A review of amphetamine extended release once-daily options for the management of attention-deficit hyperactivity disorder

ABSTRACT

Introduction

Amphetamine preparations are one of the two categories of stimulant medications approved for the treatment of attention deficit hyperactivity disorder (ADHD). Optimal treatment of ADHD aims to reduce core symptoms for as much of the waking hours as possible, leading to longer-acting delivery formats. In addition, the pediatric population commonly has difficulty swallowing pills and manufacturers have developed a variety of options to facilitate this concern. These include chewable tablets, capsules that may be sprinkled on soft food, liquids and transdermal patches.

Areas covered

This article reviews the once-daily extended-release preparations currently available for amphetamine compounds, their pharmacodynamics, and common adverse effects.

Expert opinion

There is an extensive evidence base supporting use of amphetamine preparations in the treatment of ADHD. Rapid onset of action and a favorable side effect profile make these widely used. The availability of once-daily extended-release chewable tablets, capsules that can be opened and sprinkled, and liquid formulations provides clinicians with multiple options to meet the specific needs of patients with difficulty swallowing whole pills.

KEYWORDS:

• Amphetamine
• ADHD
• dextroamphetamine
• delivery
• extended-release
• once-daily treatment

Article highlights

• Amphetamine treatment for children’s behavior problems was first described more than 85 years ago and remains the pharmacologic treatment for ADHD with the greatest effect size.

• The difference in the levo- and dextroamphetamine effects on attention, hyperactivity, and impulsivity symptoms as well as their differing adverse effects on appetite, sleep, and the cardiovascular system has led to manufacturers developing a variety of formulations of these compounds.

• With a strong evidence base demonstrating effectiveness in treating ADHD, formulations that help support medication adherence such as once daily extended-release formats have become the preferred choice for clinicians and patients.

• The once daily extended-release amphetamine compounds used to treat ADHD are very effective. Adverse events, namely anorexia, insomnia, dry mouth, headache, and abdominal pain are often dose dependent.

• Once daily extended-release amphetamine formulations have not only demonstrated a positive impact on hyperactivity, impulsivity, and inattention but have also demonstrated evidence of improvement in executive function, health-related quality of life, and driving performance.

Declaration of interest

D Coury has received research grant support from GW Biosciences, Stalicla and Stemina and serves on advisory boards for As You Are, BioRosa, Cognoa, GW Biosciences, MaraBio, Quadrant Bioscience, and Stalicla. None of these activities are related to ADHD or its pharmacologic treatment. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.