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Not All ADHD Drugs Are Equal

Researchers at the University of Virginia Health System have found that teenage drivers with attention deficit hyper activity disorder (ADHD) drive better when they took// OROS methylphenidate (OROS MPH), a controlled-release stimulant, rather than extended release amphetamine salts (se-AMPH ER). The findings, which reinforce the use of OROS MPH to improve driving performance in teens with ADHD, will appear in the Sept. issue of Pediatrics.

“Car collisions are two to four times more likely to occur among teens with ADHD. Past studies have shown that stimulants commonly used to treat ADHD can help improve driving performance among this group,” said Daniel Cox, Ph.d., lead author and professor of psychiatric medicine at the University of Virginia Health System. “However, there are many different formulations of stimulant drugs to treat ADHD and parents need to know which ones will have the best positive effect.”

In previous studies, Cox and his team set out to determine whether immediate-release and extended release drug formulations influence driving performance throughout the day. They found that OROS MPH (Concerta) compared with immediate-release methylphenidate (Ritalin) was better at improving driving performance. The OROS technology uses osmotic pressure to deliver the drug at a controlled rate.

In this study, researchers compared Concerta to se-AMPH ER (Adderall XR). Both are long-acting stimulants used to treat ADHD. Using a driving simulator, teen drivers between 16 and 19 years of age, displayed their driving skills after taking Concerta, Adderall XR or placebo. Study participants took their medications at 8 a.m. They came to the driving simulator laboratory and completed 15-minute simulated drives at 5 p.m., 8 p.m. and 11p.m. Driving performance was determined by sophisticated computer algorithms.

Researchers found that treatments with Concerta led to fewer inattentive driving errors and less hyperactive or im pulsive driving errors, such as speeding and inappropriate braking, compared with Adderall XR and placebo.

“This was the first study of its kind to demonstrate that OROS methylphenidate has therapeutic benefits among teens for up to 15 hours,” said Cox. “We hope these results encourage teens to be vigilant in taking their medication as prescribed to help contribute to their driving safety and help them appreciate the benefits of stimulant therapy.”

“The study suggests that Concerta should be the initial treatment of choice for teen drivers with ADHD, though teens already on Adderall XR should not necessarily switch medications if they demonstrate a robust therapeutic response”, according to Cox.

In addition, accidents occur most frequently in the evenings and on weekends, meaning parents should not necessarily limit medication use to school days.

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