Skip to main content
Log in

Consider clinically relevant pharmacokinetic drug interactions when co-prescribing drugs in attention-deficit/hyperactivity disorder

  • Drug Reactions and Interactions
  • Published:
Drugs & Therapy Perspectives Aims and scope Submit manuscript

Abstract

Polypharmacy is common in the treatment of attention-deficit hyperactivity disorder (ADHD). However, the use of multiple drugs increases the risk of pharmacokinetic drug–drug interactions (DDIs) and subsequent adverse safety outcomes. Clinically relevant pharmacokinetic DDIs can be prevented by adjusting the dose of the ADHD drug or, if possible, by using an alternative drug that would not have a pharmacokinetic effect on the ADHD drug.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mattingly GW, Wilson J, Ugarte L, et al. Individualization of attention-deficit/hyperactivity disorder treatment: pharmacotherapy considerations by age and co-occurring conditions. CNS Spectr. 2020. https://doi.org/10.1017/S1092852919001822.

    Article  PubMed  Google Scholar 

  2. Schoretsanitis G, de Leon J, Eap CB, et al. Clinically significant drug–drug interactions with agents for attention-deficit/hyperactivity disorder. CNS Drugs. 2019;33(12):1201–22.

    Article  CAS  PubMed  Google Scholar 

  3. Mazhar H, Foster BC, Necyk C, et al. Natural health product-drug interaction causality assessment in pediatric adverse event reports associated with attention-deficit/hyperactivity disorder medication. J Child Adolesc Psychopharmacol. 2020;30(1):38–47.

    Article  PubMed  Google Scholar 

  4. Childress AC, Sallee FR. Attention-deficit/hyperactivity disorder with inadequate response to stimulants: approaches to management. CNS Drugs. 2014;28(2):121–9.

    Article  CAS  PubMed  Google Scholar 

  5. Harstad EB, Weaver AL, Katusic SK, et al. ADHD, stimulant treatment, and growth: a longitudinal study. Pediatrics. 2014;134(4):e935–e944944.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bolea-Alamanac B, Nutt DJ, Adamou M, et al. Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: update on recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2014;28(3):179–203.

    Article  PubMed  Google Scholar 

  7. Subcommittee on Attention-Deficit/Hyperactivity D, Steering Committee on Quality I, Management, et al. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011;128(5):1007–222.

    Article  Google Scholar 

  8. Bond DJ, Hadjipavlou G, Lam RW, et al. The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and comorbid attention-deficit/hyperactivity disorder. Ann Clin Psychiatry. 2012;24(1):23–37.

    PubMed  Google Scholar 

  9. Spina E, Hiemke C, de Leon J. Assessing drug-drug interactions through therapeutic drug monitoring when administering oral second-generation antipsychotics. Expert Opin Drug Metab Toxicol. 2016;12(4):407–22.

    Article  CAS  PubMed  Google Scholar 

  10. Weiss M, Hechtman L, Adult ARG. A randomized double-blind trial of paroxetine and/or dextroamphetamine and problem-focused therapy for attention-deficit/hyperactivity disorder in adults. J Clin Psychiatry. 2006;67(4):611–9.

    Article  CAS  PubMed  Google Scholar 

  11. Vyvanse® (lisdexamfetamine dimesylate): US prescribing information. Lexington: Shire US Inc: 2017.

  12. Schaller JL, Behar D. Carbamazepine and methylphenidate in ADHD. J Am Acad Child Adolesc Psychiatry. 1999;38(2):112–3.

    Article  CAS  PubMed  Google Scholar 

  13. Behar D, Schaller J, Spreat S. Extreme reduction of methylphenidate levels by carbamazepine. J Am Acad Child Adolesc Psychiatry. 1998;37(11):1128–9.

    Article  CAS  PubMed  Google Scholar 

  14. Wharton RN, Perel JM, Dayton PG, et al. A potential clinical use for methylphenidate with tricyclic antidepressants. Am J Psychiatry. 1971;127(12):1619–25.

    Article  CAS  PubMed  Google Scholar 

  15. Sauer JM, Ring BJ, Witcher JW. Clinical pharmacokinetics of atomoxetine. Clin Pharmacokinet. 2005;44(6):571–90.

    Article  CAS  PubMed  Google Scholar 

  16. Li A, Yeo K, Welty D, et al. Development of guanfacine extended-release dosing strategies in children and adolescents with ADHD using a physiologically based pharmacokinetic model to predict drug-drug interactions with moderate CYP3A4 inhibitors or inducers. Paediatr Drugs. 2018;20(2):181–94.

    Article  PubMed  Google Scholar 

  17. Intuniv® (guanfacine) extended-release tablets: US prescribing information. Lexington: Shire US Inc: 2019.

  18. Kiechel JR, Lavene D, Guerret M, et al. Pharmacokinetic aspects of guanfacine withdrawal syndrome in a hypertensive patient with chronic renal failure. Eur J Clin Pharmacol. 1983;25(4):463–6.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

The preparation of this review was not supported by any external funding.

Author information

Authors and Affiliations

Authors

Contributions

EK searched the literature, prepared the bibliography and wrote the first draft. YAH contributed to the content and revision of the article.

Corresponding author

Correspondence to Young-A. Heo.

Ethics declarations

Conflict of interest

EK and YAH are contracted or salaried employees of Adis International Ltd./Springer Nature and declare no relevant conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, E., Heo, YA. Consider clinically relevant pharmacokinetic drug interactions when co-prescribing drugs in attention-deficit/hyperactivity disorder. Drugs Ther Perspect 36, 386–388 (2020). https://doi.org/10.1007/s40267-020-00749-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40267-020-00749-3

Navigation