12 hourly Some patients may require 40-60 mg/day Patients who are unable to sleep if medication is taken late in the day should take the last dose before 6 pm May increase dose at weekly intervals Max dose (children and adults): 60 mg/day	Adverse Reactions Occur early in treatment and tend to decrease over time. If persistent, consider decrease in dose or adjust dosing schedule CV effects (serious CV events, increased HR and BP); GI effects (decreased appetite, stomachache, nausea/vomiting); CNS effects (insomnia, headaches); Ophthalmologic effects (blurred vision, difficulty in accommodation); Endocrine and metabolic effect (growth suppression); Other effects (motor tics, nasopharyngitis) Dose dependent: Over-focused, overly inhibited, rarely psychotic reactions, hallucinations, mood disorders Has been associated with sudden death at normal doses in children with structural cardiac abnormalities Special Instructions Before initiation of treatment with stimulants, do the following: (1) screen for personal past history and family history of cardiac problem, (2) obtain measurement of BP and pulse rate, (3) perform a simple cardiac physical exam, (4) ECG or further investigation if cardiac problem is suspected Avoid in patients with moderate-severe hypertension, cardiac arrhythmia, heart failure, severe angina, recent MI, glaucoma, tics, diagnosis or family history of Tourette syndrome, hyperthyroidism, thyrotoxicosis, with marked agitation, tension and anxiety, pre-existing psychosis and patients concomitantly taking MAO inhibitors or within 2 weeks of discontinuing MAO inhibitors Use with caution in patients with severe GI narrowing, history of seizures Start with low dose and titrate based on patient response. Continue to increase dose to achieve maximum response. May need to decrease dose if side effects occur If relief of symptoms is only necessary for school environment, may administer drug on school days only Monitor BP and heart rate regularly Monitor CBC for those on prolonged treatment Marked variability in dose-response relationship Avoid abrupt withdrawal due to potential for drug dependency
	Extended-release, long-acting (18 mg, 27 mg, 36 mg, 54 mg) Initial dose for patients new to Methylphenidate, or stimulants other than Methylphenidate: Children ≥6 years old: 18 mg PO 24 hourly in morning Adults: 18- 36 mg PO 24 hourly in morning Patients currently using Methylphenidate: Initial dose based on current regimen and clinical judgement Children ≥6 years old and adults: Switch from regular-release 5 mg PO 8-12 hourly: 18 mg PO 24 hourly Switch from regular-release 10 mg PO 8-12 hourly: 36 mg PO 24 hourly Switch from regular-release 15 mg PO 8-12 hourly: 54 mg PO 24 hourly Switch from regular-release 20 mg PO 8-12 hourly: 72 mg PO 24 hourly May increase dose in 18 mg increments at weekly intervals Max dose children 6-12 years old: 54 mg/day Max dose adolescents: 72 mg/day Max dose adults: 108 mg/day
	Extended-release, intermediate-acting (20 mg, 30 mg, 40 mg) Children ≥6 years old, adolescents: Initial 20 mg PO 24 hourly Max dose: 60 mg/day Adults: Initial 20 mg PO 24 hourly Max dose: 80 mg/day
*Therapy in children, adolescents and young adults is associated with clinical worsening, suicidality or unusual changes in behavior. Close observation of the patient and communication with the prescribing physician is warranted.

Drug	Dosage	Remarks
Lipirinen (Phosphatidylserine conjugated to Omega-3 fatty acids enriched with Eicosapentaenoic acid)	150 mg PO 24 hourly	Adverse Reactions GI effects (GI discomfort, nausea,); CNS effects (insomnia, headache, tics, tantrum, hyperactivity); Other effects (atopic dermatitis, altered SGOT, high triglycerides) Special Instructions Use with caution in patients with hypersensitivity to shellfish

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.