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Q: “Why Are There So Many Different ADHD Medications?”

March 17, 2023

Q: “Our child is newly diagnosed with ADHD. Saying yes to trying medication alone was tough for us, and now we are positively overwhelmed with all the available medication options. And frustrated. Unbeknownst to us, our doctor initially prescribed a medication in capsule form, which my son can’t swallow. We switched to a liquid medication, only to learn that our insurance didn’t cover it. After much, much hassle, we finally landed on another medication (for now). Why are there so many different ADHD medications? What distinguishes them?”

How Many Different ADHD Medications Exist?

ADHD medications come in two major forms: stimulants and non-stimulants. Stimulants are the most effective treatments for attention deficit hyperactivity disorder. Of the 46 medications currently approved by the U.S. Food and Drug Administration (FDA) to treat ADHD, 36 are stimulants.

All these medication choices exist, in part, to allow patients and clinicians to develop a tailored treatment plan — one that reduces the symptoms of ADHD and increases functioning with minimal side effects and hassle for that individual patient. Variety is essential because no two patients with ADHD respond the same way to a given medication.

Short-Acting and Long-Acting ADHD Medications

Without any modifications, the two stimulant medications for ADHD — methylphenidates and amphetamines — are short-acting in nature. They begin to take effect after 30 minutes, peak after about two hours, and wear off about four hours after being taken.

This means that patients with this type of medication will have to remember to take multiple doses a day for full symptom control — not the most effective method for individuals with symptoms of inattention, distractibility, and poor working memory. Unsteady medication levels in the body also affect a patient’s psychological state. This is why children are often irritable when medication starts to wear off.

[Get This Free Download: Comparison Chart of Stimulants & Non-Stimulants]

For a long-time, short-acting medications (like Ritalin and Adderall) were the only medications available for patients with ADHD. Over time, pharmaceutical companies have developed long-acting preparations to extend the therapeutic effectiveness of methylphenidate and amphetamine. Popular long-acting medications today include Ritalin LA (up to 8 hours), Adderall XR (up to 9 hours), Focalin XR (up to 9 hours), Concerta (up to 12 hours), Vyvanse (up to 12 hours), Adhansia XR (up to 12 hours) and Jornay PM (up to 24 hours). Each one uses a different method for extending the lifespan of the medication, which helps explain the many different brand names for ADHD medications today.

This is not to say that short-acting medications are not effective or have no place in treating ADHD. Some doctors prescribe a short-acting medication to take as the long-acting medication is wearing off to further extend its effectiveness. For other patients, adding a low dose of a short-acting pill allows the long-acting medication to wear off more gradually, reducing the irritability side effect that often occurs when medication wears off.

Different Delivery Systems

Whether short- or long-acting, ADHD medications today are also available in the following forms:

tablets
capsules
liquid preparations
chewable tablets
orally dissolving tablets
skin patch

Each delivery mechanism has its benefits. Dissolving tablets and liquid preparations, for example, are excellent options for young children who have trouble swallowing pills. Liquid preparations also work well for accurately fine-tuning doses.

[Read: The Top ADHD Medications for Children — Rated by Readers]

As mentioned earlier, there are two stimulant medications, methylphenidate and amphetamine for treating ADHD. But with short-acting and long-acting preparations, four different mechanisms, and six different delivery systems, it is not difficult to produce many different brand name medications for the treatment of ADHD. But remember, in the end, all of these medications are still either methylphenidate or amphetamine.

What About Non-Stimulant Medications?

Non-stimulants are effective in treating ADHD symptoms, but not as effective as stimulants. But compared to stimulants, non-stimulants produce fewer side effects and actually treat many of the side effects that develop from stimulants. That is why non-stimulants can either be used alone to treat ADHD or in combination with stimulants to reduce side effects.

Non-stimulants approved for the treatment of ADHD include clonidine (Catapres, Kapvay), guanfacine (Tenex, Intuniv), atomoxetine (Strattera), bupropion (Wellbutrin), and viloxazine (Qelbree).

Where Can I Learn More About ADHD Medications?

In sum, stimulant medications are the most effective medications for the treatment of ADHD, and they are available in two forms: methylphenidate and amphetamine. They are also available in multiple therapeutic durations and multiple delivery systems, all of which improve compliance and accurate dosing. Awareness of these medication options and benefits result in more effective treatment with fewer side effects.

You can use the Medication Lookup Table on my website (www.adhdmedicationbook.com) to find ADHD medications based on criteria like stimulant type, duration, preparation, and more. For example, if you select “methylphenidate” and “long-acting,” the table will present medication options like Adhansia XR, Concerta, Daytrana, Jornay PM, Quilivant XR and other available medications that fit these exact specifications. But if you extend the criteria to include, say, only liquid preparations, the Lookup Table will show Quilivant XR, the only long acting, liquid methylphenidate medication currently available.

How to Treat ADHD in Children: Next Questions

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “ADHD Medication Options and Benefits for Children” [Video Replay & Podcast #438] with Walt Karniski, M.D., which was broadcast on January 19, 2023.