Some non-stimulant medicines may be appropriate for children who have been diagnosed with
Attention Deficient Hyperactivity Disorder (ADHD) and certain coexisting conditions. These include ADHD with accompanying
tic disorders (such as Tourette Syndrome), for example. In some cases, these medicines can treat both conditions at the same time. Proven alternate choices of stimulant medications for children include
Atomoxetine,
Guanfacine XR and Clonidine XR.
|
Generic Class
(Brand Name)
|
Dosage |
Prescribing Schedule |
Atomoxetine (Strattera) |
Once a day to twice a day | 0.5 mg/kg per day increasing to 1.4 mg/kg per day |
|
Guanfacine
|
|
1-4 mg daily
|
Start at lower doses
|
|
1-2 mg 2 to 3 times daily |
Start at lower doses
|
Clonidine
|
|
0.1 – 0.3 mg 2 to 3 times daily |
Start at lower doses
|
|
0.1 – 0.2 mg twice daily |
Start at lower doses
|
|
0.1 – 0.3 mg patch daily |
Start at lower doses
|
Note: These are newer
FDA approved medications that have not been used as long as
stimulants. Atomoxetine, guanfacine XR and clonidine XR are considered second-line (second-choice) treatments. Products are mentioned for informational purposes only and do not imply an endorsement by the American Academy of Pediatrics. Your doctor or pharmacist can provide you with important safety information for the products listed.
Atomoxetine
Atomoxetine (Strattera) is a non-stimulant approved by the FDA for the treatment of ADHD. It is in the class of medications known as selective norepinephrine reuptake inhibitors. Because atomoxetine does not have a potential for abuse, it is not classified as a controlled substance.
Atomoxetine is a newer medication and the evidence supporting its use is more limited than for stimulants. Atomoxetine, unlike stimulants, is active around the clock. However, atomoxetine has been found to be only about two-thirds as likely to be effective as stimulant medications. After starting atomoxetine, it may take up to 6 weeks before it reaches its maximum effectiveness.
Possible side effects
Atomoxetine has a warning on it that it may, in a very small number of cases, have some potential for causing
suicidal thoughts in the first few weeks of treatment. Atomoxetine may be helpful in the treatment of children who have both
ADHD and anxiety, since stimulants may worsen anxiety symptoms. Side effects are generally mild but can include decreased appetite, upset stomach, nausea or vomiting, tiredness, problems sleeping, and dizziness. Jaundice (turning yellow) is mentioned in a warning on the medication, but is extremely rare. Taking atomoxetine with food can help avoid nausea and stomachaches.
Atomoxetine should be used in lower doses in children also taking certain antidepressants like fluoxetine (Prozac) or paroxetine (Paxil), because they can raise the atomoxetine levels in the bloodstream.
Atomoxetine is now considered an option for first-line therapy for ADHD, and is the first non-stimulant to fall into the first-line category. Parents concerned about the possibility that
stimulants may be used for substance abuse may choose atomoxetine as the first-line agent for their child. It is often used for children who have had unsuccessful trials of stimulants.
Long-acting guanfacine
Long-acting guanfacine (Intuniv) is in the group of medications known as alpha agonists. These medications were developed for the treatment of
high blood pressure but have also been used to treat children with ADHD who have tics, sleep problems and/or aggression. It has recently been approved by the FDA for the treatment of children with ADHD.
Long-acting guanfacine is a pill, but it cannot be crushed, chewed, or broken and must be swallowed whole. Like atomoxetine, it is not a controlled substance.
Possible side effects
It does not suppress appetite much, so may be a good choice for children who lost a significant amount of weight when taking a stimulant. Side effects can include sleepiness, headaches, fatigue, stomachaches, nausea, lethargy, dizziness, irritability, decreased blood pressure, and decreased appetite. Although sleepiness occurs in a large number of children when children start taking long-acting guanfacine, it seems to get better as they continue to take it. It may take 3 to 4 weeks to see medication benefit.
Long-acting clonidine
Long-acting clonidine (Kapvay) is also FDA approved for the treatment of ADHD. It is taken twice a day while long acting guanfacine is once a day. Both long-acting alpha agonists have been studied for use alone or as an add-on to stimulants when the stimulant alone does not stop all the symptoms of ADHD.
Two other shorter-acting alpha agonists are available for use, but not approved by the FDA for ADHD. These are clonidine (Catapres) and short-acting guanfacine (Tenex). These can be used as adjunctive medications, or if FDA-approved medications are not helpful.
If no FDA-approved medication has been found helpful for your child, you should also consider whether ADHD is the
correct diagnosis, and whether additional coexisting conditions might be present.
More information