MHM Magazine

Treatment options Stimulants Methylphenidate Short-acting (3-5 hours) Long-acting (6-8 hours) Ultra long-acting (10-12 hours) Amphetamines Lisdexamphetamine Dexamphetamine Non-stimulants Atomoxetine Concerta ® Neucon ® Contramyl ® XR Mefedenil ® Radd ® Acerta ® Unicorn MPH ® Ritalin ® LA Medikinet ® MR Ritalin ® Douglas MPH ® Biotech MPH ® Strattera ® INIR ® Attentra ® Attencit ® Atastrat ® Concitron ® Atteze ® Stratex ® Vyvanse ® Amfexa ® Substance Trade name Formulation Doses Dosing strategy Methylphenidate Ritalin ® Douglas MPH ® Biotech MPH ® Available in 10mg tablets Approximately 1mg/kg/dose. Initiate at 5mg bd or tds with daily or weekly increments according to efficacy and tolerability (max 100mg/day po). Methylphenidate Extended release Ritalin LA ® Spheroidal oral drug absorption system (SODAS) Available in 10mg, 20mg, 30mg, and 40mg capsules Once or twice daily dose at equivalent of total daily dose of IR. Medikinet MR ® Modified release pellets Available in 5mg, 10mg, 20mg, 30mg and 40mg capsules Once or twice daily dose at equivalent of total daily dose of IR. Concerta ® Neucon ® Mefedenil ® Unicorn MPH ® Osmotic controlled release oral delivery system (OROS) Available in 18mg, 36mg and 54mg capsules/tablets Once or twice daily dose at equivalent of total daily dose of IR. Contramyl XR ® Multi-unit pellet system (MUPS) Radd ® Hydrophilic matrix release system Acerta ® Extended release film coated tablets Dexamphetamine sulphate Amfexa ® *registered for children and adolescents aged 6-17 years Available in 5mg and 10mg snap tablets Initiate at 5-10mg/day po, with 5mg increase per week, to a max of 20mg/d (40mg for older children in exceptional cases). Lizdexamphetamine dimesylate Vyvanse® *registered for adolescents and adults from age 13 years Amfetamine based pro-drug Available in 30mg, 50mg and 70mg tablets Initiate at 30mg per day, with 20mg increase after 2 weeks, to a max of 70mg/d. In patients with severe renal impairment, the maximum dose should not exceed 50mg/kg. Atomoxetine Strattera ® NIR ® Attencit ® Attentra ® Atteze ® Atastrat ® Concitron ® Strattex ® Available in 10mg, 18mg, 25mg, 40mg, 60mg and 80mg capsules Initiate at approximately 0.5mg/kg/day in patients <70kg with recommended daily dose 1.2mg/kg/day. In patients >70kg initiate at 40mg/day with monthly increments of 20mg/day to a maximum of 100mg/ day (*maintain at least 12 weeks before judging clinical response). Bupropion Wellbutrin XL ® Budep ® Weldep XR ® XR (extended release) 150mg and 300mg tabs Initiate at 75mg – 150mg/day po. Dosage may be adjusted in increments of 150mg at approximately monthly intervals to a maximum dose of 450mg/day. Voxra XL ® SR (slow release) Bupropion XR Adco ® XR 150mg capsules Venlafaxine HCl Efexor XR ® Venlor XR ® Efegen XR ® Sandoz Venlafaxine ® Venlafaxine Unicorn XR ® Venlafaxine XR Adco ® XR 37.5mg, 75mg and 150mg capsules Initiate at 75mg/day po. Dosage may be adjusted in increments of 75mg at approximately monthly intervals up to a maximum dose of 300/day. Illovex XR ® XR 37.5mg, 75mg, 150mg, 225mg and 300mg tabs Odiven ® 75mg and 150mg tabs Imipramine HCl Ethipramine ® Tofranil ® 10mg and 25mg tabs Initiate at 20mg to 70mg/day (10mg in elderly patients) and increase gradually to a maintenance dose of 100mg to 150mg/day (50mg in elderly patients). Current treatment options (registered for the treatment of ADHD) available in South Africa Medication schedule (registered, as well as off-label products available) Issue 1 | 2024 | MENTAL HEALTH MATTERS | 7 MHM