Prescribing
Around two out of every five people diagnosed with ADHD are prescribed medication for ADHD. Before starting medication, there should be a full baseline assessment including a review of mental and physical health. This should include cardiovascular assessment if stimulants are being considered.1,10
The key drugs are methylphenidate, lisdexamfetamine, dexamfetamine, atomoxetine, and guanfacine (see Table 1). Not all may be licensed for certain age groups or may need to be prescribed off label for ADHD. For example, adults should not be prescribed guanfacine without advice from a tertiary ADHD service , or doses prescribed by consultants may exceed licensed doses.1
Doses should be carefully titrated in accordance with changes to baseline symptoms, impairment and adverse effects. A Drug Safety Update issued by the MHRA in September 2022 reminded prescribers and dispensers to use caution if switching patients between different long-acting formulations of methylphenidate as different instructions for use and different release profiles may affect symptom management. 1,13
Table 1: NICE core drug recommendations for ADHD1
|
ADHD medication |
Adult | Children 5-17 |
Children under 5 years |
| 1st line | lisdexamfetamine or methylphenidate | methylphenidate | none |
| 2nd line | methylphenidate or lisdexamfetamine (if first option not successful) | lisdexamfetamine | Only on specialist (tertiary service) advice |
| 3rd line | dexamfetamine | dexamfetamine | |
| Alternative | atomoxetine |
atomoxetine or guanfacine |