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Current issues around the pharmacotherapy of ADHD in children and adults

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Abstract

Background New drugs and new formulations enter the growing market for ADHD medication. The growing awareness of possible persistence of ADHD impairment beyond childhood and adolescence resulting in increased pharmacotherapy of ADHD in adults, is also a good reason for making an inventory of the what is generally known about pharmacotherapy in ADHD. Aim To discuss current issues in the possible pharmacotherapy treatment of ADHD in children, adolescents and adults with respect to the position of pharmacotherapy in ADHD treatment guidelines, the pharmacoepidemiological trends, and current concerns about the drugs used. Methods A search of the literature with an emphasis on the position of pharmacotherapy in ADHD treatment guidelines, the pharmacoepidemiological trends, and current concerns about the drugs used in pharmacotherapy. Results According to the guidelines, the treatment of ADHD in children consists of psychosocial interventions in combination with pharmacotherapy when needed. Stimulants are the first-choice drugs in the pharmacological treatment of ADHD in children despite a number of well known and frequently reported side effects like sleep disorders and loss of appetite. With regard to the treatment of adults, stimulant treatment was recommended as the first-choice pharmacotherapy in the single guideline available. Both in children and adults, there appears to be an additional though limited role for the nonadrenergic drug atomoxetine. The increase of ADHD medication use, in children, adolescents and in adults, can not only be interpreted as a sign of overdiagnosis of ADHD. Despite the frequent use of stimulants, there is still a lack of clarity on the effects of long-term use on growth and nutritional status of children. Cardiovascular effects of both stimulants and atomoxetine are rare but can be severe. The literature suggests that atomoxetine may be associated with suicidal ideation in children. Conclusion Although pharmacotherapy is increasing common in the treatment of ADHD in both children and adults, there are still a lot of questions about side effects and how best to counter them. This suggests an important role for close monitoring of children and adults treated with stimulants or atomoxetine.

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Conflicts of interest statement

Willemijn Meijer is an employee of PHARMO Institute. This research institute performs financially supported studies for several pharmaceutical companies. For this publication no relations apply.

In the past Adrianne Faber received a limited research grant from Janssen-Cilag. For this publication no relations apply.

Els van den Ban received following financial supports: from Janssen-Cilag for lecture, reimbursed travel to convention; from Ely-Lilly for scientific research (no personal grant), lecture, advisory board, reimbursed travel to convention; from UCB Pharma for advisory board, reimbursed travel to convention: from Eurosept for lecture (no personal grant), reimbursed travel to convention. For this publication no relations apply.

Hilde Tobi received financial support from Janssen-Cilag for other research projects. For this publication no relations apply.

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  1. PHARMO Institute, P.O. Box 85222, 3508, Utrecht, The Netherlands

    Willemijn M. Meijer

  2. SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands

    Adrianne Faber

  3. Altrecht, Division Child, Youth and Family, Utrecht, The Netherlands

    Els van den Ban

  4. Research Methodology, Wageningen University and Research Centre, Wageningen, The Netherlands

    Hilde Tobi

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Meijer, W.M., Faber, A., van den Ban, E. et al. Current issues around the pharmacotherapy of ADHD in children and adults. Pharm World Sci 31, 509–516 (2009). https://doi.org/10.1007/s11096-009-9302-3

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