ADHD MEDICATIONS IN AUTSIM GUIDE SHEET

ADHD MEDICATIONS IN AUTSIM GUIDE SHEET

STIMULANTS

Methylphenidate-based

Amphetamine-based

(more commonly recognized as “Ritalin” type)

(more commonly recognized as “Adderall” type)

Short-acting

Long-acting

Long-acting

Short-acting

NON-STIMULANTS

FDA-approved for ADHD

Off-label use for ADHD

Alpha-2 Agonist

SNRI

Amantidine

Bupropion

Nortryptaline

Co-occurring depression/substance abuse

ODD/ADHD/Sleep/ Bedwetting

Attention & hyperactivity/anxiety symptoms in autistic individuals

Guanfacine

Strattera

Clonidine

Qelbree

ExtendedRelease

ImmediateRelease

ExtendedRelease

ImmediateRelease

Bupropion (Wellbutrin)

• An atypical antidepressant sometimes used off-label for ADHD, especially when mood and motivation are also concerns
• Key Points:
• Off-label ADHD option – May help with focus, energy, weight loss, and motivation, especially when stimulants aren’t a good fit or when depression/anxiety is also present.
• Works on dopamine + norepinephrine – Targets similar pathways as stimulants but with a different mechanism, and without being a controlled substance.
• Can support mood and emotional energy – Helpful for individuals with ADHD + depression, or ADHD that presents more as low drive or “inertia.”
• Not sedating – Typically activating, which can improve sluggishness but may also lead to trouble sleeping, increased anxiety, or irritability in some—so it’s important to monitor closely.
• Available in multiple formulations – Comes in IR (immediate release), SR (sustained release), and XL (extended release) versions. XL is typically preferred for ADHD due to smoother coverage and once-daily dosing.
• Can lower seizure threshold – Especially at higher doses or in individuals with eating disorders or a seizure history. Dosing must be cautious and individualized.
• 📉 Not FDA-approved for ADHD – Its use in ADHD is based on clinical experience and smaller studies, especially in teens and adults.

Extended Release Clonodine

• Slower to start working, but lasts about 12 hours for steady blood levels.
• FDA-approved for ADHD
• Helps with daytime ADHD symptoms like hyperactivity and impulsivity.
• Once-daily dosing, can give in AM or PM
• It cannot be crushed, split, or chewed (it must be swallowed whole).
• Milder sedation than IR, but it still helps STAY asleep.
• Comes in once weekly skin patches, tablets, and liquid (ONYDA XR)
• Can combine with all other ADHD medications
• Also helpful for executive functioning, agitation, self injury behaviors PTSD
• Doses 0.1 to 0.4 mg

Immediate Release Guanfacine

• Guanfacine ER is preferred for ADHD, while IR is rarely used today except in specific cases.
• It can also help a lot with daytime anxiety in patients where SSRIs do not work
• Originally approved for hypertension, sometimes used off-label for ADHD.
• More sedating due to higher peak drug levels after each dose.
• Stronger blood pressure-lowering effects compared to ER.
• Helps more with falling asleep but may wear off overnight.
• Higher risk of rebound hypertension if stopped suddenly.
• Comes in tablets that can be crushed or split for flexible dosing.

Immediate Release Clonodine

• Fast acting, lasts 3-4 hours
• Used off-label for ADHD, anxiety, or tic disorders.
• Helps with falling asleep.
• Can be given in multiple doses per day.
• Available in pills and liquid formulations.
• OK to crush for easier administration.
• Can combine with all other ADHD medications
• Stronger effect on lowering blood pressure - need to stay well hydrated!
• Even when given only at bedtime, it can help decrease impulsivity the next day.!
• Doses 0.1 to 0.4 mg

Extended Release Guanfacine

• More substantial effects on working memory
• Tends to be less sedating, making it a preferable option for some patients
• More selective for αlpha receptors, leading to fewer side effects
• Less sedating and has weaker blood pressure-lowering effects
• Longer half-life (~16-18 hours) allows for once-daily dosing.
• Helps with staying asleep rather than falling asleep.
• Less sedating than clonidine but still improves sleep quality.
• Cannot be crushed, can get it compounded into a liquid
• Doses 1 to 4 mg

Key Points:

• Off-label alternative to stimulants – May help with ADHD symptoms and mood swings, especially in kids who are sensitive to traditional stimulant medications.
• Works through NMDA inhibition – Its main mechanism is blocking NMDA receptors, which helps regulate the glutamatergic system and may have neuroprotective effects.
• Flexible dosing – Common starting dose is 25 mg/day, with gradual increases by 25 mg every 4–7 days. Typical target dose is 100–150 mg/day, depending on weight.

