Choosing the Best ADHD Medication: A Guide for Children and Adults – GoodRx

Choosing the Best ADHD Medication: A Guide for Children and Adults – GoodRx

Maybe you’re ready to see if treatment can help. Or do you have some nervousness about whether treatment will work?

First, know that the best treatment for ADHD in children involves a combination of parent and child behavior therapy, school interventions, and if necessary, medication. Making a habit of healthy behaviors like regular physical activity, mindfulness practice, and limited screen time also helps to improve ADHD symptoms.

Here’s what you need to know about ADHD medications.

Stimulant medications for ADHD

Stimulants are the most popular medications for treating ADHD because they work well, act fast, and have been used safely for many decades. Researchers think they work by boosting levels of dopamine and norepinephrine in the brain––those chemicals that fuel messaging within different parts of the brain and body.    

Types of stimulant medications for ADHD

  • Methylphenidates
    • Short-acting: Ritalin, Focalin
    • Long-acting: Ritalin LA, Focalin XR, Concerta, Daytrana patch
    • Short-acting: Adderall
    • Long-acting: Adderall XR, Mydayis, Vyvanse

    Methylphenidates vs. amphetamines

    A large review of 10,000 children and 8,000 adults across 133 clinical trials in 2018 showed that amphetamines worked better at lowering symptoms of ADHD, but methylphenidates caused fewer side effects. Because of this, ADHD specialists recommend methylphenidates should be the first choice when treating children and adolescents, and amphetamines should be the first choice in adults.

    Short-acting vs. long-acting stimulants

    There is no difference in how well short-acting and long-acting stimulants treat ADHD. The choice boils down to preference and cost.

    Short-acting stimulants, such as Ritalin, Focalin, and Adderall, are older, have a great safety record, and are available in generic (cheaper) formulations. They start having an effect in less than one hour. But, because they are short-acting, they need to be taken 2 to 3 times per day for round-the-clock effect, and there can be a significant “wearing off” between doses.

    Long-acting stimulants, such as Ritalin LA, Focalin XR, Concerta, Adderall XR, Mydayis, Vyvanse, and Daytrana patch can be taken just once a day, and do not have a “wearing off” effect. Like the short-acting stimulants, they start working in under an hour. But, side effects can last longer throughout the day, and the medications tend to be more expensive as there are fewer generics available.

    Side effects of stimulants

    Stimulants are controlled substances. They come with a risk of addiction and dependence, as they can cause a pleasant “high”. This is less likely with long-acting medications compared to short-acting ones because long-acting medications are released into the blood more steadily, avoiding a “high”.

    That being said, stimulants have been used safely for decades, and they work. There is no real difference in side effects between the different stimulant medications, and many of their side effects are mild, settle quickly, and can be fixed with small tweaks to dose or dosing schedule.

    Common side effects:

    • Low appetite*
    • Slow growth
    • Weight loss in children (growth will be monitored throughout treatment)
    • Sleep disturbance (medication should be taken in the morning or early afternoon to avoid this)
    • Jitteriness and emotional changes*

    * These side effects may be worse with Adderall, Adderall-XR, and Mydayis according to research studies in 2006 and 2017.

    Less common side effects:

    • Fast heart rate
    • High blood pressure
    • Headache
    • Dizziness
    • Upset stomach
    • Long-lasting erections (rarely)
    • Cold and painful hands or feet (Raynaud’s phenomenon)

    Non-stimulant medications for ADHD

    Non-stimulant medications for ADHD are less good at treating ADHD symptoms and take several weeks to start working (compared to under one hour for most stimulants). But, they are an option if there is a medical reason (previous or risk of substance abuse), or a personal preference not to use stimulants. They can also be tried if stimulants have not worked.

    In terms of non-stimulant medications, ADHD specialists recommend using atomoxetine (Strattera) as a first choice in children and adults, followed by guanfacine or clonidine in children, or bupropion or nortriptyline in adults.

    Side effects of atomoxetine include low appetite, weight loss, stomach pain, nausea, vomiting, indigestion, headache, dizziness, sleepiness, irritability, long-lasting (non-sexual) erections. In adults, side effects also include erectile dysfunction and excessive sweating.

    Atomoxetine comes with a boxed warning about increased risk of suicide and suicidal thoughts in children and adolescents. Children need to be closely monitored by their families and doctors for any unusual changes in behavior, especially in the first 4 to 5 months of treatment, and after any dose increases.

    There is also a rare, but serious risk of sudden cardiac death in children and adolescents and heart attack in adults. The recommendation is that everyone should be tested for heart problems before starting on atomoxetine.

    How much do ADHD treatments cost?

    How much you pay for your ADHD medications will depend on which you take, the dose, and how many pills you buy.

    For a typical dose of a short-acting stimulant, such as 10 mg three times a day, you can pay as little as $42.97 for a one-month supply of amphetamine salt combo (generic Adderall), compared to $635.31 for the brand, or $25.32 for methylphenidate (generic Ritalin), compared to $90.50 for the brand, if you use a GoodRx coupon.  

    An equivalent dose of a long-acting stimulant, such as amphetamine salt combo XR (generic Adderall XR), will cost $57.95 ($219.95 for the brand) or $59.59 for methylphenidate ER (generic Ritalin LA) (compared with $310.70 for the brand) with a GoodRx coupon. A one-month supply of 50 mg Vyvanse, a long-acting stimulant for which there is no generic, costs $316.11 with a GoodRx coupon.
    A non-stimulant, such as atomoxetine (generic Strattera), can cost $96.22 for a one-month supply of 80 mg (compared to $467.27 for the brand).

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