![]() ![]() In a parallel group, 7-week study, 67.3% of children and adolescents receiving ER formulation of d-MPH that was clinically titrated up to 30 mg (mean dose=24 mg) were rated “much improved” or “very much improved” on the Clinical Global Impressions-Improvement (CGI-I) Scale compared with 13.3% of those receiving placebo (Greenhill et al. ![]() Thus, the MPH and AMP formulations used in this study are formulated in a very similar manner. Similar to MAS ER, 50% of the drug is released initially with the remaining 50% released approximately 4 hours later. Dexmethylphenidate hydrochloride (Focalin XR ER d-MPH) is the pharmacologically active d-threoenantiomer of racemic MPH. Anorexia, insomnia, and mood lability were more common in children receiving ER MAS compared with placebo, occurring in 21.9%, 16.6%, and 8.6% of subjects, respectively. Behavioral and cognitive effects were demonstrated to last for 12 hours, with the 30 mg condition associated with the most robust gains. MAS ER is one of the most frequently prescribed stimulant medications for ADHD (Olfson, Marcus and Wan 2009) Dose-dependent efficacy versus placebo in childhood has been demonstrated in a large, parallel group study of 584 children treated with 10, 20, or 30 mg (Biederman et al. MAS ER is a racemic mixture of dextro- and levo-isomers of AMP salts that contains 50% IR MAS and 50% delivered at a second pulse 4 hours later. For the two stimulant medications, we chose Dexmethylphenidate Hydrochloride ER (Focalin XR, here referred to as d-MPH ER) and Adderall XR (mixed AMP salts ER). In the MTA study, individually titrated doses were higher and more effective than doses of MPH in the community treatment group, which did not systematically evaluate different dose levels.Ĭurrently, ER formulations of MPH and AMP have replaced the IR formulations as first line treatments due to their longer duration of behavioral effects and convenience (Swanson and Hechtman 2005 Olfson et al. Titrating to the optimal dose in crucial, as described in the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivities Disorder (MTA) and Preschool ADHD Treatment Study (PATS) studies that utilized double-blind procedures to determine the optimal dose level (Greenhill et al. In addition, early studies did not routinely dose the two medications comparably. 2002 Faraone and Buitelaar 2010), although reviews and meta-analyses are likely to over-represent data from older studies, many of which utilized older IR stimulant formulations. Other reviews and a recent meta-analysis of 23 studies have concluded that effect sizes are somewhat greater for AMP (Arnold 2000 Faraone et al. For example, the Texas Algorithm for ADHD recommends using either class of stimulant medication as the initial treatment for ADHD, and switching to the other stimulant class if the first is either not effective or not well tolerated (Pliszka et al. MPH and AMP formulations have equal efficacy and similar side effect profiles according to several reviews, practice guidelines, and algorithms (American Academy of Child and Adolescent Psychiatry 2002 Daughton and Kratochvil 2009). Yet, we know relatively little about the similarities and differences between the two main classes of stimulants due to a paucity of head-to-head studies with newer, long-acting agents. S timulant medications, including immediate release (IR) and extended release (ER) methylphenidate (MPH) and amphetamine (AMP), have been shown to be highly efficacious for improving attention-deficit/hyperactivity disorder (ADHD) symptoms in literally hundreds of placebo-controlled trials (Swanson 1993 Wilens and Spencer 2000). ![]()
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