The Medication Corner
Jay D. Tarnow, M.D.
Many patients and parents have been calling and asking if there are any new medicines for ADHD. There really is not a new medicine at the present. However,
there are new delivery systems that have been created to alter the time course of methylphenidate. As most of you know, stimulants have a short half-life and
only last about 4 hours. This is a problem for students who must go in the middle of the day to the school nurse to receive their second dose. Many students
feel embarrassed and ashamed by being stigmatized by this process. Schools have also become increasingly apprehensive about administering medication.
Many parents complain that their children miss mid-day dosages at school. In addition some patients have severe rebound when the short acting medication
wears off.
For the past 30 years Ritalin SR and Dexedrine Spansules offered medications that were advertised to last 8 hours. However, only 50% of patients had a
positive experience with these medications. They were unreliable in their length of action. Ritalin SR is more reliable than Dexedrine Spansules. Dexedrine used
the same technology as the cold medicine Contact. There are small beads in the capsule that dissolve at different speeds. When the beads dissolve, the
medicine is absorbed. Ritalin SR has the methylphenidate embedded into a wax substance that dissolved slowly. Both of these processes were often influenced
by the stomach contents and acidity.
Adderall was a medication that utilized the chemical structure of a mixture of amphetamine salts to prolong the length of action. This medication was effective inproviding a longer action in approximately 50% of patients. Shire, the company that sells Adderall, has developed a new long action compound that is in the
final stages of FDA approval. In fact I will be conducting a study using this long acting Adderall this summer for children under the age of 12.
Last year Concerta was introduced. This is the first new generation of methylphenidate using the new delivery system Oros. Concerta was reported in this
newsletter about 8 months ago in detail. Therefore, I will not repeat myself. Concerta uses a laser hole in a capsule to slowly release the medication. It has
shown to be effective for many patients that require long action, up to 10-12 hours.
Metadate CD is the latest methylphenidate extended release capsule. It uses the Diffucaps bead delivery system. This is a sophistication of the spansule system
that Dexedrine utilizes. The Metadate CD capsule is filled with 2 different types of beads. The drug from the rapid release bead reaches the bloodstream very
quickly and the peak concentrations occur at about 1.5 hours after intake. The continuous-release beads are designed to dissolve more slowly and to deliver
medication over an 8-hour period. The continuous-release beads reach their peak concentration in 4.5 hours after intake. My analysis of the data shows that
the peak concentrations of the new extended release Metadate CD is lower than giving 10 mg. at 4-hour intervals. Thus, some patients may need a higher
dose. Interestingly, this is exactly what parents and patients found with Concerta. Many patients became discouraged that Concerta was not as effective as
their past medication. I quickly realized that this was only a matter the dose of Concerta to achieve the needed effect. However, when the makers of Concerta did their research for the FDA, they only presented data using a
maximum of 54 mg., which for some patients was much too low.
The big problem for me as a psychiatrist is that all these long acting medications so far make big jumps in dosages for children. Concerta goes up by 18 mg.
jumps and Metadate by 20 mg., and these are capsules that cannot be broken and divided. Since Adderall creates the long action by its chemical structure,
these pills can be cut to each person’s needs. However, remember Adderall does not provide the long action for everybody. Perhaps their new long actionmedication will allow for precise dosing. In summary, there is no new miracle pill for ADHD, yet!
The Medication Corner, provided by
the Tarnow Center for Self-Management, will be a featured article in each
of the ADDA Newsletters. The article will provide you with the latest
information and research about the medications which are being used to treat
Attention Deficit Disorder. Mary Jo Taft, M.D. and Jay Tarnow, M.D. will keep
you abreast of all the latest happenings in the medical community. In order for
us to address your needs,, we would like to encourage you to "ask the
professionals" your questions. Write the Tarnow Center for Self-Management
with your questions and we will see that they are answered in each edition of
the newsletter. You may contact us at: Tarnow
Center for Self-Management: The Medication Corner, 1001 West Loop South #215, Houston,
Texas 77027, or fax: (713)621-7015, or call: (713)621-9515.
Visit the
Tarnow Center web site.
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