Choosing a Medication

Methylphenidate  and Dextroamphetamine have been used for first line therapy for many years. Clonidine is being used with increasing frequency by the primary care provider particularly for patients with aggressive/hyperaroused behaviors or comorbid tic disorders. The mechanisms by which these drugs modulate their effects are not fully understood. It is presumably through their effects on multiple catecholamine neurotransmitters With this approach 60-90% of children respond to therapy (37).

No clinical data clearly predict the medicine to which a particular child is most likely to respond. The presence of a comorbid diagnosis and parental preference best dictate the choice of medication. The advantages and disadvantages of each medication are detailed in each medication summary .

Pemoline a central nervous system stimulant structurally dissimilar to dextroamphetamine and methylphenidate, was being used with increasing frequency in the primary care setting. However, because of reports of life threatening liver failure, pemoline is no longer felt to be a first line treatment agent. Other medications (e.g., tricyclic antidepressants, carbamazepine) are used primarily in patients with complicating factors (e.g., comorbid psychiatric conditions, contraindications to first line agents) or if symptoms are resistant to first line agents. These medications are used infrequently in the primary care setting and are not discussed in this review.