PSYCHIATRY UPDATE 2016

Managing ADHD: What Matters Most When Selecting a Treatment Option
Michael Feld, MD, Alexian Brothers Behavioral Health Hospital for Violence Prevention Clinic/Program and ADHD Clinic

In an industry-sponsored symposium, Dr. Feld began his review of therapeutic strategies by noting that stimulant medications have long been recommended first-line therapy for children diagnosed with attention-deficit/hyperactivity disorder (ADHD). Nonstimulant ADHD agents, such as atomoxetine, are a second-line option; antidepressants are third. Today, newer formulations of stimulants give clinicians an additional option to test and adjust at the start of therapy.

Dr. Feld discussed the utility of the brand-name extended-release (ER) methylphenidate HCl (Aptensio) for its value in children—specifically, its ability to “extend the day” without additional dosing of a short-action medication. The design of Aptensio—a multilayered beaded delivery system in which every bead is both an immediate- and an extended-release vehicle—allows an early peak serum drug level and later peak level (at 8 hours). Aptensio is administered by sprinkling the contents of a capsule on applesauce; it is is safe practice, Dr. Feld explained, to augment the ER drug delivery with an immediate-release agent when deemed necessary, by observing how difficult it is for the patient to make it through the day at home, school, or work.

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