Primary care plays a key role in the management of
ADHD
Facilitating and encouraging adherence to treatment regimens
Preferred pharmacotherapy for ADHD management is monotherapy with methylphenidate or dexamphetamine. Separate trials may be required of these agents to find out which is the most suitable. Dosage is titrated against effect on behaviour and side effects and the optimum dose required varies considerably between individuals.
The effective dose ranges are:
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Correct timing of doses is important
Timing of doses is important. Both these agents have onset of action within about 30 minutes. Methylphenidate has a half-life of about three hours and dexamphetamine about six hours. However there is considerable variation in duration of action between individuals. Administration is usually timed to give optimum effect during school hours. Poor response may be due to poor adherence to the treatment regimen or may indicate need to adjust timing of the doses.
Methylphenidate is usually given first thing in the morning and at lunchtime. Long-acting preparations remove the need for a lunchtime dose.
Long-acting preparations have a longer period until the onset of action after the dose is taken. This may make the first hour or two of the day difficult. A small dose of normal action methylphenidate may be given with the long-acting methylphenidate to give earlier onset of action.
The effects of long-acting methylphenidate may continue into the evening and result in difficulty getting to sleep, requiring a change in dose, timing or strength or a change to a short-acting preparation.
Long-acting methylphenidate tablets can be halved, although this is not generally recommended by manufacturers.
Dexamphetamine only needs to be taken once a day and its onset of action is slightly slower than methylphenidate.
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