DTB review: Update on drugs for hyperactivity in childhood.

The authors of this DTB review update a previous review from 2001, focusing on the newer products for attention deficit hyperactivity disorder (ADHD). The following topics are covered in the review:

• Background
• The drugs (methylphenidate, dexamfetamine, atomoxetine)
• Efficacy of drug treatment
• Safety issues
• Cost

The authors suggest that drug treatment should be managed under the supervision of a specialist and should only be used as an adjunct to other interventions, for example behavioural and educational. They conclude:

“Current evidence suggests that the drugs licensed for such use in children and adolescents (methylphenidate, dexamfetamine and atomoxetine) are effective in tackling core symptoms of ADHD. However, it does not allow clear distinction between the drugs in terms of efficacy. The longer history of use with methylphenidate is a compelling reason for preferring it as a first choice. Modified-release methylphenidate is more expensive than the immediate-release forms, but avoids midday doses and, therefore, the need to take this controlled-drug to school. Dexamfetamine is an alternative for children unresponsive to methylphenidate. Atomoxetine is a comparatively new treatment. Unlike methylphenidate and dexamfetamine, it is not a controlled drug. However, its long-term safety is not clear, so its use should be reserved for patients in whom stimulants are contraindicated or cause unwanted effects.”

Drug Therap Bull May 2007: Vol. 45(5)