Weight-based guidance:

• ~100 mg/day for kids under 30 kg
• ~150 mg/day for kids over 30 kg
• (Max dose: usually not above 300–400 mg/day)
• Usually lasts all day – One morning dose is often enough, but a small afternoon booster (around 3:30 PM) may be needed for some.
• Formulations available – Comes in 100 mg capsules and liquid syrup (10 mg/mL) for flexible dosing
• FUN FACT Originally developed as an antiviral medication in the 1960s

What is Nortriptyline?Nortriptyline is a tricyclic antidepressant (TCA) that’s been around for decades. While originally used to treat depression, it’s also prescribed off-label to help with ADHD symptoms, sleep, anxiety, irritability, and bedwetting (enuresis).Key Points:

• A tricyclic antidepressant sometimes used off-label for ADHD, mood, sleep, and even bedwetting
• Off-label option for ADHD – Can support attention, emotional regulation, and sleep, pain, particularly when stimulants cause side effects or aren’t tolerated.
• Works on multiple systems – Increases norepinephrine levels and has antihistamine and anticholinergic effects, which contribute to calming and sedating properties.
• Often improves sleep and irritability – Commonly given at night to support sleep and reduce evening mood swings or aggressive behavior.
• Can reduce bedwetting – Nortriptyline has been used for nocturnal enuresis, as its anticholinergic effects help the bladder hold urine longer overnight.
• Slow titration is key – Typically started at 10–25 mg at bedtime, gradually increased as needed. Target ADHD doses usually range from 25–75 mg/day.
• EKG monitoring recommended – Tricyclics can affect heart rhythm, so a baseline EKG is often done before starting, especially in children.
• Use with caution in bipolar disorder – Like all antidepressants, Nortriptyline can trigger manic symptoms in children with bipolar disorder or mood instability, especially when used without a mood stabilizer.

Approved ages 6 and older. Works by modulating norepinephrine and serotonin levels in the brain—two neurotransmitters involved in attention, impulse control, and mood regulation.Key Points:

• Takes time to work – May take several weeks to see full effects, as it works more gradually than stimulants. Also has antidepressant and anti-anxiety effects.
• Can cause drowsiness – Common side effects include sleepiness, fatigue, and decreased appetite. This gets better over a few weeks.
• Helpful in autism – Sometimes used to support ADHD symptoms in autistic individuals when stimulants aren’t well tolerated.
• Black box warning – Like many antidepressant-type medications, Qelbree carries a warning for increased risk of suicidal thoughts in children and young adults (monitoring is important, especially early on).
• May improve emotional regulation – Some individuals notice smoother mood and reduced irritability in addition to focus improvements.
• Capsule can be opened- sprinkled on applesauce or similar soft food, which is helpful for kids or others who can’t swallow pills.

• Similar to Qelbree – Both are non-stimulant ADHD medications that may be helpful when stimulants aren’t a good fit, especially for individuals with anxiety, sleep challenges, or irritability. Slower onset – Can take 2–6 weeks to notice full effects, especially for attention.
• Common side effects – Sleepiness, upset stomach, decreased appetite, and mood changes in some.

• 📈 May improve emotional regulation – Especially useful in kids with ADHD who also struggle with frustration, anxiety, or mood swings.

• 🔬 How it's different from Qelbree – Strattera works only on norepinephrine, while Qelbree affects both norepinephrine and serotonin systems. Some individuals may respond better to one based on their symptom profile and side effect tolerance. Also capsules are not meant tobe opened unlike QELBREE. You can get it compounded in liquid.

• Also qelbree is dosed by age, strattera by WEIGHT

Alpha-2 Agonist

• Both guanfacine and clonidine enhance prefrontal cortex function by stimulating alpha-2 adrenergic receptors in the brain.
• The prefrontal cortex regulates behavior, thought, emotion, and long-term planning.
• These medications help improve impulse control, focus, and executive functioning.
• They can also reduce anxiety, tics, and nightmares in some individuals.
• Response to these medications varies—some people may benefit more from one over the other or experience side effects with one but not the other, so it may be worth trying different options.
• The choice between immediate-release (IR) and extended-release (ER) can impact both effectiveness and side effects.
• Have delayed effects in ADHD, taking 2-4 weeks to build up (and get used to any initial tiredness) for full benefits.